S6312 Misleading Signs of Portal Hypertension: A Hidden Case of Gastric Linitis Plastica

Introduction: Linitis plastica (LP) is a rare type of gastric tumor which presents as thickening of gastric wall and submucosal hypertrophy consisting mainly of connective and muscular tissues. Although prevalent in only 3% of the gastric adenocarcinoma cases, it has an aggressive course making an early diagnosis imperative. Here we discuss a particular a misleading case of LP presenting with signs of clinical significant portal hypertension though to be decompensated cirrhosis. Case Description/Methods: Fifty-four-year-old woman with history of chronic gastritis presented for 2 weeks of progressively increasing abdominal distention. She also reported approximately 50 lbs weight loss noticed over 5 months. Initial computed tomography (CT) abdomen showed ascites and hepatomegaly. Following magnetic resonance imaging (MRI) abdomen showed diffuse thickening of gastric wall seen especially in the antrum, portal hypertensive pattern including para-umbilical and para-esophageal varices. To interrogate the cause for portal hypertension, a diagnostic paracentesis was performed which showed a SAAG of 0.9, not consistent with portal hypertension but rising the suspicion of an underlying malignancy. Given the previous MRI findings, the patient underwent upper gastrointestinal endoscopy which showed thickened, non-distensible friable mucosa concerning for diffuse malignant process. Deep cold forceps biopsies were obtained and showed adenocarcinoma with signet ring features confirming the diagnosis of LP. Discussion: Diagnosis of LP can be challenging and warrants high clinical suspicion. Endoscopic examination with deep mucosal biopsies is fundamental, however, if the diagnosis is not established, further tissue acquisition should be considered using endoscopic ultrasound-guided sampling or a surgical approach.