Metastatic Breast Cancer Presenting as Gastric Linitis Plastica

Abstract Linitis plastica is a diffuse thickening of the stomach resulting from the infiltration of the gastric submucosa and muscularis propria by neoplastic cells. The most common cause is gastric adenocarcinoma, followed by metastatic disease, most frequently breast cancer in its invasive lobular subtype. We present the case of a 57yo woman, with a history of invasive ductal carcinoma (Hormone receptors positive, Her2 negative) treated 8 years ago and in remission, presented for epigastric pain and coffee ground emesis. She had two positive lymph nodes. CT scan with IV contrast showed thickened gastric walls, with enlarged mesenteric lymph nodes and minimal ascites. A gastroscopy showed micro-erosive and indurated mucosa with pyloric stenosis. Biopsy showed infiltration by independent signet-ring cells consistent with adenocarcinoma of mammary origin. Hormone and Her-2-neu receptors were negative. The patient was diagnosed with metastatic triple negative breast cancer with gastric involvement in the form of linitis plastica. She was treated with Adriamycin 90mg and Carboplatin 450mg every 3 weeks. This case shows linitis plastica as a metastatic recurrence of ductal carcinoma. The originality relies on the rarity of late breast cancer relapse in the form of linitis plastica, and its rare association with the invasive ductal subtype. Keywords: Breast cancer, gastric cancer, endoscopy, linitis plastic.