A Leathery Lining

Excerpt

A 44-year-old previously healthy man from Mexico presented with 10 days of abdominal pain, nausea, and vomiting. The exam was remarkable for decreased left-sided breath sounds, diffuse abdominal tenderness, and mild abdominal distention. Chest radiograph showed a large left pleural effusion. Computed tomography of the abdomen demonstrated a markedly thickened stomach wall, loculated peritoneal fluid collections, paraaortic lymphadenopathy, and omental carcinomatosis (Fig. 1). Thoracentesis was performed and cytopathological examination of the pleural fluid showed a poorly differentiated adenocarcinoma of upper gastrointestinal origin. Esophagogastroduodenoscopy revealed a diffusely thickened and rigid stomach indicating extensive intramural malignant infiltration consistent with “linitis plastica” (Fig. 2); gastric biopsy confirmed diffuse-type gastric adenocarcinoma.

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