Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Sep 28, 2024; 16(9): 473-481
Published online Sep 28, 2024. doi: 10.4329/wjr.v16.i9.473
Secondary rectal linitis plastica caused by prostatic adenocarcinoma - magnetic resonance imaging findings and dissemination pathways: A case report
Andres Antonio Labra, Giancarlo Schiappacasse, Rolando Alfonso Cocio, Jorge Tomás Torres, Fernando Omar González, Joaquin Alberto Cristi, Marcela Schultz
Andres Antonio Labra, Giancarlo Schiappacasse, Rolando Alfonso Cocio, Jorge Tomás Torres, Fernando Omar González, Joaquin Alberto Cristi, Department of Radiology, Facultad de Medicina Clínica Alemana-Universidad del Desarrollo, Santiago 7650568, Región Metropolitana, Chile
Marcela Schultz, Department of Pathology, Clínica Alemana de Santiago, Santiago 7650568, Región Metropolitana, Chile
Author contributions: Labra AA, Schiappacasse G and Cocio RA formulated the objective and designed the structure of this case report; Cocio RA, Torres JT and González FO conducted literature search; Cristi JA and Schultz M analyzed the data and made the figures; Cocio RA and Torres JT wrote the different sections of this manuscripts.
Informed consent statement: Informed written consent was obtained from the patients for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jorge Tomás Torres, MD, Department of Radiology, Facultad de Medicina Clínica Alemana-Universidad del Desarrollo, Av. Vitacura 5951, Vitacura, Santiago 7650568, Región Metropolitana, Chile. jttorres@alemana.cl
Received: June 19, 2024
Revised: August 28, 2024
Accepted: September 3, 2024
Published online: September 28, 2024
Processing time: 100 Days and 8.5 Hours
Abstract
BACKGROUND

Secondary rectal linitis plastica (RLP) from prostatic adenocarcinoma is a rare and poorly understood form of metastatic spread, characterized by a desmoplastic response and concentric rectal wall infiltration with mucosal preservation. This complicates endoscopic diagnosis and can mimic gastrointestinal malignancies. This case series underscores the critical role of magnetic resonance imaging (MRI) in identifying the distinct imaging features of RLP and highlights the importance of considering this condition in the differential diagnosis of patients with a history of prostate cancer.

CASE SUMMARY

Three patients with secondary RLP due to prostatic adenocarcinoma presented with varied clinical features. The first patient, a 76-year-old man with advanced prostate cancer, had rectal pain and incontinence. MRI showed diffuse prostatic invasion and significant rectal wall thickening with a characteristic "target sign" pattern. The second, a 57-year-old asymptomatic man with elevated prostate-specific antigen levels and a history of prostate cancer exhibited rectoprostatic angle involvement and rectal wall thickening on MRI, with positron emission tomography/computed tomography PSMA confirming the prostatic origin of the metastatic spread. The third patient, an 80-year-old post-radical prostatectomy, presented with refractory constipation. MRI revealed a neoplastic mass infiltrating the rectal wall. In all cases, MRI consistently showed stratified thickening, concentric signal changes, restricted diffusion, and contrast enhancement, which were essential for diagnosing secondary RLP. Biopsies confirmed the prostatic origin of the neoplastic involvement in the rectum.

CONCLUSION

Recognizing MRI findings of secondary RLP is essential for accurate diagnosis and management in prostate cancer patients.

Keywords: Rectal linitis plastica; Prostatic adenocarcinoma; Signet ring cell carcinoma; Metastatic spread; Magnetic resonance imaging; Concentric wall infiltration; Case report

Core Tip: This study presents three cases of secondary rectal linitis plastica (RLP) due to prostate cancer, emphasizing the rarity and diagnostic challenges of this condition. The preservation of mucosa in RLP complicates endoscopic detection, making magnetic resonance imaging (MRI) crucial for early, accurate diagnosis. MRI findings, including stratified parietal thickening, restricted diffusion, and contrast enhancement, are pivotal in identifying RLP. Recognizing these patterns is essential for timely and appropriate management of metastatic rectal involvement, highlighting the need to consider RLP in patients with a history of prostate cancer.