Published online Oct 26, 2018. doi: 10.12998/wjcc.v6.i12.554
Peer-review started: July 2, 2018
First decision: July 24, 2018
Revised: August 3, 2018
Accepted: August 28, 2018
Article in press: August 28, 2018
Published online: October 26, 2018
Processing time: 119 Days and 12.5 Hours
Linitis plastica is a rare condition showing circumferentially infiltrating intramural anaplastic carcinoma in a hollow viscus, resulting in a tissue thickening of the involved organ as constricted, inelastic, and rigid. While most secondary rectal linitis plastica (RLP) is caused by metastasis from stomach, breast, gallbladder, or bladder cancer, we report an extremely rare and unique case of secondary RLP due to prostate cancer with computed tomography (CT) and magnetic resonance imaging (MRI) findings, including diffusion weighted imaging (DWI). A 78-year-old man presented with approximately a 2-mo history of constipation and without cancer history. On sigmoidoscopy, there was a luminal narrowing and thickening of rectum with mucosa being grossly normal in its appearance. On contrast-enhanced CT, marked contrast enhancement with wall thickening of rectum was noted. On pelvic MRI, rectal wall thickening showed a target sign on both T2-weighted imaging and DWI. A diffuse infiltrative lesion was suspected in the prostate gland based on low signal intensity on T2-weighted imaging and restricted diffusion. A transanal full-thickness excisional biopsy revealed metastasis from a prostate adenocarcinoma invading the submucosa to the muscularis propria consistent with metastatic RLP. We would like to emphasize the CT and MRI findings of metastatic RLP due to prostate cancer.
Core tip: Secondary rectal linitis plastica (RLP) from prostate cancer is extremely rare. A target sign on T2-weighted imaging and diffusion weighted imaging is characteristic for RLP. The presence of elevated serum prostate specific antigen, T2 low signal intensity, and low apparent diffusion coefficient value lesion on prostate should raise the suspicion of secondary RLP from prostate adenocarcinoma. For confirmative diagnosis, full-thickness excisional biopsy is required due to its characteristic mucosal sparing.