A 58-year-old woman presents with a 2-month history of abdominal discomfort and dark stools. Physical examination shows pallor but no evidence of jaundice. Laboratory studies disclose a microcytic, hypochromic anemia, with a hemoglobin level of 6.7 g/dL. A barium swallow radiograph reveals a "leather bottle" appearance of the stomach. Microscopic examination shows diffusely infiltrating malignant cells, many of which are "signet ring" cells, in the stomach wall. Which of the following is the most likely diagnosis?
Diffuse adenocarcinoma constitutes10% of all stomach cancers. No true tumor mass is seen macroscopically. Instead, the wall of the stomach is conspicuously thickened and firm, accounting for the radiologic "leather bottle" appearance. When the entire stomach is involved, the term linitis plastica is applied. The invading tumor cells induce extensive fibrosis in the submucosa and muscularis of the stomach wall. Gastric carcinomas typically metastasize to regional lymph nodes and the liver. Signet ring cells are so named because intracellular mucin displaces the nuclei to the periphery of the tumor cells. Gastric carcinomas and linitis plastica, in particular, have a poor prognosis. The other choices do not show the characteristic morphologic appearance of linitis plastica and generally do not exhibit signet ring cells.Diagnosis: Gastric adenocarcinoma
Fungating adenocarcinoma
Gastric leiomyosarcoma
Gastric lymphoma
Linitis plastica
G.I.T.