Linitis Plastica

LINITIS PLASTICA (from Latin limrm-linen), a rare chronic disease of the stomach, the main sign of which is that the wall of the stomach is thickened and by its whiteness and density resembles linen cloth (rete ex lino factum). The term was introduced by the English clinician Brinton (1859). When giving this name, Brinton wanted to note only the peculiarity of the condition of the stomach wall and did not express himself definitely about the nature of this disease. He assumed that in most cases it was a matter of inflammatory cirrhosis (see Gastric cirrhosis), but he also admitted other possibilities for the occurrence of this disease. Both before and after Brinton, similar diseases of the stomach were described by many authors under various names, such as: cirrhosis ventriculi hyperplastica, gastric cirrhosis, hypertrophia ventriculi simplex, stenosierende Gastritis, fibroid disease of pylorus, etc. As microscopic research shows, the thickening of the wall is due to the proliferation of connective tissue in the submucosal layer with subsequent hypertrophy of the muscular wall; in some cases there is also connective tissue proliferation of the serous coat. By the localization of the process, 3 forms can be distinguished: 1) pyloric, 2) general, spreading to the entire wall of the stomach, and 3) with spread along the peritoneum to other organs. In the pyloric form of L. p. (synonym "hypertrophic pyloric stenosis") only the area of the pylorus thickens, and the thickening is sharply demarcated from the duodenum and gradually fades out in the area of the fundus and the lesser curvature of the stomach. In the form spreading to the entire wall (synonym "gastric cirrhosis"), the stomach is usually reduced, its wall is thickened, white in color and does not collapse, so that the stomach retains its shape, resembling a thick-walled rubber tube. The mucosa is not hypertrophied; on the contrary, it is more often atrophic. Finally, forms of L. p. have been described in which the connective tissue proliferation mainly affects the serous coat. In such cases, the matter is not limited to the stomach alone, but the process also involves the omentum, mesentery, parietal and visceral peritoneum, mainly the serous coat of the intestine (syn.: peritonitis chronica retractans or peritonite nodulaire sclerogene). The thickened peritoneal sheets acquire a glazed appearance (see Glazed organs). The pathogenesis of L. p. is still a subject of controversy. The first authors who described L. p. after Brinton believed that they were dealing with chronic inflammation, but Henoch was the first, and after him Rokitansky and others, to point out that L. p. is nothing other than a special form of cancer, close to scirrhus. An unresolved controversy arose that continues to this day. Microscopic examination, especially of biopsy material, could not always resolve the question, since there are forms of fibroplastic cancer where it is almost impossible to determine the true nature of the process (see, Stomach). Most authors at the present time tend to the theory of the cancerous nature of the main mass of cases of L. p.; however, very recently cases of L. p. of non-tumor origin have again been described. Some of the authors who described these cases consider that L. p. is an independent chronic inflammatory process of unknown origin; others consider it as a result of an ulcer or former inflammation of the mucosa. Cases of syphilitic and tuberculous linitis have also been described. French researchers often speak of benign and malignant forms of L. p., implying under the first designation inflammatory proliferation of connective tissue, and under the second - a cancerous new formation of the scirrhus type. Thus, the concept of L. p. is a collective and purely morphological one; under this name are described diseases that are completely different in nature, having only a common macroscopic pathological-anatomical picture. The clinical picture of L. p. is diverse, but in general it most closely resembles scirrhus of the stomach. The antemortem diagnosis can be made radiologically or by exploratory laparotomy. The treatment is the same as for stomach cancer, i.e., symptomatic or surgical.