Non-Hodgkin Lymphoma of the Stomach: a Cause of Linitis Plastica

Purpose: To demonstrate the radiologic appearance of linitis plastica in non-Hodgkin lymphoma of the stomach and to correlate radiologic and pathologic findings.

Materials And Methods: Of 34 cases of non-Hodgkin lymphoma of the stomach in the radiologic archives of the Armed Forces Institute of Pathology, nine had a linitis plastica appearance at barium study. The radiologic, endoscopic, and pathologic findings of these cases were reviewed.

Results: All nine patients (six with primary gastric lymphoma, three with generalized lymphoma with stomach involvement) were symptomatic. Images from barium studies revealed a linitis plastica appearance with narrowing of the gastric antrum and/or body (n = 5), narrowing of the body and/or fundus (n = 3), and diffuse gastric narrowing (n = 1). On CT scans (n = 7), marked circumferential soft-tissue thickening (average thickness, 2.9 cm) of the gastric wall was seen. Patients were treated with subtotal gastrectomy and gastrojejunostomy (n = 5) or total gastrectomy and esophagojejunostomy (n = 4). In all cases, histopathologic specimens revealed a thickened gastric wall with lymphomatous cell infiltration. Wall thickening was associated with areas of fibrosis in only one case.

Conclusion: Non-Hodgkin gastric lymphoma should be recognized as another cause of linitis plastica, especially in patients with a history of lymphoma or evidence of generalized lymphoma at presentation.