11. Linitis plastica and Krukenberg tumor

Organ: Stomach, uterus, ovaries

Description:

The stomach is whitish, fibrotic and diffusely thickened. The two ovaries both contain metastases. The uterus is normal.

Diagnosis: Linitis plastica with Krukenberg tumor

Causes:

Helicobacter pylori
Alcohol
Smoking
Epstein Barr virus
Intestinal metaplasia

Theory:

The signet ring cells found in the diffuse type stomach cancer evoke a desmoplastic reaction, meaning that scar tissue grows around them. This produces a desmoplastic neostroma, which just means that the tumor cells are surrounded by scar tissue. If this reaction isn’t stopped will the whole stomach be affected, causing it to acquire a “bottle”-like shape and become rigid and thick. This morphology is the end-stage of diffuse gastric adenocarcinoma and is called linitis plastica.

A Krukenberg tumor is bilateral metastasis in the ovaries that metastasized from a primary tumor somewhere in the GI tract, but commonly from the stomach. Both ovaries must be affected for it to be a Krukenberg tumor.