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Case Reports
. 2025 Jul 5;17(7):e87334.
doi: 10.7759/cureus.87334. eCollection 2025 Jul.

The Challenge of Diagnosing Scirrhous Gastric Cancer by Endoscopic Biopsy: A Case Report

Yuka Ikeda  1 , Masaya Iwamuro  2   1 , Tadashi Yoshino  3 , Takehiro Tanaka  4 , Nobumasa Ikeda  1 , Motoyuki Otsuka  2
Affiliations
Case Reports

The Challenge of Diagnosing Scirrhous Gastric Cancer by Endoscopic Biopsy: A Case Report

Yuka Ikeda et al. Cureus. .

Abstract

Scirrhous gastric cancer, also known as linitis plastica, is a rare and aggressive subtype of gastric carcinoma that poses significant diagnostic challenges due to its submucosal infiltration and often normal-appearing mucosa. We report a case involving a 30-year-old Japanese woman who presented with a six-month history of epigastric pain and postprandial vomiting. Initial endoscopic examination revealed erythema and mucosal swelling, with limited antral distensibility and resistance during duodenal intubation. Despite 12 mucosal biopsies, histopathological examination revealed no evidence of malignancy. Given the strong clinical and endoscopic suspicion of scirrhous gastric cancer, additional deep sections and immunohistochemical staining were performed. These revealed scattered signet-ring cell carcinoma and poorly differentiated adenocarcinoma, with positive immunostaining for p53 and Ki67. The patient underwent total gastrectomy, and the diagnosis of scirrhous gastric cancer was confirmed on the resected specimen. This case highlights the importance of a high index of clinical suspicion, close collaboration between endoscopists and pathologists, and the utility of ancillary diagnostic tools, such as immunohistochemistry, in identifying subepithelial gastric malignancies that may be missed on conventional biopsy.

Keywords: endoscopic biopsy; esophagogastroduodenoscopy; immunohistochemistry; linitis plastica; scirrhous gastric cancer.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Computed tomography (CT) finding.
CT showing marked thickening of the gastric wall, predominantly in the antrum (arrows), suggestive of infiltrative gastric malignancy. Axial (A) and coronal (B) views of the CT scan.
Figure 2
Figure 2. Endoscopic findings of the stomach.
Diffuse erythema and edematous mucosal swelling are observed, particularly along the greater curvature (A,B). Poor distensibility of the antrum despite maximal insufflation (C). These findings raised suspicion for scirrhous gastric cancer. The yellow-highlighted areas in the inset images indicate the gastric cancer lesions.
Figure 3
Figure 3. Histopathological and immunohistochemical findings of gastric biopsy specimens.
Hematoxylin and eosin staining shows preserved fundic glands with edema and vascular congestion, but no apparent epithelial atypia (A). Immunohistochemical staining for p53 highlights scattered positive nuclei among the epithelial cells (B). Panel B is a higher magnification view of the boxed area in Panel A. p53 staining shows positive nuclear staining in tumor cells (C). Ki67 immunostaining also shows positive staining in scattered neoplastic cells, indicating a high proliferative index (D).
See this image and copyright information in PMC

References

    1. Recent results of therapy for scirrhous gastric cancer. Ikeguchi M, Miyake T, Matsunaga T, et al. Surg Today. 2009;39:290–294. - PubMed
    1. Clinicopathologic characteristics and prognosis of Borrmann type IV gastric cancer: a meta-analysis. Luo Y, Gao P, Song Y, et al. World J Surg Oncol. 2016;14:49. - PMC - PubMed
    1. Evaluation of the diagnostic accuracy of gastroscopy to detect gastric tumours: clinicopathological features and prognosis of patients with gastric cancer missed on endoscopy. Voutilainen ME, Juhola MT. Eur J Gastroenterol Hepatol. 2005;17:1345–1349. - PubMed
    1. Type-specific diagnosis and evaluation of longitudinal tumor extent of borrmann type IV gastric cancer: CT versus gastroscopy. Kim JI, Kim YH, Lee KH, et al. Korean J Radiol. 2013;14:597–606. - PMC - PubMed
    1. Diagnostic value of EUS-guided fine-needle aspiration biopsy for gastric linitis plastica with negative endoscopic biopsy. Takada R, Minaga K, Hara A, et al. J Clin Med. 2021;10:3716. - PMC - PubMed

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