Labra Andres Antonio, Schiappacasse Giancarlo, Cocio Rolando Alfonso, Torres Jorge Tomás, González Fernando Omar, Cristi Joaquin Alberto, Schultz Marcela
Department of Radiology, Facultad de Medicina Clínica Alemana-Universidad del Desarrollo, Santiago 7650568, Región Metropolitana, Chile.
Department of Pathology, Clínica Alemana de Santiago, Santiago 7650568, Región Metropolitana, Chile.
World J Radiol. 2024 Sep 28;16(9):473-481. doi: 10.4329/wjr.v16.i9.473.
Secondary rectal linitis plastica (RLP) from prostatic adenocarcinoma is a rare and poorly understood form of metastatic spread, characterized by a desmoplastic response and concentric rectal wall infiltration with mucosal preservation. This complicates endoscopic diagnosis and can mimic gastrointestinal malignancies. This case series underscores the critical role of magnetic resonance imaging (MRI) in identifying the distinct imaging features of RLP and highlights the importance of considering this condition in the differential diagnosis of patients with a history of prostate cancer.
Three patients with secondary RLP due to prostatic adenocarcinoma presented with varied clinical features. The first patient, a 76-year-old man with advanced prostate cancer, had rectal pain and incontinence. MRI showed diffuse prostatic invasion and significant rectal wall thickening with a characteristic "target sign" pattern. The second, a 57-year-old asymptomatic man with elevated prostate-specific antigen levels and a history of prostate cancer exhibited rectoprostatic angle involvement and rectal wall thickening on MRI, with positron emission tomography/computed tomography PSMA confirming the prostatic origin of the metastatic spread. The third patient, an 80-year-old post-radical prostatectomy, presented with refractory constipation. MRI revealed a neoplastic mass infiltrating the rectal wall. In all cases, MRI consistently showed stratified thickening, concentric signal changes, restricted diffusion, and contrast enhancement, which were essential for diagnosing secondary RLP. Biopsies confirmed the prostatic origin of the neoplastic involvement in the rectum.
Recognizing MRI findings of secondary RLP is essential for accurate diagnosis and management in prostate cancer patients.
前列腺腺癌所致继发性直肠皮革胃（RLP）是一种罕见且了解甚少的转移扩散形式，其特征为促结缔组织增生反应和直肠壁同心性浸润且黏膜保留。这使内镜诊断变得复杂，并可能酷似胃肠道恶性肿瘤。本病例系列强调了磁共振成像（MRI）在识别RLP独特影像学特征方面的关键作用，并突出了在前列腺癌病史患者的鉴别诊断中考虑这种情况的重要性。
3例因前列腺腺癌导致继发性RLP的患者表现出不同的临床特征。首例患者为一名76岁晚期前列腺癌男性，有直肠疼痛和失禁症状。MRI显示前列腺弥漫性浸润以及直肠壁明显增厚，呈特征性的“靶征”模式。第二例是一名57岁无症状男性，前列腺特异性抗原水平升高且有前列腺癌病史，MRI显示直肠前列腺角受累及直肠壁增厚，正电子发射断层扫描/计算机断层扫描PSMA证实转移扩散源自前列腺。第三例患者为一名80岁接受过前列腺根治术的男性，出现难治性便秘。MRI显示一个肿瘤性肿块浸润直肠壁。在所有病例中，MRI均一致显示分层增厚、同心性信号改变、扩散受限和对比增强，这些对于诊断继发性RLP至关重要。活检证实直肠肿瘤性受累源自前列腺。
认识继发性RLP的MRI表现对于前列腺癌患者的准确诊断和管理至关重要。
