Dumontier I, Roseau G, Palazzo L, Barbier J P, Couturier D
Hepatogastroenterology Unit of Cochin Hospital, Paris V University, France.
Gastrointest Endosc. 1997 Dec;46(6):532-6. doi: 10.1016/s0016-5107(97)70009-9.
Rectal linitis plastica (RLP) is a rare tumor with a poor prognosis. RLP can be a primary tumor, secondary to gastric linitis, or a metastatic form of breast or prostate carcinoma. Diagnosis is difficult because of nonspecific clinical and endoscopic findings and frequent negative biopsies (50%). The aim of this study was to evaluate the endosonographic appearance of RLP and to study the usefulness of endoscopic ultrasonography (EUS) in the follow-up of patients with RLP.
Twenty-two video-recorded EUS examinations performed in 11 patients with histologically proven RLP were retrospectively studied. Response to conservative treatment was evaluated in three patients with secondary RLP.
In every case of RLP, EUS showed a circumferential thickening of the rectal wall (mean 13 mm); the thickening was mainly seen in the submucosa and the muscularis propria. In nine cases EUS showed signs of locoregional involvement (perirectal fat infiltration [n = 6], ascites [n = 5], lymph nodes [n = 3]) which was not seen by CT. In follow-up evaluations, EUS showed a lack of response to treatment in two patients with RLP secondary to gastric linitis. In the remaining patient with RLP secondary to breast carcinoma, EUS at first showed no response. The chemotherapy protocol was modified, and then improvement became evident at EUS.
RLP shows typical features of rectal EUS that may assist in the diagnosis of this rare disease. Moreover, EUS can be useful in evaluating the response of this disease to treatment.
直肠皮革胃是一种罕见的肿瘤，预后较差。直肠皮革胃可以是原发性肿瘤，继发于胃皮革胃，也可以是乳腺癌或前列腺癌的转移形式。由于临床和内镜检查结果不具有特异性且活检经常为阴性（50%），因此诊断困难。本研究的目的是评估直肠皮革胃的内镜超声表现，并研究内镜超声（EUS）在直肠皮革胃患者随访中的作用。
回顾性研究了11例经组织学证实为直肠皮革胃的患者进行的22次视频记录的EUS检查。对3例继发性直肠皮革胃患者的保守治疗反应进行了评估。
在每例直肠皮革胃病例中，EUS均显示直肠壁环形增厚（平均13mm）；增厚主要见于黏膜下层和固有肌层。9例EUS显示有局部受累迹象（直肠周围脂肪浸润[n = 6]、腹水[n = 5]、淋巴结[n = 3]），CT未发现这些表现。在随访评估中，EUS显示2例继发于胃皮革胃的直肠皮革胃患者对治疗无反应。在其余1例继发于乳腺癌的直肠皮革胃患者中，EUS最初显示无反应。修改了化疗方案，随后EUS显示病情明显改善。
直肠皮革胃显示出典型的直肠EUS特征，这可能有助于诊断这种罕见疾病。此外EUS可用于评估该疾病对治疗的反应。
