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A gut feeling: Case report of gastric linitis adenocarcinoma in a 35 year old male

Miguel Lorenzo G Faustino

 Gastric cancer is rare before the age 40. Establishing a diagnosis in this subset of younger patients is challenging because initial symptoms are nonspecific. This case report aims to present a case of diffuse gastric adenocarcinoma in a young patient with the intent of raising awareness on its subtle presentation whose clinical diagnosis is anchored on an astute physician???s high index of suspicion. We report the case of a 35 year old, Filipino male, with no known comorbidities and no family history of malignancy, who complained of early satiety and bothersome postprandial fullness 7 months in evolution. Repeated endoscopic evaluation and CT imaging revealed linitis plastica with a rigid and thickened gastric mucosa. Multiple biopsies taken only showed increased lymphoplasmacytic infiltrates with no evidence of dysplasia, metaplasia or atrophy. In this experience, subtle presentation, inconclusive results of the diagnostic investigation and the aggressive biology of the disease underscores the importance of the physician???s high index of suspicion in diagnosing gastric cancer in this subset of patients. Establishing a diagnosis early is crucial so that key interventions may be offered and prolong our patient???s life. In 2016, back symptoms were the sixth most common reason for emergency department (ED) visits.1 Patients presenting with chronic back pain are often presumed to have a musculoskeletal etiology of pain. Multiple limb- or life-threatening diagnoses must be considered in these patients. Some of those diagnoses include acute spinal cord compression, cauda equina syndrome, aortic dissection, abdominal aortic aneurysm, and spinal infections, or hematomas. Another etiology commonly seen in the ED is back pain due to pathologic fractures of the spine secondary to metastatic disease.