The diagnosis of the colic linitis is difficult, considering its rarety and biopsies that are frequently negative [1].
Colic linitis affects equally males and females with a young age trend with invasion of the ganglions (86%) and the peritoneum but rarely hepatic metastasis [2].
Linitis plastica occurs most frequently in the stomach. Colonic involvement is usually secondary to a primary gastric localisation [3].
Primary linitis of the colon develops primarily on the left colon. Transverse colon localization suspects a secondary linitis with a gastric starting point [1].
The search for a primitive is imperative, because only its negativity affirms the primary character of the tumor [2].
The endoscopic exploration shows the integrity of the mucosa, with a narrowing lumen or impassable stenosis. Biopsies are negative in 50% of the cases that’s why it’s interesting to do deep biopsies, even surgical [2].
In this case, the diagnosis was based on the histopathological examination of the specimen with specific aspects including: 1) macroscopically: A rigid and tubulated segment of the colon with the retraction of the mesos,
2) Microscopically: a scirrhous carcinoma with diffuse thickening and hardening of the bowel wall consisted of independent signet ring cells ( fig 2 ), mostly muco-secreting localized in the sub-mucosa and muscularis ( fig
3+4) respecting the mucosa, plus an important fibrous stroma reaction [1].
Immunohistochemistry could help in the differential diagnosis between primary colonic ADK (CK7-; CK20+) and colonic metastasis from gastric linitis (CK 7+, CK 20 - ) [4].
In our case, tumor cells were positive for CDX2 (intensive and diffuse marking) (fig 5).
The prognosis of primary colic linitis is usually poor, because of the lymphatic metastases often found at the time of the diagnosis [3].
The average survival in the Shirouzu series was 10 months (extremes: 5-13 months) from the 6 patients with primary colorectal linitis [2].