Primary signet ring cell carcinoma of the pancreas in the elderly with indistinct imaging characteristics: a case report

Abstract

Signet ring cell carcinoma occur in < 1% of pancreatic cancers with few reported cases worldwide. Commonly, it arises in the stomach (96%). Early diagnosis is vital due to its poor prognosis. Further studies are needed to understand this type of malignancy. A 69/F, with 4 wks epigastric discomfort w/ jaundice & weight loss, came for 2nd opinion. No cause of obstruction on previous Ct scan. On MRCP, biliary tree dilatation & a vague mass at pancreatic head was seen. Normal tumor markers, no evidence of metastasis. Underwent Whipples procedure. Histopathology: SIGNET RING CELL ADENOCARCINOMA, R0 resection. Chemotherapy was planned, but patient opted alternative treatment. 5 months later, recurrence documented by CT scan. Etiology of SRCC is still unknown, most researchers consider a genetic mutation in the pancreatic parenchyma secondary inflammation. EUS-FNA only provides cytologic sample with inadequate cellularity that is needed for proper identification. Reliability of tumor markers such as Ca 19-9 and CEA can still be in question since clinicopathologic behavior of SRCC especially in pancreas. High index of suspicion should prompt the search of cause for biliary obstructive diseases especially in the elderly where malignancy is common. Risk factors should always be considered in profiling a patient. Utilization of a high yield imaging is vital in decision making process whether to proceed with surgical treatment that has a high morbidity percentage. Further studies are needed to understand the clinicopathologic character of this rare subtype.