Report of a Case of Primary Signet-ring Cell Carcinoma of the Bladder and Review of the Literature

Baiyun Gao,Yutong Li,Bin Pan,Guo Chen

doi:10.11648/j.ijcu.20200402.23

Abstract

Primary signet-ring cell carcinoma of the bladder is a relatively rare tumor that progresses rapidly and has an extremely poor prognosis. We report a case of primary signet-ring cell carcinoma of the bladder. The patient underwent transurethral holmium laser lithotripsy for bladder calculi in another hospital, and a bladder tumor was found intraoperatively. Bladder tumor biopsy revealed infiltrating high-grade urothelial carcinoma with adenoid differentiation and invasion to the muscular layer. Gastrointestinal endoscopy ruled out other possible sources of tumor, and the patient was admitted to our hospital for treatment in October 2018. Cystoscopy revealed a large round mass in the trigone and right bladder wall, without probing the pedicle of the mass. After radical cystectomy, postoperative pathology showed signet-ring cell carcinoma, which infiltrated the full-thickness of the bladder wall, and cancer emboli were found in vasculature. The prostate gland and bilateral seminal vesicle were involved. After surgery, the patient did not receive any follow-up treatment due to personal factors. The Computed Tomography (CT) review at the 3rd month showed no tumor recurrence or metastasis, and the CEA review at the 6th month was 6790.2 ng/ml, considering that tumor metastasis had occurred. The patient was followed up for 9 months after surgery, and the postoperative survival time was more than 8 months. The prognosis of primary signet-ring cell carcinoma of the bladder is poor and most patients are in advanced stage at the time of diagnosis. Chemotherapy and radiotherapy have poor effect on it. Usually only total cystectomy may bring some hope to patients. Thus, early diagnosis and treatment are crucial.

Highlights

Primary signet-ring cell carcinoma of the urinary bladder (PBSRCC) is a special type of bladder urothelial carcinoma (UC) [1]
Considering that radical cystectomy did better to patient’s survival, radical cystectomy was performed under general anesthesia
Taking into consideration the patient's physical condition, in order to reduce the tumor and for palliative purpose, radical cystectomy was performed under general anesthesia instead of reconstruction of bladder with ileum

Summary

Introduction

Primary signet-ring cell carcinoma of the urinary bladder (PBSRCC) is a special type of bladder urothelial carcinoma (UC) [1]. Bladder urothelial carcinoma accounts for more than 90% of bladder cancer types, primary signet-ring cell carcinoma of the bladder is still relatively rare. The latest study showed that only 318 of 57,762 patients with urothelial carcinoma had primary signet-ring cell carcinoma, with an incidence of 0.55% [2]. It is difficult to treat primary signet-ring cell carcinoma of the bladder, which is insensitive to chemotherapy and radiotherapy. Primary signet-ring cell carcinoma of the bladder is an independent predictor of lower overall survival after radical cystectomy compared with pure urothelial carcinoma of the bladder [4].

Case Report

Findings

Discussion

Conclusion