Colorectal Signet-ring Carcinoma Research Articles

Signet-ring colorectal carcinoma

Introduction. Colorectal cancer is the third most common cancer worldwide. Signet-ring carcinoma is an extremely rare subtype of colorectal cancer, with frequency ranges 0.3?4.6%. The diagnosis of this type of cancer is based on pathohistological analysis. Case outline. A 58-year-old patient was admitted due to abdominal pain and abdominal swelling. The physical findings indicated abdomen above the level of the chest, soft, painfully sensitive in the left hemiabdomen, with positive clinical signs of ascites. Laboratory analyzes indicated positive inflammatory syndrome, elevation of D-dimer and CA-19-9. Ascites analysis showed the presence of malignant cells. Computed tomography revealed hepatomegaly, liver steatosis, as well as multiple secondary deposits in the liver, ascites, and peritoneal implants. Colonoscopy showed ulceration of the right colon, which was covered with fibrin. The pathohistological findings indicated poorly differentiated, invasive adenocarcinoma of the signet ring carcinoma type. The patient was treated with analgesics, diuretics, proton pump inhibitors, beta 2 blockers, angiotensin-converting enzyme inhibitors, low-molecular-weight heparin, antibiotics, and supportive therapy. The patient was discharged after 10 days of hospitalization. He was presented to the multidisciplinary team, which decided on further symptomatic therapy. Conclusion. Signet-ring colon cancer is a rare, aggressive tumor with a poor prognosis. Although it is most often localized in the stomach, it is necessary to think about the colorectal localization of this tumor in the differential diagnosis of patients with colonic complaints, especially if they have ?alarm symptoms? and if they are younger.

Comparison of CT manifestations of primary colorectal mucinous adenocarcinoma and signet ring cell carcinoma

To compare the difference in CT manifestations between primary colorectal mucinous adenocarcinoma and signet ring cell carcinoma in order to improve radiologic diagnosis. Clinicopathological data and CT findings of 109 patients with colorectal mucinous adenocarcinoma and 46 patients with primary colorectal signet-ring cell carcinoma confirmed by surgery and pathology from March 2008 to February 2015 in the Tumor Hospital of Yunnan Province were retrospectively collected. Differences in age, gender, tumor location, length and thickness of the involved intestinal wall, thickening pattern of the intestinal wall, lesion density, calcification, contrast-enhanced form, peri-intestinal invasion, occurrence of intestinal obstruction and metastasis of other organs were compared between the two groups. Among 109 patients with colorectal mucinous adenocarcinoma, 68 were men and 41 were women with a mean age of (56.8±15.4) years. Among 46 patients with primary colorectal signet-ring cell carcinoma, 26 were men and 20 were women with a mean age of (42.9±15.6) years. Compared with mucinous adenocarcinoma group, signet-ring cell carcinoma group showed more concentric bowel-wall thickening[93.5%(43/46) vs. 81.6%(89/109), χ2=9.19, P=0.030], higher lesion density [(42.0±3.0) Hu vs. (28.5±1.5) Hu, t=37.30, P=0.000], more marked enhancement [54.3%(25/46) vs. 12.8%(14/109), χ2=35.21, P=0.000], less vast-low-density region in enhanced CT imaging[2.2%(1/46) vs. 45.0%(49/109), χ2=73.31, P=0.000] and more severe peri-intestinal invasion [41.3% (19/46) vs. 17.4%(19/109), χ2=10.25, P=0.006]. Calcification was found in 18.3%(20/109) of mucinous adenocarcinoma cases, but was not found in signet-ring cell carcinoma cases (χ2=9.69, P=0.002). Target ring sign in contrast-enhanced scan was observed in 15.2%(7/46) of signet-ring cell carcinoma cases, while in none of mucinous adenocarcinoma cases (χ2=17.37, P=0.000). There were no statistically significant differences in lesion location, length and thickness of the involved intestinal wall, occurrence of intestinal obstruction, lymph node metastasis, liver or peritoneum metastasis between two groups(all P>0.05). Signet-ring cell carcinoma is often found in younger patients, whose CT manifestation is characterized by the target ring sign in contrast-enhanced scan, while primary colorectal mucinous adenocarcinoma is often in older patients, whose CT manifestation is characterized by calcification in unenhanced scan and low density region in enhanced CT show.

Signet ring colorectal carcinoma: Do we need to improve the treatment algorithm?

AIMTo elaborate about this peculiar variant from a tertiary cancer center from India.METHODSIt’s a retrospective study (2011-2014) of all patients diagnosed with signet ring colo-rectal cancer (SRCC). Various clinico-pathological variables were studied.RESULTSOne hundred and seventy consecutive patients with SRCC were diagnosed (11.4% of all colorectal cancers). Median Age of the cohort was 41 years. Most common location was recto-sigmoid area (54.7%). Majority patients presented in stage III and IV (91.2%). Most of the stage IV patients had isolated peritoneal metastases (86.5%). Colonic tumors had higher incidence of peritoneal metastases (91.8% vs 83.3%) as well as isolated peritoneal recurrences (37.5% vs 16.7%) than rectal primaries. Thirty-seven point five percent of patients recurred after curative surgery. Amongst them 63.63% patients had isolated peritoneal recurrences. Circumferential resection margin (CRM) was involved in 17.9% patients. Median relapse free survival (RFS) and overall survival (OS) of the cohort were 14.9 and 18.13 mo respectively. CRM involvement, colonic primary were associated with poorer RFS and OS.CONCLUSIONSRCC has predilection for peritoneal dissemination. More aggressive and/or extended chemotherapy schedules as well as prophylactic hyperthermic intra-peritoneal chemotherapy at the time of primary surgery may be attempted in these patients.

PWE-284 Signet ring colorectal carcinoma (SRCC): do we need to improve the treatment algorithm?

Introduction SRCC is an aggressive variant affecting younger population and has poorer prognosis. The literature explaining the biology as well as the optimum treatment algorithm of this particular variant is scarce due to its low incidence. Here, we present our experience about this peculiar variant from a tertiary cancer centre from India (Tata Memorial Centre, Mumbai). Method It’s a retrospective study (2011–2014) of all patients diagnosed with SRCC with department of gastro-intestinal oncology. SRCC was defined as per WHO criteria (adenocarcinoma with more than 50% of signet-ring cells). Peritoneal metastases or recurrences constituted peritoneal deposits, malignant ascites, omental deposits, ovarian deposits. SPSS-20 was used for statistical calculation. Results 170 consecutive patients with SRCC were diagnosed. It constituted 11.4% of all colorectal cases (170/1487). Median Age of the cohort was 41 years. Male to female ratio was 1.8:1. Most common location was recto-sigmoid area (Rectum: 41.2% and Sigmoid: 13.5%). Majority patients presented in stage III (51.8%) and stage IV (39.4%). Most of the stage IV patients had isolated peritoneal metastases (58/67, 86.5%). Colonic tumours, as compared to rectal tumours had higher incidence of peritoneal metastases (83.3% v/s 91.4%, p = 0.074) as well as isolated peritoneal recurrences (20.5% v/s 37.5%, p = 0.062). Most patients had high nodal burden (pN2: 57.9%). Curative therapy was feasible only in 56.47% (79/170) patients. 36.7% patients recurred after curative surgery. Amongst them 65.5% patients had isolated peritoneal recurrences. Amongst rectal cases, pathological complete response after NACTRT was seen in 21.6% (8/37) patients. Circumferential resection margin (CRM) was involved in 17.9% (7/39) patients. Median follow up was 17.4 months. Median relapse free survival (RFS) and overall survival (OS) of the cohort were 14.9 and 18.13 months respectively. OS of peritoneal and non-peritoneal metastases were equivalent (16 v/s 13months; p = 0.729). CRM involvement was associated with poorer RFS (15 months v/s 37.2 months; p = 0.060) and OS (19.9 months v/s 41.5 months; p = 0.018). Colonic primaries were associated with poorer OS than rectal tumours after curative resection (32.298 months v/s 40.089 months, p = 0.058) and RFS (24.74 months v/s 34.02 months; p = 0.048). Conclusion SRCC affects young patients and has predilection for peritoneal dissemination. More aggressive and/or extended chemotherapy schedules as well as prophylactic HIPEC at the time of primary surgery, especially for colonic tumours, should be attempted in a randomised control trial setting in order to improve dismal survival in these patients. Disclosure of interest None Declared.