Primary Signet Ring Cell Research Articles

Primary prostatic signet ring cell carcinoma in elderly with obstructive uropathy: a case report

BackgroundPrimary signet-ring cell carcinoma (SRCC) of the prostate is a rare and aggressive subtype of prostate adenocarcinoma with a poor prognosis, with only approximately 60 cases reported worldwide.Case presentationA 62-year-old man presented with acute urinary retention and hematuria, after a year’s history of lower urinary tract symptoms. Digital rectal examination revealed an irregular and hard prostate. Flexible cystoscopy showed bladder base infiltration by the enlarged prostate obscuring both ureteric orifices, necessitating nephrostomy and subsequent bilateral antegrade stenting to relieve the obstruction and improve his renal function. Transrectal ultrasonography biopsy of the prostate was performed revealing histological features of SRCC. Due to its rarity, there is currently no standardized treatment approach and it is often similarly treated according to the traditional management of prostate adenocarcinoma.ConclusionsSRCC of the prostate is a rare and aggressive subtype of acinar adenocarcinoma with no established guidelines. Histological criteria for SRCC of the prostate are highly variable in the available literature. It is important to differentiate between the primary and metastatic SRCC of the prostate as both are managed differently. However, the overall prognosis remains poor in general.

Primary signet ring cell histology does not portend worse survival for early stage lung cancer following lobectomy.

Signet ring cell (SRC) histology is considered a poor prognostic factor in various cancers. However, primary SRC lung adenocarcinoma is rare and poorly understood. The National Cancer Database was queried to identify treatment-naïve patients who received lobectomy for primary SRC or non-SRC pT1-2N0 lung adenocarcinoma <4 cm within four months of diagnosis. SRC lung adenocarcinoma was defined by ICD-O-3 code 8490, while non-SRC lung adenocarcinoma was defined by ICD-O-3 codes 8140, 8141, 8143, 8147, 8255, 8260, 8310, 8481, 8560, and 8570-8574. The Kaplan-Meier curve and log-rank test was used to compare five-year OS between SRC versus non-SRC lung adenocarcinoma cohorts. The impact of SRC histology on risk of death was assessed using the Cox proportional hazards regression model. 48,399 patients were included in this study: 62 with primary SRC lung adenocarcinoma and 48,337 with non-SRC lung adenocarcinoma. The mean age of the overall cohort was 67.0 ± 9.6 years. Five-year OS following lobectomy did not differ significantly between SRC lung adenocarcinoma and non-SRC lung adenocarcinoma cohorts (SRC 73.9% vs. non-SRC 69.3%, p = 0.64). SRC histology did not significantly impact risk of death within five years after lobectomy (HR 0.89, p = 0.66). Following lobectomy for pT1-2N0 tumors <4 cm, patients with primary SRC lung adenocarcinoma do not experience worse five-year OS or increased risk of death within five years relative to those with non-SRC lung adenocarcinoma. Additional study, including exploration of emerging molecular profiling data, may serve to better define optimal treatment for this histopathologic group of lung adenocarcinomas.

A case report of primary upper urinary tract signet-ring cell carcinoma and literature review

BackgroundUpper tract urothelial carcinoma with pure non-urothelial histology is an exception but variants are present in ~ 25% of cases. Primary upper urinary tract signet -ring cell carcinoma is extremely rare.Case presentationWe report the case of a 65-year-old male diagnosed primary upper urinary tract signet-ring cell carcinoma while underwent percutaneous nephrolithotomy. Radical nephroureterectomy and adjuvant chemotherapy were performed sequentially. The patient is now recovering well with a regular follow-up for more than 1 year.ConclusionsThe upper urinary tract malignancy often appears as a high grade, high stage tumor and has a uniformly poor prognosis, but a timely multimodal management can bring a good outcome.

The effects of combined modality therapy on stage II-III primary gastric signet ring cell carcinoma.

e16530 Background: To date, there is no well-defined standard of care for gastric signet ring cell carcinoma (GSRC). Clinical guidelines support that combined modality therapy (CMT) on localized gastric cancer, but this may not be appropriate for GSRC as it was generally found to be chemo-resistant. We conducted a population-based study to examine the effects of therapeutic strategies on survival outcomes by using the Surveillance, Epidemiology, and End Results (SEER) data. Methods: Analyses included primary GSRC patients with stage II-III who survived more than 6 months, and were diagnosed between 2006 and 2016 from SEER data.CMT were categorized as gastrectomy group, adjuvant CT group (gastrectomy with adjuvant chemotherapy), neoadjuvant RT group (gastrectomy with neoadjuvant radiotherapy combined adjuvant chemotherapy), and adjuvant CRT group (gastrectomy with chemoradiotherapy). Survival analyses were conducted by Kaplan-Meier method and multivariate Cox proportional hazards models, adjusted for age, gender, race, marital status, histology, AJCC stage, tumor location, and lymph nodes removed. Models were stratified by gender, AJCC stage, lymph nodes removed and tumor location. Results: Of the 1,717 cases of stage II-III primary GSRC, the mean age was 66.9 (SD: 11.0) years, over a half were male (52.8%), and the majority were white (66.0%). A total of 39.9% received adjuvant CRT. The five-year overall survival (OS) rate was 34.6% for this treatment, and 29.6% for adjuvant CT group, 25.4% for adjuvant CRT group, only 23.8% for the gastrectomy group. The median OS of patients treated with adjuvant CRT was significantly longer than that of the gastrectomy group (33 vs 24 months, aHR = 0.71, 95%CI = 0.60,0.84). Although the crude model showed a significant association between adjuvant CT and total survival (cHR = 0.81, 95%CI = 0.68,0.96), the effect measure turned null in the multivariable and sub-group analysis. Independent prognostic factors were adjuvant CRT, ≥60 years old, AJCC stage, and &gt; 20 lymoh nodes removed. Conclusions: In this study, GSRC patients with stage II-III experienced improved overall survival after receiving adjuvant CRT, which provides several treatment implications. Future clinical trials considering adjuvant CRT will be needed to verify the conclusion derived from this study.

A case of primary ovarian signet-ring cell carcinoma treated with S-1/CDDP therapy

BackgroundPrimary ovarian signet-ring cell carcinoma is extremely rare, with only five recent case reports. Almost all reported cases of ovarian signet-ring cell carcinoma have been treated with TC therapy and none have reported regarding the use of S-1/CDDP therapy. We report a case of primary ovarian signet-ring cell carcinoma treated postoperatively with S-1/CDDP therapy.Case presentationWe describe a 55-year-old woman diagnosed with stage IB primary ovarian signet-ring cell carcinoma that was treated with S-1/CDDP therapy. Preoperative transvaginal ultrasonography and contrast-enhanced computed tomography (CT) revealed a solid tumor measuring 10 cm in diameter in the pelvis. The tumor marker levels were as follows: CA125, 41.6 U/mL; CA19–9, < 2.0 U/mL; and CEA, 2.2 ng/mL. Ovarian cancer was suspected, and total abdominal hysterectomy, bilateral salpingo-oophorectomy, and omentectomy were performed. The left ovary was enlarged to greater than fist-sized, and there was a small amount of clear yellow ascites. Histological examination of the left ovary led to the diagnosis of signet-ring cell carcinoma. Histological examination of the right ovary also showed the presence of a signet-ring cell carcinoma. After surgery, upper and lower gastrointestinal endoscopy and positron-emission tomography-CT were performed to search for a possible primary lesion, but none was found. The patient was diagnosed with primary ovarian signet-ring cell carcinoma with FIGO Stage IB (PT1b, NX, M0). As postoperative adjuvant chemotherapy, S-1/CDDP therapy (S-1120 mg/day/body × 14 days, CDDP 50 mg/m2 day 8, q 21 days) was administered for six cycles. There was no recurrence 27 months after the initial treatment.ConclusionsWe considered S-1/CDDP therapy was effective for primary ovarian signet-ring cell carcinoma. This is the first case report of primary ovarian signet-ring cell carcinoma treated with S-1/CDDP therapy in the world.

Unusual case of primary cutaneous signet-ring cell (histocytoid) carcinoma

Signet-ring cell (histocytoid) carcinoma is a rare and aggressive skin neoplasm that most commonly affects elderly men. It typically originates from the upper or lower eyelid, with bilateral involvement only in rare cases, and results in a diffuse and infiltrative appearance clinically, radiologically, and histologically (the "monocle" sign). It is essential to carry out a full investigation to rule out metastasis from an internal origin.

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.

Metastasis of Gastric Signet-Ring Cell Carcinoma to the Urinary Bladder: A Case Report and Review of the Literature.

Although signet-ring cell (SRC) adenocarcinoma is commonly seen in the stomach, it is a very rarely seen histologic entity in the bladder. It is difficult to distinguish primary SRC adenocarcinoma of the bladder from bladder metastasis of SRC carcinoma of the stomach only based on histological findings. In such cases, clinical findings and immunohistochemical studies may be helpful. We present here a 48-year-old male patient presenting with hematuria and abdominal pain. Computerised tomography of the patient revealed a gastric mass, peritoneal involvement, and thickening of the bladder wall, and histopathological analysis revealed SRC adenocarcinoma in both of the endoscopic biopsies taken from the stomach and bladder. Immunohistochemical analyses confirmed the diagnosis of SRC adenocarcinoma of the bladder secondary to gastric cancer.

Complete Pathologic Response in Advanced Primary Gastric Signet-Ring Cell Carcinoma: A Case Report

Background: Gastric signet ring cell carcinoma (SRC) is a poorly differentiated adenocarcinoma in which the tumour cells invade singly or in small groups. The incidence of SRC has been reported in china as 13.9% (662 patients of 4,759) [1]. It is reported to occur more frequent among women and young patients. A regimen of epirubicin, cisplatin, and infused fluorouracil (ECF) improves survival among patients with incurable locally advanced or metastatic gastric adenocarcinoma. Case presentation: A 38-year-old female presented with a 3 weeks history of epigastralgia. Her medical history was unremarkable. The endoscopic findings of the stomach revealed an infiltrative lesion, which the guided biopsy yielded a positive pathologic diagnosis of signet ring cell carcinoma. Diagnostic imaging with an abdominal computed tomography (CT) scan revealed a gastric thickening, with lymph nodes. Induction chemotherapy was recommended, based on 6 cycles of ECX (Epirubicin 50 mg/m2, Cisplatin 60 mg/m2, Capecitabine 625 mg/m2). The total gastrectomy specimen showed a pathological complete response. The patient, who is always followed in consultation, is in complete remission 19 months after the diagnosis Conclusion: SRC is a distinctive histological type of gastric cancer. The ECX or EOX (epirubicin, oxaliplatine, capecitabine) remains the standard treatment of advanced primary gastric signet-ring cell carcinoma. Our case illustrates a complete pathologic response to ECX, which confirmed the effectiveness of this protocol on this histology.

Ureterosigmoidostomy Associated Signet Ring Colon Cancer Presenting as Hip Pain

We present a case of a young male with a history of ureterosigmoidostomy who presented with hip pain, the subsequent workup of which revealed metastatic bone lesions from a primary sigmoid signet ring cell adenocarcinoma. Review of literature was conducted using databases PubMed Medline (1966-current), PubMed Central (1970-current), and EMBASE (1988-2009) to explore previous studies on the topic; used the Surveillance, Epidemiology and End Results Program for epidemiological data; and used the National Comprehensive Cancer Network guidelines for management recommendations. Ureterosigmoidostomy is well-documented risk factor for colonic neoplasms, the reported incidence being 2-41% with a latent period of 10 to 30 years and a risk of occurrence 80-7,000 times higher than in the general population. The most common histological type of colon cancer seen after ureterosigmoidostomy is adenocarcinoma, but cases of signet-ring cell carcinoma have also been described. Signet-ring cell adenocarcinoma occurs predominantly in stomach but may infrequently arise from other organs such as breast, urinary bladder, and small and large bowel. This case underscores the importance of prolonged screening in patients with ureterosigmoidostomies and also calls for heightened awareness among primary care physicians regarding long-term risks associated with this unique entity.

Clinical and pathologic characteristics of primary prostatic signet ring cell carcinoma

Objective To discuss the clinicopathologic features, diagnosis and treatment of pri-mary prostatic signet ring cell carcinoma (PPSRCC). Methods Clinical data of 23 PPSRCC cases were retrospectively reviewed. The mean age was 74 years and majority of them had aggravated dysu-ria. The mean serum PSA was 45.3 ng/ml (7.4-126.8 ng/ml). To exclude the metastasis from stomach and colon SRCC, upper gastric tract endoscopy and barium enema were carried out. Seven pa-tients received radical prostatectomies and 2 patients who had positive margins received hormonal and radiation therapy. The rest of patients received maximal androgen blockade therapy. Photoselective vaporization of the prostate was performed on 11 patients who had lower urinary tract symptoms. All cases were investigated by routine pathological, immunohistochemical studies. Results Seventeen cases of PPSRCC were associated with concurrent high-grade prostatic carcinoma, only 6 cases were pure SRCC. Immunohistochemical stains were positive in all cases for PSA and PAP. Stains were ne-gative for AB/PAS (23/23) and CEA (21/23). The clinical TNM stages were 7 of Ⅱ , 10 of Ⅲ and 6 of Ⅳ. Follow-up was available on 20 cases with a mean 24 months and 3 cases were lost during follow up. Eight cases died of metastasis. Five cases had evidence of recurrence 12-21 months from presen-tation. Conclusions The diagnosis of PPSRCC depends on pathological and immunohistochemical studys after metastasis from stomach and colon SRCC is excluded. Early diagnosis and combination treatment for PPSRCC might improve its prognosis. Key words: Prostatic neoplasms; Carcinoma; Signet ring cell

Non-neoplastic endometrial signet-ring cell change

Background Non-neoplastic signet-ring cell change in the endometrium appears to be a degenerative phenomenon associated with abnormal bleeding and exogenous hormone use. It more often occurs from the fourth decade onwards. Understanding this change can aid in distinguishing this condition from potential malignant mimicks. Case report We report four cases of endometrial curettings displaying florid non-neoplastic endometrial signet-ring cell change from women in their fourth and fifth decades with menorrhagia and/or post-menopausal bleeding. All women were on exogenous hormone therapy. All biopsies showed inactive endometrium, with prominent stromal pseudo-decidualisation. The decidual cells showed prominent cytoplasmic vacuolation and were negative for mucin (PAS-D, Alcian blue, mucicarmine), pancytokeratins (AE1/AE3) and histiocytic markers (CD68, MAC387). Electron microscopy showed the vacuoles devoid of organelles. Follow-up curettings showed no neoplastic change. Discussion Non-neoplastic signet-ring change should be recognised and reported where present. The change was first described as an idiopathic postmenopausal decidual reaction. It was recognised as a potential mimick of metastatic carcinoma. The incidence of non-neoplastic endometrial signet-ring cell change is not known. Further study is required to understand this change, and may provide insight to an individual’s response to a specific exogenous hormone regime. A panel of histochemical and immunohistochemical methods should be applied to differentiate this change from various signet-ring cell neoplasms. Conclusions Non-neoplastic endometrial signet-ring cell change is a benign condition. It is important to differentiate this change from a primary or secondary signet-ring cell neoplasm.

Primary Stomach and Colon Signet Ring Cell Carcinoma Immunohistochemical Staining Patterns Using CDX2, MUC2 and Muc6

Primary Stomach and Colon Signet Ring Cell Carcinoma Immunohistochemical Staining Patterns Using CDX2, MUC2 and Muc6

Treatment outcomes in patients with signet ring cell carcinoma of the colorectum

Background The aim of this study was to evaluate the clinicopathologic features and prognosis of signet ring cell (SRC) carcinoma and compare them with those of mucinous and poorly differentiated adenocarcinomas of the colorectum. Methods The clinicopathologic data of 35 patients with primary SRC carcinoma were reviewed and compared with the data from 294 patients with mucinous and 252 patients with poorly differentiated adenocarcinoma. Results Eighty percent of the SRC patients presented with more advanced disease (stages III and IV), whereas 55.1% and 64.7% of the patients in the mucinous and poorly differentiated groups had advanced disease at diagnosis, respectively (80% vs 55.1%, P = .04 and 80.0% vs 64.7%, P = .437). Median survival time for patients with SRC was 18.4 months (95% confidence interval 10.4 to 19.6). Three- and 5-year survival rates in the SRC group were 33.7% and 25.3%, respectively. The overall survival rate of patients with SRC was significantly poorer than that of patients with mucinous or poorly differentiated adenocarcinoma ( P < .001). Conclusions SRC of the colorectum is characterized by advanced stage at diagnosis with lower rates of curative resection. It tends to affect younger patients with more propensity for lymphovascular invasion.

Primary Bladder Signet Ring Cell Carcinoma Extended to Prostate

49세 남자환자가 2개월 전 시작된 육안적 혈뇨, 요절박, 배뇨통을 주소로 내원하였다. 환자는 개인병원에서 치료 후 증상의 호전이 없어 본원으로 전원되었고, 과거력과 신 체검사에서 특이사항은 없었다. 요검사에서 적혈구가 현미 경 시야의 반에서 보였고, 소변세포검사에서 비정형세포가 관찰되었다. 방광경검사에서 전립선요도 근위부에 1cm 정 도의 base가 넓은 비유두상의 종양이 관찰되었고, 방광 점 막은 전반적으로 충혈된 소견이었다. 방광암 의심하에 경요도방광암절제술 후 다발성 방광 조 직검사를 시행하였다. 조직검사에서 방광은 모두 만성염증 소견이었고, 전립선요도부위의 종양은 전립선의 실질까지 침범한 반지세포암종으로 진단되었다 (Fig. 1). 병기를 결정 하기 위한 복부컴퓨터단층촬영에서는 좌측 방광기저부의 비후와 전반적으로 방광벽이 두꺼워 보였고 림프절이나 원 격전이는 없었다 (Fig. 2). 위내시경을 포함한 소화기계 검 사에서 이상소견은 없었다. 이상에서 전립선에서 기원한 반지세포암종으로 생각하고, 근치적 후치골전립선절제술 을 계획하였다. 수술장에서 전립선절제 후 요도방광문합술 을 위해 방광경부를 만져보았을 때 방광경부 3시 방향에 전립선을 침범한 방광의 원발성 반지세포암종