Rectal Signet-ring Cell Carcinoma Research Articles

A case of metastatic gastric cancer derived from rectal signet-ring cell carcinoma

A case of metastatic gastric cancer derived from rectal signet-ring cell carcinoma

Rectal dural metastasis masquerading as chronic subdural hematoma: illustrative case.

Intracranial dural metastasis causing subdural hematoma formation is a rare clinical entity associated with significant morbidity and mortality. A 61-year-old female patient known to have rectal signet ring cell carcinoma presented with cranial computed tomography scan findings of bilateral subdural hematoma. She underwent evacuation of the hematoma with dural biopsy, which showed tumor emboli consistent with colorectal origin. There was an early recurrence of the subdural collection, and an emergency subdural-peritoneal shunt insertion was done; however, there was no sustained clinical improvement. This work reports the first case of rectal dural metastasis presenting as chronic subdural hematoma and discusses the clinical course and current literature. The cases described in these studies are consistent with the clinical course of our patient; that is, evacuation of the subdural hematoma provided temporary clinical improvement and re-accumulation occurred within 3 days. The authors recommend maintaining a high index of suspicion in this select group of patients, including prompt discussion about treatment plans with the patient's family.

Diagnosis and Progression of Rectal Signet Ring Cell Carcinoma in a 15 Year Old Lebanese Boy: A Case Report

Introduction: Colorectal cancer (CRC) is a rare entity in children and adolescents compared to adults. In the young, it is mostly detected in the right and transverse parts of the colon. Among the variants of CRC are the uncommon Signet Ring Cell Carcinoma (SRCC) which has a late presentation and pessimistic prognosis. Patients are asymptomatic for a long time and suddenly develop changes in bowel habits or obstruction. Case Report: A 15-year-old boy with no known health issues presented with recent rectorrhagia and weight loss. He was stable but pale with abdominal tenderness and no rectal mass on digital rectal examination (DRE). Colonoscopy unveiled a 13 centimeters segment of circumferential ulcerated blackish mucosa extending from the upper rectum to the rectosigmoid junction. Pathology studies revealed SRCC of the rectum and sigmoid. Metastatic workup showed rectosigmoid wall thickening and denoted the tumor a stage IV with ascites and intraperitoneal implants. Palliative treatment with chemotherapy was initiated, and a follow-up CT was done later to assess disease progression and response to treatment. The disease had worsened and the patient deteriorated. Conclusion: In children, colorectal SRCC is scarce and usually presents at a late stage due to the lack of characteristic symptoms and findings. It is then usually missed by physicians and not considered in the differential thus delaying the diagnosis and rendering the prognosis poorer. To improve the outcome, pediatricians ought to keep CRC in mind when facing obstructive symptoms or refractory abdominal pain.

Breast Metastasis From Rectal Signet-Ring Cell Carcinoma: A Case Report and Review of Literature.

BackgroundMetastatic rectal cancer (mRC) of the breast is an extremely rare clinical situation. There are few reported cases in domestic or foreign literature. The clinicopathologic characteristics along with the diagnostic and therapeutic strategies of such cases remain relatively unclear. Here, we would like to provide our comprehensive insights into this rare entity.MethodsWe present a case that till now is the first reported breast metastasis from rectal cancer pathologically diagnosed as a signet-ring cell carcinoma, and we review the current literature on this rare event. The detailed clinical data, histopathology, management, and follow-up aspects were gathered for analysis.ResultsA total of 15 cases were collected including the current case. Breast metastases from rectal cancer present at an average age of 47.7 years (range, 28 to 69 years) and appear with an average interval of 28.4 months (range, 5 months to 18 years) following primary tumor diagnoses. Of the 15 cases, 8 and 5 are pathologically diagnosed as adenocarcinomas and mucinous adenocarcinomas, respectively. Most cases (11/15) are accompanied by extramammary metastases. About half of the breast metastases (7/15) were to the left. In all cases, the main complaints were palpable mass. The average maximum diameter of the metastatic mass is 2.7 cm (range, 1–11 cm). The majority (8/12) of cases with accessible therapy information exclude the option of local surgery.ConclusionPrevious cancer history and accurate immunohistochemistry data play critical roles to distinguish mammary metastasis from a primary neoplasm of the breast. Mastectomy and molecular-targeted drugs should be considered with priority if systemic condition supports them.

Rectal Signet Ring Cell Carcinoma: Post-Chemoradiotherapy Evaluation by MRI and Corresponding to Pathology.

BackgroundSignet ring cell carcinoma (SRCC) is recognized as an uncommon subtype of colorectal carcinoma (CRC). It showed characteristic magnetic resonance imaging (MRI) manifestations. However, the MRI features post-chemoradiotherapy (CRT) were not reported, and it is unknown whether the current tumor regression grade (TRG) system by MRI (mrTRG) is applicable to SRCC.PurposeTo summarize the image features of rectal SRCC on post-CRT images corresponding to the pathology, and to determine the predicting value of mrTRG compared with TRG by pathology (pTRG).MethodsWe retrospectively enrolled seven patients (male: female = 3:4; mean age, 45.1 years) with biopsy-pathology proved SRCC, who underwent pre- and post-CRT MR imaging followed by surgery. An experienced gastrointestinal radiologist accessed mrTRG using a 5-point grading system by mandard standard on T2 weighted image (T2WI) and then added diffusion weighted image (DWI) in a 1-month interval. Additionally, MRI features were recorded on pre- and post-CRT images as follows: pattern (target sign) and main signal intensity of T2WI, characterized manifestation of DWI, and mean Apparent Diffusion Coefficient (ADC)values. The mrTRG and all MR image features were compared to the post-operative pathology.ResultsAt post-CRT histology, five patients got a good response (TRG 1, n = 4; TRG 2, n = 1), one patient got a partial response, and one patient got a poor response. The accuracy of MRI predicted the pathology response by mandard standard was 14% and increased to 71.4% when added DWI. After CRT, different degrees of homogeneous high SI without enhancement representing acellular mucin were observed in all patients, and the thick-ring high SI turned into a thin-target sign in most good responders. Moreover, the tumor volume decreased or slightly increased in good responders, while it markedly increased in the partial and poor responder by 57% and 73.8%, respectively.ConclusionHomogeneous high SI on T2WI and thin target sigh on DWI were the main MRI changes of RSRCC, which was corresponding to the mucinous regression and represents for good response post-CRT. The mrTRG and tumor volume was not a reliable indicator to the pathology response. We considered that DWI should be added to T2WI to evaluate RSRCC response to CRT.

Rectal signet ring cell carcinoma presenting as stercoral ulceration and fecal incontinence

article: Rectal signet ring cell carcinoma presenting as stercoral ulceration and fecal incontinence - Gazzetta Medica Italiana - Archivio per le Scienze Mediche 2021 July-August;180(7-8):391-4 - Minerva Medica - Journals

Signet ring cell carcinoma of rectum metastasizing to synchronous renal cell carcinoma: a case report

BackgroundRectal signet ring cell carcinoma is a rare type of colorectal adenocarcinoma characterized by an aggressive biological behavior and poor prognosis. The co-occurrence of colorectal carcinoma and renal cell carcinoma (RCC) has found in many hundreds of patients, many of whom also have additional malignancies. Cancer to cancer metastasis is rare and an uncommon phenomenon in malignancy, especially at the time of initial diagnosis, suggesting a genetic susceptibility.Case presentationWe present the case of a 66-year-old Macedonian man with synchronous rectal signet ring cell carcinoma and RCC with tumor to tumor metastasis feature. He underwent a left nephrectomy and anterior rectal resection after complaining of constipation for 3–4 months and the appearance of synchronous tumors on the imaging studies. Morphology and immunohistochemical analysis of specimens from the RCC revealed signet ring cells identical to the rectal signet ring cell carcinoma. The next-generation sequencing study revealed mutations in TP53 and ERBB2, and microsatellite stable signet ring cell carcinoma was determined by deoxyribonucleic acid (DNA) sequencing.ConclusionsCancer to cancer metastasis, although rare, needs to be considered in synchronous tumors. RCC, when diagnosed in multiple synchronous tumors, should be examined carefully. The paucity of reported cases indicates the need for advanced research in imaging methods for metastasis and new therapeutic approaches.

Stercoral Rectal Ulceration or a Missed Diagnosis of Rectal Carcinoma: Primary Signet Ring Cell Carcinoma of the Rectum Presenting as Fecal Incontinence in an Elderly Female

Primary signet ring cell carcinoma of the rectum is a rare entity accounting for approximately 1% of all colorectal carcinomas. It arises more frequently in the stomach and is associated with younger patient population and advanced stage on presentation. Constipation is the main factor for development of stercoral ulcer which originates as a result of pressure necrosis of the colorectal mucosa. We describe an atypical case of an elderly female with primary signet ring cell carcinoma of the rectum presenting with fecal incontinence. A 68-year old woman presented with worsening fecal incontinence and hematochezia. Rectal exam revealed a firm tissue in the lateral anal canal. The endoscopic evaluation showed a friable partially necrotic ulcerated lesion at the anorectal junction extending at least 5 cm proximally. The histologic examination of the lesion was diagnostic for a primary signet ring cell carcinoma of the rectum (positive for CK 7 and CK 20 and negative for CDX-2). Computed tomography scan of the abdomen/pelvis revealed rectal wall thickening and MRI of the pelvis demonstrated a low rectal tumor with perianal involvement, clinical T3N2 with an enlarged right external iliac lymph node. Patient received chemo-radiation and later underwent laparotomy with abdominal perineal resection and an end colostomy was performed. Patient had good clinical progress and was discharged to a skilled nursing facility. Patient had a colonoscopy done three years prior for similar symptoms and was noted to have stercoral ulcerations in the rectum but rectal biopsies at that time were unremarkable. This case highlights the following important points. Ulcers particularly stercoral ulcers may herald a concealed malignant disease, hence surveillance colonoscopy/sigmoidoscopy should be considered. Also, the diagnosis of primary rectal signet ring cell carcinoma should be investigated in the elderly presenting with the complaint of fecal incontinence.1670_A Figure 1. Colonoscopy revealed a friable, necrotic and ulcerated rectal lesion.1670_B Figure 2. CT scan demonstrated rectal wall thickening.

Preoperative radiotherapy improves survival in rectal signet-ring cell carcinoma-a population-based study

BackgroundTo investigate the clinical value of preoperative and postoperative radiotherapy (RT) in patients with rectal signet-ring cell carcinoma (SRCC).MethodsUsing the Surveillance, Epidemiology, and End Results program patients with stage II–III rectal SRCC were retrospectively included between 1988 and 2012. Univariate and multivariate Cox regression analyses were performed to analyze the effect of preoperative and postoperative RT on cause-specific survival (CSS).ResultsA total of 292 patients were included: 138 patients received preoperative RT, 101 patients received postoperative RT, and 53 patients underwent surgery alone. Overall, 5– and 10-year CSS was 43.8 and 37.6%, respectively. Preliminary survival analysis demonstrated that preoperative RT improved CSS versus surgery alone, especially in patients with stage III disease. Multivariate analysis demonstrated that preoperative RT was independent predictors for CSS in stage III rectal SRCC. CSS in preoperative and postoperative RT groups was comparable.ConclusionsPreoperative RT significantly improved survival outcomes in patients with stage III rectal SRCC.

Prognosis and value of preoperative radiotherapy in locally advanced rectal signet-ring cell carcinoma

As well known, signet-ring cell carcinoma (SRCC) is a rare histological subtype of colorectal adenocarcinoma, which has been associated with poor prognosis and resistant to non-surgery therapy compared with common adenocarcinoma. In this study, we assessed the effect of preoperative radiotherapy (PRT) for locally advanced rectal SRCC in a large patient group from the Surveillance, Epidemiology, and End Results program (SEER, 1988–2011) database. SRCC was found in 0.9% (n = 622) rectal cancer (RC) patients in our study. In the PRT setting, SRCC had significantly worse cancer-specific survival than mucinous adenocarcinoma and nonmucinous adenocarcinoma patients (log-rank, P < 0.001). In terms of SRCC, stage III RC patients benefited from PRT (log-rank, P < 0.001) while stage II did not (P = 0.095). The multivariate Cox proportional hazard model showed that PRT was an independent benefit factor in stage III rectal SRCC patients (HR, 0.611; 95% CI, 0.407–0.919; P = 0.018). In conclusion, SRCC was an independent predictor of poor prognosis in stage III RC patients, but not in stage II. In the PRT setting of locally advanced RC, SRCC patients had significantly worse prognosis. PRT was an independent prognostic factor associated with improved survival in stage III rectal SRCC.

胃転移を認めた直腸印環細胞癌の1例

胃転移を認めた直腸印環細胞癌の1例

P-0279 - Ordinary Rectal Adenocarcinoma vs. Primary Rectal Signet-Ring Cell Carcinoma

P-0279 - Ordinary Rectal Adenocarcinoma vs. Primary Rectal Signet-Ring Cell Carcinoma

Primary gastric, duodenal, and rectal signet ring cell carcinoma revealed by cutaneous metastasis

Primary gastric, duodenal, and rectal signet ring cell carcinoma revealed by cutaneous metastasis

Rectal Signet-ring Cell Carcinoma associated with Schistosomiasis in A Nigerian Teenager: A Case Report and Literature Review

Rectal adenocarcinoma is rare in children and young adult worldwide. Apart from genetic predisposition, other factors including chronic schistosomal infection have been implicated in its aetiopathogenesis. Furthermore, many of the recorded cases of rectal carcinoma occurring along with schistosomiasisusually occur not commonly in teenagers but in older patients.We present an 18-year-old Nigerian male who came to the hospital on account of bloody diarrhoea and was later discovered to have signet-ring carcinoma ofthe rectum in association with schistosomiasis. Available literatures on role of schistosomiasis in aetiopathogenesis of colorectal adenocarcinoma arereviewed.

Preoperative radiotherapy in rectal signet-ring cell carcinoma – magnetic resonance imaging and treatment outcome

Background. Signet-ring cell carcinoma (SRCC) is an uncommon tumor entity in rectal cancer, often considered to be resistant to non-surgical therapy. In locally advanced primary or recurrent rectal cancer, diagnostic information from magnetic resonance imaging (MRI) is considered superior in planning the optimal treatment strategy, which usually includes preoperative radiotherapy. The recognition of MRI features that correlate with the radiation response might ultimately be used to select patients for tailored treatment and, in addition, avoid potentially toxic therapy in non-responding patients. Material and methods. In a cohort of 120 rectal cancer patients who had received preoperative radiotherapy (50 Gy in 2 Gy fractions), six patients were noted to have SRCC tumor differentiation. Initial diagnostic MRI examination included assessment of local T- and N-stage and tumor morphology. Histological tumor response was subsequently assessed in the resected specimens, and postoperative follow-up data was compiled until disease recurrence. Results. Following the preoperative radiotherapy, two distinctly different histological responses – complete response (ypT0N0) or no response – were observed. Extensive mesorectal lymph node metastasis (N2 disease) at the pretreatment MRI examination was unambiguously associated with lack of response and rapid development of disseminated disease. Importantly, patients with complete response have been observed for 23–52 months postoperatively without evidence of recurrent disease. Discussion. Our review may suggest that patients with locally advanced growth of rectal SRCC, despite poorer outcome when compared to patients with conventional-type rectal adenocarcinoma, when presenting limited lymph node disease should be offered preoperative radiotherapy in a tentatively curative setting.

Primary rectal signet ring cell carcinoma with peritoneal dissemination and gastric secondaries

Disseminated signet ring cell carcinomas frequently arise from the stomach. However, primaries in the colon and rectum have also been reported. We present a 68 year old lady who presented with a change in her bowel habit. Colonoscopy showed a stenosing rectal tumour at 7 cm to 8 cm from the anal verge. Multiple scattered ulcers were also noted along the entire length of the colon. Biopsy of the lesions revealed signet ring cell adenocarcinoma. Gastroscopy showed multiple nodules with ulceration over several areas of the stomach which were similar in appearance to the colonic lesions. However, no primary tumour of the stomach was seen. Biopsy of the gastric lesions also showed signet ring cell adenocarcinoma. Computed tomography scan of the abdomen and pelvis revealed circumferential tumour at the rectosigmoid junction with possible invasion into the left ischiorectal fossa. The overall picture was that of a primary rectal signet ring cell carcinoma with peritoneal dissemination. The patient was referred for palliative chemotherapy in view of the disseminated disease. In the present report, we discuss this interesting pathological entity and review the role of various histolological techniques in helping to identify the primary tumor.

CLINICAL CHARACTERISTICS and PROGNOSIS OF COLORECTAL SIGNET‐RING CELL CARCINOMA

Background/aims Colorectal signet‐ring cell carcinoma (SRCC) is uncommon tumor. The aim of this study was to evaluate the clinical characteristics of primary and metastatic colorectal SRCC.Methods We retrospectively examined the records of patients who had undergone surgery for colon cancer and was diagnosed pathologically as colorectal SRCC from 1988 to 2000.Results Among 1812 patients with colorectal cancer examined, the number of patients with SRCC was 28 (1.5%); eight patients (28.6%) were metastatic and 20 patients (71.4%) were primary. Male to female ratio was 19:9 and mean age was 44.2 (primary, 42.5; metastatic, 48.3). Mean age of primary SRCC of rectosigmoid area was lower than that of ascending colon (37.4 vs. 54.5). The topographic incidences of primary SRCC were nine patients in rectum; five patients in sigmoid colon; six patients in ascending colon. Metastatic SRCC's were mostly found in splenic flexure and rectosigmoid area. Biopsy positive rate at first was 13 of 18 in primary SRCC, and 3 of 5 in metastatic SRCC. Five cases (55.6%) of primary rectal SRCC showed linitis plastica type. The stage of primary SRCC showed a preponderance of Astler–Coller C2 lesions; 3 (15%) were in B2, 1 (5%) was in C1, 14 (70%) were in C2, 2 (10%) were in D. One and two years survival of primary SRCC were 62.7 and 45.7%, respectively.Conclusions Colorectal SRCC is rare among colon cancer and common in young age group especially which is primary or occurs in rectosigmoid area. The primary SRCC's were mostly found in advanced stage, and the prognosis might be poor.