Signet Ring Cell Adenocarcinoma Research Articles

Malignant Transformation of Long-Standing Ileal Crohn's Disease Likely Favors Signet Ring Cell Adenocarcinoma Histology.

Signet ring cell adenocarcinomas (SRCCs) are a rare and aggressive histological subtype of adenocarcinomas typically with poor prognosis usually secondary to late stage at detection. In the small bowel, they constitute only 1% of all malignancies. In the last decade, there have been multiple case reports and small case series that have identified SRCCs, typically in the ileum, in patients with Crohn's disease. Crohn's disease is a transmural inflammatory condition that normally manifests in the distal ileum and colon, and is known to temporally increase the risk of malignancy. Given the profound rarity of SRCCs, establishing an association between Crohn's disease and SRCC is challenging. In this study, we performed a systematic review of case reports and small case series describing small bowel SRCCs in Crohn's disease patients. Most cases were found in the distal/terminal ileum, at a mean age of 59 years old. Virtually all tumors were locally advanced (pathological T stage 3 and 4), typically with at least N1 nodal disease. Two case studies (one is a case-control study and the other a cohort design) demonstrated that small bowel SRCC, as opposed to conventional adenocarcinoma, was significantly correlated to a history of Crohn's disease (35% vs. 0%, 73.5% vs. 28.5%), with a propensity to arise in the ileum (95% vs. 30%, 66.7% vs. 42.1%), and at earlier mean age (43 vs. 68 years, 53.7 vs. 61.7 years). We additionally used the Surveillance, Epidemiology, and End Results (SEER) database for insights into the clinicoepidemiological characteristics of ileum SRCCs. SRCCs composed 28.1% of all ileal SRCCs, compared to 11.0% for the adenocarcinomas, with a younger age at diagnosis (60.7 vs. 64.6 years), more distant disease at presentation (41.3% vs. 26.4%), and shorter overall median survival time (20 vs. 39 months). In summary, while there is limited direct evidence to support an association between small bowel SRCC and Crohn's disease, the phenomenon has been increasingly documented in the literature in the last decade. Clinicians treating Crohn's disease patients should consider this in their differential diagnosis, particularly when managing disease complications, as early detection and surgical intervention offer the best prognosis.

A descriptive analysis of gastric cancer with an immunohistochemical Study of Ki67 and p53 as prognostic factors.: Bahrain experience.

To describe the increasing number of gastric cancer cases at Bahrain Defense Force Hospital with implementation of immunohistochemistry markers as prognostic factors. This study included histologically confirmed malignant gastric tumors diagnosed at Bahrain Defense Force Hospital from January 2009 to June 2019. Various epidemiological and pathological data were abstracted and recorded with immunohistochemical analysis of the proliferation marker Ki67 and cell-cycle regulator p53 as prognostic factors. A total of 53 patients with gastric cancer were included in the study, with mean age of 59.75 ± 12.9 years. The typical histological types were signet ring cell adenocarcinoma (68%) and intestinal type adenocarcinoma (17%). Helicobacter pylori and intestinal metaplasia were significantly associated with gastric cancer (p<0.01). The studied population's mortality was 39 (74%). The Ki67 proliferation index showed a mean and standard deviation of 67.09 ± 16.338, with a higher mortality rate in patients with low Ki67 but no difference in survival time. No statistically significant association was found between clinicopathological findings with p53 immunostaining positivity. The common gastric cancers are signet ring cell adenocarcinoma and intestinal type adenocarcinoma, affecting a wide range of age groups (33-91 years), with those over 60 years at greater risk. Interestingly, low Ki67 is associated with a higher mortality rate, whereas p53 has no prognostic significance. Expression of both Ki67 and p53 showed no association with survival time.

Primary signet ring cell adenocarcinoma arising in exstrophy of the urinary bladder (epispadias-exstrophy complex).

Bladder exstrophy is a rare congenital anomaly in which the urinary bladder develops outside the body. It may be part of the bladder epispadias-exstrophy-cloacal complex, which is a serious embryological defect where a spectrum of abnormalities involving the urinary tract, genital tract, musculoskeletal system, and intestinal tract is seen. Primary signet ring cell adenocarcinoma (PSRCA) arising in exstrophy of the urinary bladder is extremely rare with only a few cases reported in the literature. A 32-year-old man with congenital, untreated bladder exstrophy presented with a large fungating mass on the lower abdominal wall. Physical examination revealed a 15 × 12 cm exophytic mass with a penile epispadias. Ultrasonography showed a replacement of the urinary bladder by a mass of size 9 × 8 × 7 cm with a defect in the abdominal wall. On Contrast-enhanced computed tomography (CECT), a mass protruding from a large, inferior abdominal wall defect of 5.3 cm was seen. Widened pubic symphysis with divarication of recti and an absent urinary bladder, consistent with bladder exstrophy, was also noted. The biopsy showed a signet ring cell adenocarcinoma. A radical cystectomy with ileal conduit and left inguinal lymph node dissection was done. Histopathology examination revealed a PSRCA with metastasis to the left inguinal lymph nodes. Immunohistochemistry (IHC) showed strong positivity with CDX2 and CK20 while CK7 was negative. PSRCA shows an aggressive behavior, as was seen in our case, which had metastatic inguinal lymph nodes at the time of presentation. Metastatic signet ring cell adenocarcinomas from other sites need to be ruled out. Bladder exstrophy can develop high-grade malignancies at any stage of life. Hence, surgical treatment early in life with lifelong follow-up is recommended.

S4153 Metastatic Signet Ring Cell Adenocarcinoma Manifesting as Chronic Leg Pain

S4153 Metastatic Signet Ring Cell Adenocarcinoma Manifesting as Chronic Leg Pain

S4067 Beyond the Obstruction: Unveiling Signet Ring Cell Adenocarcinoma's Intriguing Presentation

S4067 Beyond the Obstruction: Unveiling Signet Ring Cell Adenocarcinoma's Intriguing Presentation

An interesting case of gastric adenocarcinoma presenting as bicytopenia in young adult

Abstract A 28-year-old male with no prior comorbidities came with chief complaints of loss of weight for 4 months, generalised weakness for 1 month and blackish discolouration of stools for 20 days. On general examination, pallor present; rest of the physical examination was normal. Laboratory investigations showed low haemoglobin (4.8 g/dL) and platelet count (10,000/mm3). Atypical cells were present in the peripheral blood smear and accounted for 4%. packed red blood cells and platelet-rich plasma transfusions were given. As the blood counts were not improving, bone marrow aspiration and biopsy were done which showed metastatic signet-ring cell carcinoma. In view of melaena, endoscopy was done, which showed carcinoma stomach with active bleeding. The patient was diagnosed to have metastatic signet-ring cell adenocarcinoma with bone marrow metastasis. In view of the advanced nature of disease, the patient was given palliative and supportive treatment.

Gastric Signet-Ring Cell Adenocarcinoma in a Dog

Gastric Signet-Ring Cell Adenocarcinoma in a Dog

CLINICO-HISTOPATHOLOGICAL ANALYSIS OF PRE-MALIGNANT AND MALIGNANT LESIONS OF THE INTESTINAL TRACT

Aim: The current study’s aim is to correlate clinical variables with histopathological findings of pre-malignant and malignant lesions of the intestinal tract. Methods: The sample size includes all the endoscopic biopsies and surgically resected specimens of the intestinal tract received at the Department of Pathology, S.V. Medical College, Tirupathi for 2 years from November 2016 to October 2018. All the specimens are fixed in 10% formalin and stained with Hematoxylin and Eosin. Special stains and Immunohistochemistry were done wherever required. Results: During the study, we studied 113 specimens of endoscopic biopsies and 759 specimens of surgically resected. Out of 113 endoscopic biopsies, 33 biopsies were premalignant and malignant lesions, among which 8 were premalignat lesions and 25 were malignant. Out of 759 surgically resected specimens, 37 specimens were premalignant and malignant lesions, among which 1 was premalignant and 36 were malignant. Out of 70 lesions, 3 occurred in the small intestine, 59 occurred in large intestine, 8 occurred in the anal canal. In the small intestine, 3 lesions were encountered among which, one each of adenoma, PJP, adenocarcinoma was noted. Out of 59 lesions of large intestine 4 were adenomas, 2 were ulcerative colitis, 48 were adenocarcinoma and its variants, 2 were MANECs, one each of carcinoid and GIST and malignant melanoma were reported. In the anal canal, there were 1 adenoma, 2 mucinous adenocarcinomas, and 5 squamous cell carcinomas reported. A case of adenoma occurred in male patient, among 2 mucinous adenocarcinomas one occurred in female patient and one in male patient. Out of 5 squamous cell carcinomas, 3 occurred in female patients and 2 in male patients. Among 3 lesions of the small intestine, one case each of adenoma, PJP, and adenocarcinoma, all occurred in male patients. 33 out of 48 adenocarcinomas occurred in male patients. The most common symptom was bleeding per rectum (63.83%) followed by constipation, pain in abdomen and diarrhea. The association between Adenocarcinoma and Smoking is not correlated with p=0.67. The association between Adenocarcinoma and Smoking is not correlated with a p=0.38. Conclusion: Most of the neoplasms were from the large intestine followed by the anal canal. The most common neoplasm and also most common malignancy was Adenocarcinoma. Different variants of adenocarcinoma encountered in the study were Mucinous adenocarcinoma and Signet ring cell adenocarcinoma. Adenomas were common in Male patients. Mixed adenoneuroendocrine tumor and gastrointestinal stromal tumor of large intestine were confirmed with IHC study.

Systemic Chemo in Patients With Appendix Adenocarcinoma

Systemic Chemo in Patients With Appendix Adenocarcinoma

Metastatic gastric cancer from breast carcinoma presenting with paraneoplastic rheumatic syndrome: A case report

Breast cancer is the most frequently diagnosed cancer worldwide. It is the leading cause of death by malignant disease in women. A female patient, 73 years of age, sought care due to weakness, mild abdominal pain, arthralgia, and weight loss. She was taking anastrazole as maintenance therapy for localized breast cancer and had moderate anemia and elevated acute-phase markers. Upper digestive endoscopy showed isolated erosion in the gastric corpus. This lesion was compatible with signet-ring cell adenocarcinoma in anatomopathological study and was confirmed as metastasis of a breast carcinoma in immunohistochemistry, which was positive for estrogen antibody. Further imaging studies determined numerous proximal bone metastases. The patient was treated with prednisone for paraneoplastic syndrome, which improved the anemia and rheumatic disease, and with chemotherapy, which greatly improved the symptoms. She has been followed-up for 6 mo, and her anemia, arthralgias, and acute phase markers have normalized. Systemic treatment strategies seem to be the best choice for gastric metastasis from breast cancer, resulting in disease control and relapse-free survival. Prospective studies with longer follow-up are needed to better understand the biological, pathological, and clinicopathological characteristics and outcomes of the endoscopic features associated with metastatic gastric cancer from breast carcinoma.

MP11-17 SIGNET RING CELLS ON PROSTATE BIOPSY IN THE SETTING OF PRIMARY ACINAR ADENOCARCINOMA

You have accessJournal of UrologyCME1 Apr 2023MP11-17 SIGNET RING CELLS ON PROSTATE BIOPSY IN THE SETTING OF PRIMARY ACINAR ADENOCARCINOMA Daniel Nemirovsky, Zoe Blake, Alexander Kenigsberg, Neil Mendrihatta, Jacob Enders, Michael Rothberg, Antoun Toubaji, Sandeep Gurram, and Peter Pinto Daniel NemirovskyDaniel Nemirovsky More articles by this author , Zoe BlakeZoe Blake More articles by this author , Alexander KenigsbergAlexander Kenigsberg More articles by this author , Neil MendrihattaNeil Mendrihatta More articles by this author , Jacob EndersJacob Enders More articles by this author , Michael RothbergMichael Rothberg More articles by this author , Antoun ToubajiAntoun Toubaji More articles by this author , Sandeep GurramSandeep Gurram More articles by this author , and Peter PintoPeter Pinto More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003226.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Signet ring cells (SRC) on pathology are typically associated with gastric carcinoma, but are also rarely seen in other malignancies, including prostate cancer (PCa). Though primary SRC adenocarcinoma of the prostate is a well-described aggressive malignancy, there is a paucity of literature describing the oncologic significance of SRC on prostate biopsy in patients with primary acinar adenocarcinoma. In this study, we aimed to describe the clinicopathologic characteristics and outcomes of these patients. METHODS: A prospectively collected database of patients with PCa was queried for presence of SRC on prostate biopsy. Patients with primary SRC adenocarcinoma were excluded. Demographics, imaging, pathological and treatment data were collected. Patients who received radical prostatectomy (RP) without neoadjuvant therapy were examined for adverse features, including extraprostatic extension (EPE), seminal vesicle invasion (SVI), lymphovascular invasion (LVI), as well as post-RP biochemical recurrence (BCR). RESULTS: Between 2014-2022, 46 patients with SRC on biopsy were found. Clinicopathologic data is displayed in Table 1. Patients had a mean of 2.2 cores with SRC on biopsy, and 40/46 (87.0%) of these cores were GG ≥4. Oncologic outcomes are shown in Table 2. Every lesion containing SRC was MRI-visible, 93.3% of which were PIRADS 4 or 5. Of 14 patients with available whole-mount pathology data after RP, 12/14 (85.7%) had Gleason grade group ≥ 3 disease. 5/14 (35.7%) patients had EPE, 4/14 (28.6%) had SVI, and 3/14 (21.4%) had LVI. 3/14 (21.4%) patients experienced BCR post-RP, with a median time to BCR of 12 months (3-28). CONCLUSIONS: Signet ring cells on biopsy were typically identified in the setting of MRI-visible high-grade acinar adenocarcinoma and frequently associated with adverse features on whole mount pathology. While the biological significance of signet ring features in prostate cancer remains to be elucidated, clinical and pathologic correlates suggest an association with high risk disease and should prompt further study of this entity. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e131 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Nemirovsky More articles by this author Zoe Blake More articles by this author Alexander Kenigsberg More articles by this author Neil Mendrihatta More articles by this author Jacob Enders More articles by this author Michael Rothberg More articles by this author Antoun Toubaji More articles by this author Sandeep Gurram More articles by this author Peter Pinto More articles by this author Expand All Advertisement PDF downloadLoading ...

Lymphangitic carcinomatosis as the initial manifestation of primary signet-ring cell adenocarcinoma of the lung: A case report

Signet-ring cell carcinomas are an aggressive, poorly differentiated, and highly invasive adenocarcinoma carrying a poor prognosis. Most of these tumors originate in gastrointestinal organs; however, primary lung signet-ring cell adenocarcinomas can rarely occur. Tumoral lymphatic infiltration is a complication of these tumors and can cause phenomena such as lymphangitic carcinomatosis, characterized by a nodular thickening of the pleura, pleural effusions, and mediastinal lymphadenopathies. We report a case of a 63-year-old ex-smoker with a 2-week clinical course of dyspnea and pleuritic chest pain in which a nodular thickening of the pleura and pleural effusion were documented and led to the diagnosis of a primary signet-ring cell adenocarcinoma of the lung with lymphangitic carcinomatosis. This complication has never been described in the context of a primary lung tumor of this subtype. Both entities carry a high mortality and have no therapeutical options. This report adds to the information available about them.

Impact of neoadjuvant systemic chemotherapy followed by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for appendiceal adenocarcinoma.

Peritoneal dissemination of infiltrative appendiceal tumors is a rare and poorly understood phenomenon. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a well-recognized treatment option for selected patients. Neoadjuvant systemic chemotherapy (NAC) has been shown to be associated with improved overall survival (OS) in colorectal peritoneal metastases but little is known of the impact of this from an appendiceal adenocarcinoma perspective. A prospective database of 294 patients with advanced appendiceal primary tumors undergoing CRS±HIPEC between June 2009 and December 2020 was reviewed. Baseline characteristics and long-term outcomes were compared between patients with adenocarcinoma who received neoadjuvant chemotherapy or upfront surgery. Eighty-six (29%) patients were histologically diagnosed with an appendiceal cancer. These included intestinal-type adenocarcinoma (11.6%), mucinous adenocarcinoma (43%), and goblet cell adenocarcinoma (GCA) or signet ring cell adenocarcinoma (SRCA) (45.4%). Twenty-five (29%) of these underwent NAC, of which eight (32%) exhibited some degree of radiological response. There was no statistical difference in OS at 3 years between the NAC and upfront surgery groups (47.3% vs. 75.8%, p=0.372). Appendiceal histology subtypes, particularly GCA and SRCA (p=0.039) and peritoneal carcinomatosis index >10 (p=0.009), were factors independently associated with worse OS. Administration of NAC did not appear to prolong OS in the operative management of disseminated appendiceal adenocarcinomas. GCA and SRCA subtypes display a more aggressive biological phenotype.

Primary signet ring cell adenocarcinoma as a rare cause of colonic stenosis in a young patient with Crohn’s disease – the case report

Summary: Signet ring cell carcinoma (SRCC) is a rare type of highly malignant adenocarcinoma that produces mucin and predominantly affects the stomach, ovaries, and the small intestine. Primary localisation in the colon is rare, and the prognosis of this type of adenocarcinoma is very poor. We present a case report of a 44-year-old woman who suffered from Crohn‘s disease beginning in the year 2000. During the last three years of her treatment, she was treated using bio­logical therapy with ustekinumab. The treatment led to clinical, laboratory, and endoscopic remission. In February 2021, she had widely metastatic primary signet ring cell carcinoma of the colon, which mimicked the IBD activity in the case of her colon obstruction. Because of the extensive infiltration of her liver and peritoneum at the time of the dia­gnosis, in addition to the symptoms of the passage disorders she was experiencing, she proceeded with an end ileostomy and palliative treatment was started. The patient‘s prognosis was unfavourable, and she died within 5 months of the dia­gnosis in hospice care. Key words: primary signet ring cell carcinoma – colon cancer – Crohn‘s disease – colonic stenosis

Bidirectional Chemotherapy in Advanced Colorectal Cancer Peritoneal Metastases.

Colorectal cancer (CRC) patients with extensive peritoneal metastases who are not candidates for CRS-HIPEC have poor prognoses. We evaluated the role of systemic and intra-peritoneal (IP) chemotherapy in these patients. CRC patients with confirmed peritoneal metastasis were enrolled. After implantation of IP chemoport patients received weekly IP paclitaxel in incremental doses of 20 mg/m2 with systemic chemotherapy. The primary end-points were the feasibility, safety, and tolerance (perioperative complications), and the secondary end-point was the clinico-radiological response. Patients included in the study were registered between January 2018 and November 2021. IP chemoport was implanted in 18 patients of which 14 patients underwent successful instillation of IP chemotherapy. Four patients did not receive IP chemotherapy in view of port-site infection for which IP ports were removed. The median age was 39 years (range: 19-61 years). The site of the primary tumor was equal in the colon and rectum. Fifty percent of patients had signet ring-cell adenocarcinoma, and 21% had poorly differentiated adenocarcinoma. The median serum of CEA level was 12.27 ng/mL (1.63-116.16 ng/mL). The median PCI score was 25 (18-35). The median number of IP chemotherapy cycles (weekly) was 3.5 (1-12 cycles). In 14.3% of patients, IP chemoport had to be removed due to block and infection. Three, five, and four patients had clinico-radiologically disease progression, stable disease, and partial response, respectively. One patient underwent subsequent successful CRS-HIPEC. There were no grade 3-5 (CTCAE 3.0) complications. Incremental doses of IP paclitaxel with systemic chemotherapy is safe and feasible in selected colorectal adenocarcinoma patients with peritoneal metastases without any serious adverse events.

Treatment patterns and oncologic outcomes of carcinoma of the ampulla of vater in a reference hospital in a middle income country: A real-world–based study.

524 Background: Gallbladder and other biliary tract tumors account for 0.6 % of all cancers. There is scarce data of Ampullary cancers, but it is known as an extremely rare neoplasia accounting just for 0.2% of gastrointestinal cancers and 7% of periampullary tumors. Most frequent histology is adenocarcinoma being intestinal and pancreatobiliary subtypes conditioning prognosis and treatment. Current approaches include, but not limited to: neo/adyuvant, radiation and palliative therapy. Methods: We conducted a retrospective study in a referral specialized center in Mexico city. We included patients with histologically confirmed ampullary cancer treated between 2008 and 2022, stages I-IV. We evaluated the frequency of surgery, radiation therapy and chemotherapy. Also, we registered, first line, subsequent and maintenance therapy and as for radiation and chemoradiation. Chi square and student T test were used for between group comparisons. Overall survival was performed using the Kaplan Meier method. Results: We included 220 patients with a median age of 60.3 years (range 28-84), female 51.8%. The clinical stage distribution was I 10%, II 16.4%, III 41.3%, IV 32.3%. Performance status 0 (26.5%), 1 (44.5%), 2 (15.6%), 3 (10.4%), 4 (2.8%). Histologic Subtype Adenocarcinoma not otherwise specified 45.7%, Intestinal Adenocarcinoma 27.1%, Pancreatobiliary Adenocarcinoma 16.7%, Mix Intestinal-Pancreatobiliary 6.2%, Signet Ring Cell Adenocarcinoma 2.4%, Neuroendocrine 1.9%. Curative intend surgery in 169 patients was possible in 90%. Initial treatment received was Adjuvant 40.9%, Palliative 27.7%, Neoadjuvant 2.3% and Never Received any kind of treatment in 29.1%. Adjuvant Treatment was given to 94 patients. Among them Gemcitabine and Capecitabine was the election of treatment in 34% and 23.4 respectively. First line Treatment. Patients receiving first line treatment (110 patients) were candidates to Gemcitabine, XELOX, and Gemcitabine-Cisplatin in 30%, 13.6% and 12.7% according to physicians and 56% other line of treatment. Patients who progressed to first line received a second line in 19%. Most frequent second line of treatment was Capecitabine 61.9% and Gemcitabine 23.8%. Of the whole population Median Overall Survival was 30.68 months, Disease Free survival: 30.71 months and 8.0 months for progression free survival in first line. Conclusions: To our knowledge first real world based large volume study reporting treatment patterns and oncologic outcomes of a rare entity.

Fundic Gland Polyps Lack DNA Content Abnormality Characteristic of Other Adenomatous Precursor Lesions in the Gastrointestinal Tract

Fundic gland polyps (FGPs) develop sporadically (frequently after proton pump inhibitor therapy) or in the setting of a hereditary polyposis syndrome, such as familial adenomatous polyposis (FAP). FAP-related FGPs often demonstrate low-grade dysplasia (LGD) and are frequently associated with APC mutations, even in the absence of dysplasia. Sporadic FGPs with dysplasia are molecularly similar to FAP-related FGPs and demonstrate frequent mutations in APC gene. Despite having similar molecular alterations with colorectal and other adenomatous precursor lesions in the gastrointestinal (GI) tract, FGPs rarely progress to advanced gastric neoplasia (high-grade dysplasia [HGD] or adenocarcinoma), and their role in gastric tumorigenesis remains unclear but likely limited. The clinicopathologic features of 192 patients diagnosed with FGPs, including 86 with FAP-related FGPs (33 with dysplastic FGPs and 53 with nondysplastic FGPs) and 106 with sporadic FGPs (12 with dysplastic FGPs and 94 with nondysplastic FGPs), were analyzed. DNA flow cytometry was performed on 111 FAP-related FGP biopsies, including 32 FGPs with LGD and 79 nondysplastic FGPs, to assess the presence of abnormal DNA content (ie, aneuploidy or elevated 4N fraction). Moreover, 40 sporadic FGP biopsies, including 14 dysplastic (13 LGD and 1 HGD) and 26 nondysplastic FGPs, were examined for DNA content abnormality. Patients with FAP and nondysplastic FGPs were more likely to be younger (mean age, 32 years) and present with multiple FGPs (92%, defined as having ≥2 FGPs) than those with sporadic nondysplastic FGPs (61 years and 65%, respectively; P < .001). They also recorded higher rates of previous or concurrent gastric epithelial dysplasia not occurring in a FGP (8%, P = .016), nongastric GI dysplasia (96%, P < .001), and nongastric GI malignancy (17%, P = .001) compared with those with sporadic nondysplastic FGPs (0%, 52%, and 2%, respectively). The sporadic group was more frequently associated with proton pump inhibitor therapy (78%, P < .001), gastric intestinal metaplasia (24%, P = .004), and a family history of gastric cancer (10%, P = .027) than the FAP group (19%, 6%, and 0%, respectively). Almost all FAP-related FGPs had a polypoid endoscopic appearance (98% vs 84% for sporadic FGPs; P = .009). The mean size of the largest FAP-related FGPs (0.5 cm) was similar to that of sporadic FGPs (0.7 cm) (P = .069). None of the 147 patients with FAP-related or sporadic nondysplastic FGPs were associated with subsequent detection of advanced gastric neoplasia within a mean follow-up time of 54 months (range, <1 to 277 months). However, 2 (4%) of the 45 patients with FAP-related or sporadic dysplastic FGPs developed advanced gastric neoplasia within a mean follow-up time of 59 months (range, <1 to 236 months). One (3%) of the 33 patients with FAP and dysplastic FGPs developed signet ring cell adenocarcinoma, whereas 1 (8%) of the 12 patients with sporadic dysplastic FGPs developed HGD (P = .445). However, none of the FAP-related and sporadic FGP biopsies, regardless of the presence or absence of dysplasia, demonstrated DNA content abnormality. In conclusion, FGPs lack large-scale chromosomal changes that are characteristic of the typical adenoma-carcinoma sequence involved in the development of other GI malignancies. Progression to advanced gastric neoplasia is rare in FGPs, which may be partly explained by the apparent lack of the chromosomal instability phenotype in these lesions.

Effects of Tumor Localization, Age, and Stage on the Outcomes of Gastric and Colorectal Signet Ring Cell Adenocarcinomas.

Signet ring cell adenocarcinomas (SRCCs) are a rare histological adenocarcinoma subtype, classically thought to have a worse prognosis than conventional adenocarcinomas. The majority of these cancers occur in the stomach, colon, and rectum. Their rarity means that most epidemiological studies into their pathology are often underpowered, and interpretations from these reports are mixed. In this study, we use the Surveillance, Epidemiology, and End Results Program (SEER) database to examine the effects of tumor localization, age, and stage on gastric and colorectal cancer outcomes. For early onset localized and regional gastric cancers, SRCCs have the same overall risk of mortality compared to conventional adenocarcinomas. Over the age of 50 years, SRCCs have worse outcomes across all stages. Gastric SRCCs are 2-3-fold more likely in younger patients, and more heavily favor the distal stomach. Like conventional adenocarcinomas, proximal gastric SRCCs have decreased survival. Across all ages, stages, and locations, colorectal SRCCs have worse outcomes. SRCCs favor the right colon, but outcomes are significantly worse for the left colon and rectal cancers. Relative to adenocarcinomas, colorectal SRCCs have the worst outcomes in younger patients. Overall, these results provide insights into SRCC disease patterns that cannot be surmised outside of population-level data.

Signet-ring cell adenocarcinoma of the lungs: An unusual and rare case

Signet-ring cell adenocarcinoma of the lungs: An unusual and rare case

A rare cause of intestinal obstruction in children: signet-ring cell adenocarcinoma of the colon.

Signet-ring cell adenocarcinoma of the colon is well-recognized in adult patients who are extremely rare and not well-documented in children. Our study aims to raise awareness about this rare disease and its long-term outcomes. We retrospectively evaluated patients with signet-ring cell colon adenocarcinoma. Six patients, three boys and three girls, with a mean age of 14.83 (range, 13-17 years), presented with signs of intesti-nal obstruction and were diagnosed with signet-ring cell colon adenocarcinoma. All patients had air-fluid levels on abdominal X-ray. Abdominal ultrasonography of all patients revealed subileus. Abdominal computed tomography was performed in five patients, and pre-operative colonoscopy was conducted in two patients before the emergency intervention. All of the patients underwent emergent exploratory laparotomy with the preliminary diagnosis of acute abdomen. In two patients, debulking surgery followed by a stoma was performed. The remaining four patients were treated with anastomosis following intestinal resection. All girls had metastases on the ovary. One of the patients died due to the burden of multiple metastases in the early period, and three died in the sixth post-operative year. We have been following the remaining two patients since then. Although signet-ring cell carcinomas (SRCCs) are rare, they should be considered in the differential diagnosis of acute abdomen and intestinal obstruction in pediatric patients. Despite early diagnosis and treatment, SRCC has a poor prognosis in the pediatric population.