Incidental Finding of Intramucosal Signet Ring Cell Gastric Carcinoma

Abstract Signet ring cell carcinoma of stomach (SRCC) is a highly malignant adenocarcinoma characterized by poorly differentiated discohesive cells. Accurate and prompt diagnosis of tumor in the early stage is of prime importance for curative measures. A 42-year-old male with an unknown family histo...

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Bibliographic Details
Published in:American journal of clinical pathology 2018-09, Vol.150 (suppl_1), p.S4-S4
Main Authors: Masood Hassan, Muhammad, Naab, Tammey
Format: Article
Language:English
Subjects:
Adenocarcinoma
Biopsy
Breast cancer
Breast carcinoma
Cell differentiation
Diagnosis
Dysphagia
E-cadherin
Esophagus
Gastric cancer
Gastric mucosa
Gastritis
Invasiveness
Lesions
Malignancy
Mutation
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Summary:Abstract Signet ring cell carcinoma of stomach (SRCC) is a highly malignant adenocarcinoma characterized by poorly differentiated discohesive cells. Accurate and prompt diagnosis of tumor in the early stage is of prime importance for curative measures. A 42-year-old male with an unknown family history of malignancy presented to the hospital for dysphagia and gastrointestinal bleeding. Esophagogastroduodenoscopy (EGD) revealed gastritis, submucosal esophageal polyp, and no gross gastric lesion. One of six gastric biopsy fragments displayed signet ring cells in a band-like pattern below the gastric mucosa. The cells displayed positivity for pancytokeratin and mucicarmine, with loss of E-cadherin, confirming the diagnosis of early intramucosal SRCC with otherwise unremarkable oxyntic mucosa. One of two follow-up EGDs revealed a gastric polyp containing intramucosal SRCC. About 10% of gastric cancer is associated with familial clustering, and 1% to 3% of gastric cancers have been attributed to hereditary diffuse gastric cancer (HDGC). HDGC is an uncommon autosomal dominant cancer syndrome leading to an increased risk of developing invasive diffuse-type (signet ring cell) gastric carcinoma. Thirty percent of HDGC cases are caused by a germline mutation involving the E-cadherin (CDH1) gene. Those cases with the CDH1 mutation have an 80% and 60% cumulative lifetime risk of developing diffuse-type gastric carcinoma and lobular breast carcinoma, respectively. Due to the focal nature of early diffuse-type gastric carcinoma, identifying early lesions with microscopic examination is critical in accurate diagnosis. De novo SRCC is often focal without an obvious gross lesion in the gastric mucosa.
ISSN:0002-9173
1943-7722
DOI:10.1093/ajcp/aqy090.009