Difference between revisions of "Signet ring cell carcinoma"
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{{ Infobox diagnosis | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | | Name = {{PAGENAME}} | ||
| Image = Signet ring cell carcinoma - very high mag.jpg | | Image = Signet ring cell carcinoma - very high mag.jpg | ||
| Width = | | Width = | ||
| Caption = Signet ring cell carcinoma. [[H&E stain]] | | Caption = Signet ring cell carcinoma. [[H&E stain]] | ||
| Micro = ovoid cells with abundant cytoplasm and a peripheral crescentic hyperchromatic nucleus | | Micro = ovoid cells with abundant cytoplasm and a peripheral crescentic hyperchromatic nucleus | ||
| Subtypes = | | Subtypes = | ||
| LMDDx = [[serous fat atrophy]], benign histiocytes ([[mucocele]], [[xanthoma]]) | | LMDDx = [[serous fat atrophy]], benign histiocytes ([[mucocele]], [[gastric xanthoma|xanthoma]]) | ||
| Stains = | | Stains = [[PAS stain]] | ||
| IHC = pankeratin +ve, CD68 -ve | | IHC = pankeratin +ve, CD68 -ve | ||
| EM = | | EM = | ||
| Line 14: | Line 14: | ||
| Gross = | | Gross = | ||
| Grossing = | | Grossing = | ||
| Site = [[stomach]], [[breast]], | | Site = [[stomach]], [[small intestine]], [[large intestine]], [[breast]], [[pancreas]], [[urinary bladder]], [[prostate gland]], [[lung]] | ||
| Assdx = [[Invasive lobular carcinoma]], [[mucinous carcinoma]] | | Assdx = [[Invasive lobular carcinoma]], [[mucinous carcinoma]] | ||
| Syndromes = familial diffuse gastric cancer | | Syndromes = [[familial diffuse gastric cancer]] | ||
| Clinicalhx = | | Clinicalhx = | ||
| Signs = | | Signs = | ||
| Line 23: | Line 23: | ||
| Bloodwork = | | Bloodwork = | ||
| Rads = | | Rads = | ||
| Endoscopy = linitis plastica (classic finding in the stomach) | | Endoscopy = [[linitis plastica]] (classic finding in the stomach) | ||
| Prognosis = poor | | Prognosis = poor | ||
| Other = | | Other = | ||
| Line 30: | Line 30: | ||
{{ Infobox external links | {{ Infobox external links | ||
| Name = {{PAGENAME}} | | Name = {{PAGENAME}} | ||
| EHVSC = | | EHVSC = 9982 | ||
| pathprotocols = | | pathprotocols = | ||
| wikipedia = Signet ring cell carcinoma | | wikipedia = Signet ring cell carcinoma | ||
| Line 38: | Line 38: | ||
==General== | ==General== | ||
*It has been said that there are two types of pathologists... those that have missed SRCCs ''and'' those that will miss SRCCs. | *Signet ring cell carcinoma are notoriously easy to miss in a small biopsy. | ||
**It has been said that there are two types of pathologists... those that have missed SRCCs ''and'' those that will miss SRCCs. | |||
*The name comes from the shape of cells. They look like signet rings that are lying flat on the ground and one is looking from above - see microscopic section. | |||
=== | ===Anatomical Site=== | ||
It may arise from the:<ref>URL: [http://cancerhelp.cancerresearchuk.org/about-cancer/cancer-questions/what-is-a-signet-cell-cancer http://cancerhelp.cancerresearchuk.org/about-cancer/cancer-questions/what-is-a-signet-cell-cancer]. Accessed on: 7 March 2012.</ref> | It may arise from the:<ref>URL: [http://cancerhelp.cancerresearchuk.org/about-cancer/cancer-questions/what-is-a-signet-cell-cancer http://cancerhelp.cancerresearchuk.org/about-cancer/cancer-questions/what-is-a-signet-cell-cancer]. Accessed on: 7 March 2012.</ref> | ||
*[[Esophagus]]. | |||
**>50% signet ring cells - as per a study definition.<ref>URL: [https://clinicaltrials.gov/ct2/show/NCT01824966 https://clinicaltrials.gov/ct2/show/NCT01824966]. Accessed on: April 23, 2022.</ref> | |||
*[[Stomach]]. | *[[Stomach]]. | ||
*[[Small intestine]] | *[[Small intestine]] | ||
| Line 71: | Line 75: | ||
*[[Mucocele]] - muciphages may mimic signet ring cells.<ref name=pmid9591723>{{Cite journal | last1 = De Petris | first1 = G. | last2 = Lev | first2 = R. | last3 = Siew | first3 = S. | title = Peritumoral and nodal muciphages. | journal = Am J Surg Pathol | volume = 22 | issue = 5 | pages = 545-9 | month = May | year = 1998 | doi = | PMID = 9591723 }}</ref> | *[[Mucocele]] - muciphages may mimic signet ring cells.<ref name=pmid9591723>{{Cite journal | last1 = De Petris | first1 = G. | last2 = Lev | first2 = R. | last3 = Siew | first3 = S. | title = Peritumoral and nodal muciphages. | journal = Am J Surg Pathol | volume = 22 | issue = 5 | pages = 545-9 | month = May | year = 1998 | doi = | PMID = 9591723 }}</ref> | ||
**Muciphages = cytoplasm lightly eosinophilic, multivaculated (classic) or finely reticulated. | **Muciphages = cytoplasm lightly eosinophilic, multivaculated (classic) or finely reticulated. | ||
*[[Gastric xanthoma]]. | |||
*[[Goblet cell adenocarcinoma]] (''crypt cell carcinoma'' or ''goblet cell carcinoid'').<ref name=pmid22933998>{{Cite journal | last1 = Pericleous | first1 = M. | last2 = Lumgair | first2 = H. | last3 = Baneke | first3 = A. | last4 = Morgan-Rowe | first4 = L. | last5 = E Caplin | first5 = M. | last6 = Luong | first6 = TV. | last7 = Thirlwell | first7 = C. | last8 = Gillmore | first8 = R. | last9 = Toumpanakis | first9 = C. | title = Appendiceal goblet cell carcinoid tumour: a case of unexpected lung metastasis. | journal = Case Rep Oncol | volume = 5 | issue = 2 | pages = 332-8 | month = May | year = 2012 | doi = 000339607 | PMID = 22933998 }}</ref> | |||
*Ischemic mucosal changes - cells within the lumen.<ref name=pmid22082777>{{Cite journal | last1 = Dhingra | first1 = S. | last2 = Wang | first2 = H. | title = Nonneoplastic signet-ring cell change in gastrointestinal and biliary tracts: a pitfall for overdiagnosis. | journal = Ann Diagn Pathol | volume = 15 | issue = 6 | pages = 490-6 | month = Dec | year = 2011 | doi = 10.1016/j.anndiagpath.2011.07.006 | PMID = 22082777 }}</ref> | |||
===Images=== | ===Images=== | ||
www | <gallery> | ||
Image:Medieval Signet Ring (FindID 226489).jpg|A medieval signet ring. On the left it is lying flat and looks similar to a so called signet ring cell. (WC/Staves) | |||
</gallery> | |||
====www==== | |||
*[http://www.engravingarts.com/sales/LVX2.jpg Signet rings (engravingarts.com)]. | *[http://www.engravingarts.com/sales/LVX2.jpg Signet rings (engravingarts.com)]. | ||
====Case - stomach==== | |||
<gallery> | <gallery> | ||
Image:Signet_ring_cell_carcinoma_-_low_mag.jpg | SRCC - low mag. - demonstrating that it can be subtle. (WC/Nephron) | Image:Signet_ring_cell_carcinoma_-_low_mag.jpg | SRCC - low mag. - demonstrating that it can be subtle. (WC/Nephron) | ||
Image:Signet_ring_cell_carcinoma_-_high_mag.jpg | SRCC - high mag. (WC/Nephron) | Image:Signet_ring_cell_carcinoma_-_high_mag.jpg | SRCC - high mag. (WC/Nephron) | ||
Image:Signet_ring_cell_carcinoma_-_very_high_mag.jpg | SRCC - very high mag. (WC/Nephron) | Image:Signet_ring_cell_carcinoma_-_very_high_mag.jpg | SRCC - very high mag. (WC/Nephron) | ||
</gallery> | |||
====Case - bladder==== | |||
<gallery> | |||
Image: Signet ring cell carcinoma of the urinary bladder -- intermed mag.jpg | SRCC - bladder - intermed. mag. | |||
Image: Signet ring cell carcinoma of the urinary bladder - alt -- intermed mag.jpg | SRCC - bladder - intermed. mag. | |||
Image: Signet ring cell carcinoma of the urinary bladder -- high mag.jpg | SRCC - bladder - high mag. | |||
Image: Signet ring cell carcinoma of the urinary bladder -- very high mag.jpg | SRCC - bladder - very high mag. | |||
</gallery> | |||
====Additional cases==== | |||
<gallery> | |||
Image:Signet_ring_cells_5.jpg | SRCC metastasis. (WC/Nephron) | Image:Signet_ring_cells_5.jpg | SRCC metastasis. (WC/Nephron) | ||
Image:Gastric_signet_ring_cell_carcinoma_histopatholgy_(1).jpg | SRCC. (WC/KGH) | Image:Gastric_signet_ring_cell_carcinoma_histopatholgy_(1).jpg | SRCC. (WC/KGH) | ||
| Line 85: | Line 107: | ||
==Stains== | ==Stains== | ||
*Alcian blue-PAS stain +ve (stomach and colorectum).<ref name=pmid23573317>{{Cite journal | last1 = Terada | first1 = T. | title = An immunohistochemical study of primary signet-ring cell carcinoma of the stomach and colorectum: I. Cytokeratin profile in 42 cases. | journal = Int J Clin Exp Pathol | volume = 6 | issue = 4 | pages = 703-10 | month = | year = 2013 | doi = | PMID = 23573317 }}</ref> | |||
*PAS stain +ve. | *PAS stain +ve. | ||
* | *[[Mucicarmine stain]] -ve (stomach).{{fact}} | ||
Note: | |||
*Mucin staining varies somewhat by the anatomical site.<ref name=pmid16740030>{{cite journal |authors=Nguyen MD, Plasil B, Wen P, Frankel WL |title=Mucin profiles in signet-ring cell carcinoma |journal=Arch Pathol Lab Med |volume=130 |issue=6 |pages=799–804 |date=June 2006 |pmid=16740030 |doi=10.5858/2006-130-799-MPISCC |url=}}</ref> | |||
==IHC== | ==IHC== | ||
*AE1/AE3 +ve. | *AE1/AE3 +ve. | ||
*CK7 +ve. | *CK7 +ve (usually). | ||
==See also== | ==See also== | ||
Latest revision as of 23:49, 25 March 2024
| Signet ring cell carcinoma | |
|---|---|
| Diagnosis in short | |
 Signet ring cell carcinoma. H&E stain | |
|
| |
| LM | ovoid cells with abundant cytoplasm and a peripheral crescentic hyperchromatic nucleus |
| LM DDx | serous fat atrophy, benign histiocytes (mucocele, xanthoma) |
| Stains | PAS stain |
| IHC | pankeratin +ve, CD68 -ve |
| Site | stomach, small intestine, large intestine, breast, pancreas, urinary bladder, prostate gland, lung |
|
| |
| Associated Dx | Invasive lobular carcinoma, mucinous carcinoma |
| Syndromes | familial diffuse gastric cancer |
|
| |
| Prevalence | uncommon |
| Endoscopy | linitis plastica (classic finding in the stomach) |
| Prognosis | poor |
| Signet ring cell carcinoma | |
|---|---|
| External resources | |
| EHVSC | 9982 |
| Wikipedia | Signet ring cell carcinoma |
Signet ring cell carcinoma, abbreviated SRCC, is a type of malignant epithelial neoplasm that can arise from a number of places. It is commonly associated with the stomach.
General
- Signet ring cell carcinoma are notoriously easy to miss in a small biopsy.
- It has been said that there are two types of pathologists... those that have missed SRCCs and those that will miss SRCCs.
- The name comes from the shape of cells. They look like signet rings that are lying flat on the ground and one is looking from above - see microscopic section.
Anatomical Site
It may arise from the:[1]
- Esophagus.
- >50% signet ring cells - as per a study definition.[2]
- Stomach.
- Small intestine
- Large intestine.
- Breast
- Pancreas.
- Urinary bladder.
- Prostate gland.
- Lung.
Microscopic
Features:
- Signet ring cells resemble signet rings.
- They contain a large amount of mucin, which pushes the nucleus to the cell periphery.
- The pool of mucin in a signet ring cell mimics the appearance of the finger hole.
- The nucleus mimics the appearance of the face of the ring in profile.
- Signet ring cells are typically 2-3x the size of a lymphocyte.
- Smaller than the typical adipocyte.
- Often have a crescent-shaped or ovoid nucleus.
- Capillaries sectioned on their lumen have endothelial cells - the nuclei of these are more spindled.
Note:
- SRCs are usually close to friend, i.e. they are adjacent to another SRC.
- This helps differentiate SRCs from capillaries sectioned on their lumen.
- The mucin is often clear on H&E... but maybe eosinophilic.
DDx:
- Serous fat atrophy.[3]
- Mucocele - muciphages may mimic signet ring cells.[4]
- Muciphages = cytoplasm lightly eosinophilic, multivaculated (classic) or finely reticulated.
- Gastric xanthoma.
- Goblet cell adenocarcinoma (crypt cell carcinoma or goblet cell carcinoid).[5]
- Ischemic mucosal changes - cells within the lumen.[6]
Images
A medieval signet ring. On the left it is lying flat and looks similar to a so called signet ring cell. (WC/Staves)
.jpg)
www
Case - stomach
SRCC - low mag. - demonstrating that it can be subtle. (WC/Nephron)
SRCC - high mag. (WC/Nephron)
SRCC - very high mag. (WC/Nephron)
Case - bladder
SRCC - bladder - intermed. mag.
SRCC - bladder - intermed. mag.
SRCC - bladder - high mag.
SRCC - bladder - very high mag.
Additional cases
SRCC metastasis. (WC/Nephron)
SRCC. (WC/KGH)
SRCC - PAS stain. (WC/KGH)
.jpg)
_PAS_stain.jpg)
Stains
- Alcian blue-PAS stain +ve (stomach and colorectum).[7]
- PAS stain +ve.
- Mucicarmine stain -ve (stomach).[citation needed]
Note:
- Mucin staining varies somewhat by the anatomical site.[8]
IHC
- AE1/AE3 +ve.
- CK7 +ve (usually).
See also
References
- ↑ URL: http://cancerhelp.cancerresearchuk.org/about-cancer/cancer-questions/what-is-a-signet-cell-cancer. Accessed on: 7 March 2012.
- ↑ URL: https://clinicaltrials.gov/ct2/show/NCT01824966. Accessed on: April 23, 2022.
- ↑ Clarke, BE.; Brown, DJ.; Xipell, JM. (Jan 1983). "Gelatinous transformation of the bone marrow.". Pathology 15 (1): 85-8. PMID 6222282.
- ↑ De Petris, G.; Lev, R.; Siew, S. (May 1998). "Peritumoral and nodal muciphages.". Am J Surg Pathol 22 (5): 545-9. PMID 9591723.
- ↑ Pericleous, M.; Lumgair, H.; Baneke, A.; Morgan-Rowe, L.; E Caplin, M.; Luong, TV.; Thirlwell, C.; Gillmore, R. et al. (May 2012). "Appendiceal goblet cell carcinoid tumour: a case of unexpected lung metastasis.". Case Rep Oncol 5 (2): 332-8. doi:000339607. PMID 22933998.
- ↑ Dhingra, S.; Wang, H. (Dec 2011). "Nonneoplastic signet-ring cell change in gastrointestinal and biliary tracts: a pitfall for overdiagnosis.". Ann Diagn Pathol 15 (6): 490-6. doi:10.1016/j.anndiagpath.2011.07.006. PMID 22082777.
- ↑ Terada, T. (2013). "An immunohistochemical study of primary signet-ring cell carcinoma of the stomach and colorectum: I. Cytokeratin profile in 42 cases.". Int J Clin Exp Pathol 6 (4): 703-10. PMID 23573317.
- ↑ Nguyen MD, Plasil B, Wen P, Frankel WL (June 2006). "Mucin profiles in signet-ring cell carcinoma". Arch Pathol Lab Med 130 (6): 799–804. doi:10.5858/2006-130-799-MPISCC. PMID 16740030.