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'''Signet ring cell carcinoma''', abbreviated '''SRCC''', is a type of malignant epithelial neoplasm that | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | |||
| Image = Signet ring cell carcinoma - very high mag.jpg | |||
| Width = | |||
| Caption = Signet ring cell carcinoma. [[H&E stain]] | |||
| Micro = ovoid cells with abundant cytoplasm and a peripheral crescentic hyperchromatic nucleus | |||
| Subtypes = | |||
| LMDDx = [[serous fat atrophy]], benign histiocytes ([[mucocele]], [[gastric xanthoma|xanthoma]]) | |||
| Stains = [[PAS stain]] | |||
| IHC = pankeratin +ve, CD68 -ve | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = | |||
| Grossing = | |||
| Site = [[stomach]], [[small intestine]], [[large intestine]], [[breast]], [[pancreas]], [[urinary bladder]], [[prostate gland]], [[lung]] | |||
| Assdx = [[Invasive lobular carcinoma]], [[mucinous carcinoma]] | |||
| Syndromes = [[familial diffuse gastric cancer]] | |||
| Clinicalhx = | |||
| Signs = | |||
| Symptoms = | |||
| Prevalence = uncommon | |||
| Bloodwork = | |||
| Rads = | |||
| Endoscopy = [[linitis plastica]] (classic finding in the stomach) | |||
| Prognosis = poor | |||
| Other = | |||
| ClinDDx = | |||
}} | |||
{{ Infobox external links | |||
| Name = {{PAGENAME}} | |||
| EHVSC = 9982 | |||
| pathprotocols = | |||
| wikipedia = Signet ring cell carcinoma | |||
| pathoutlines = | |||
}} | |||
'''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== | ==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 34: | Line 74: | ||
*[[Serous fat atrophy]].<ref name=pmid6222282>{{Cite journal | last1 = Clarke | first1 = BE. | last2 = Brown | first2 = DJ. | last3 = Xipell | first3 = JM. | title = Gelatinous transformation of the bone marrow. | journal = Pathology | volume = 15 | issue = 1 | pages = 85-8 | month = Jan | year = 1983 | doi = | PMID = 6222282 }}</ref> | *[[Serous fat atrophy]].<ref name=pmid6222282>{{Cite journal | last1 = Clarke | first1 = BE. | last2 = Brown | first2 = DJ. | last3 = Xipell | first3 = JM. | title = Gelatinous transformation of the bone marrow. | journal = Pathology | volume = 15 | issue = 1 | pages = 85-8 | month = Jan | year = 1983 | doi = | PMID = 6222282 }}</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> | *[[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. | |||
*[[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=== | ||
<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)]. | |||
====Case - stomach==== | |||
<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_-_high_mag.jpg | SRCC - 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:Gastric_signet_ring_cell_carcinoma_histopatholgy_(1).jpg | SRCC. (WC/KGH) | |||
Image:Gastric_signet_ring_cell_carcinoma_histopatholgy_(2)_PAS_stain.jpg | SRCC - PAS stain. (WC/KGH) | |||
</gallery> | |||
==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== | ||