Signet ring cell carcinoma

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Signet ring cell carcinoma, abbreviated SRCC, is a type of malignant epithelial neoplasm that typically arises from the stomach.

General

  • It has been said that there are two types of pathologists... those that have missed SRCCs and those that will miss SRCCs.

Differential diagnosis

It may arise from the:[1]

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:

  • Fat atrophy.[2]

Images:

Stains

  • PAS stain +ve.
  • Alican blue-PAS stain +ve.

IHC

  • AE1/AE3 +ve.
  • CK7 +ve.

References

  1. URL: http://cancerhelp.cancerresearchuk.org/about-cancer/cancer-questions/what-is-a-signet-cell-cancer. Accessed on: 7 March 2012.
  2. Clarke, BE.; Brown, DJ.; Xipell, JM. (Jan 1983). "Gelatinous transformation of the bone marrow.". Pathology 15 (1): 85-8. PMID 6222282.