Signet ring cell carcinoma

From Libre Pathology
Jump to: navigation, search
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 mucicarmine stain, 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.

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:

Images

www

Case - stomach

Case - bladder

Additional cases

Stains

  • PAS stain +ve.
  • Alcian blue-PAS stain +ve.[6]

IHC

  • AE1/AE3 +ve.
  • CK7 +ve.

See also

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.
  3. De Petris, G.; Lev, R.; Siew, S. (May 1998). "Peritumoral and nodal muciphages.". Am J Surg Pathol 22 (5): 545-9. PMID 9591723.
  4. 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.
  5. 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.
  6. 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.