Difference between revisions of "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]].
{{ 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.


===Differential diagnosis===
===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 12: Line 52:
*[[Pancreas]].
*[[Pancreas]].
*[[Urinary bladder]].
*[[Urinary bladder]].
*[[Prostate gland]]  
*[[Prostatic_signet_ring_cell_carcinoma|Prostate gland]].
*[[Lung]].  
*[[Lung]].


==Microscopic==
==Microscopic==
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DDx:
DDx:
*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>
**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)].  
*[http://www.engravingarts.com/sales/LVX2.jpg Signet rings (engravingarts.com)].  
*[http://commons.wikimedia.org/wiki/File:Signet_ring_cells_5.jpg SRCs (H&E) by Nephron (WC)].
====Case - stomach====
*[http://commons.wikimedia.org/wiki/File:Gastric_signet_ring_cell_carcinoma_histopatholgy_(2)_PAS_stain.jpg SRC AL-PAS stain (WC)].
<gallery>
*[http://commons.wikimedia.org/wiki/File:Gastric_signet_ring_cell_carcinoma_histopatholgy_(1).jpg SRC H&E stain (WC)].
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.
*Alican blue-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]

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

  • A medieval signet ring. On the left it is lying flat and looks similar to a so called signet ring cell. (WC/Staves)

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)

Stains

Note:

  • Mucin staining varies somewhat by the anatomical site.[8]

IHC

  • AE1/AE3 +ve.
  • CK7 +ve (usually).

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. ↑ URL: https://clinicaltrials.gov/ct2/show/NCT01824966. Accessed on: April 23, 2022.
  3. ↑ Clarke, BE.; Brown, DJ.; Xipell, JM. (Jan 1983). "Gelatinous transformation of the bone marrow.". Pathology 15 (1): 85-8. PMID 6222282.
  4. ↑ De Petris, G.; Lev, R.; Siew, S. (May 1998). "Peritumoral and nodal muciphages.". Am J Surg Pathol 22 (5): 545-9. PMID 9591723.
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ 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.
  8. ↑ 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.
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