Diagnostic Dilemma of Epithelial Signet Ring Cells in Calculous Cholecystitis

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S65-S65
Author(s):  
Ali Afsari ◽  
Tammey Naab ◽  
Muhammad Hassan
Keyword(s):  
Signet Ring Cell ◽  
Wall Thickening ◽  
Diagnostic Dilemma ◽  
Ki 67 ◽  
Signet Ring Cells ◽  
Signet Ring ◽  
Mucosal Erosion ◽  
Ring Cell ◽  
Epithelial Change ◽  
Calculous Cholecystitis

Abstract Classic neoplastic signet ring cells are characterized by peripheral nuclear displacement by accumulation of cytoplasmic mucin in some adenocarcinomas. However, epithelial nonneoplastic signet ring cells may accumulate in the setting of mucosal erosion and ischemia as a reactive change of damaged columnar mucosa. Nonneoplastic signet ring cells may also occur as part of an inflammatory reaction due to histiocytes with signet-ring cell mucicarminophilia. A 58-year-old female presented with a 3-day history of increasing right upper quadrant abdominal pain. MRI showed distended gallbladder with 2 large stones, thickening of the gallbladder wall, and pericholecystic edema, consistent with acute cholecystitis. Laparoscopic cholecystectomy revealed a 15 × 6.0 × 3.5-cm gallbladder with eroded fundic mucosa, marked wall thickening (2 cm), and two intraluminal yellow stones, measuring 2.5 cm and 2.2. cm in diameter, respectively. The differential diagnosis included incidental gallbladder adenocarcinoma. Clusters of signet ring cells were seen in the fibrinous debris and were focally present in the superficial lamina propria. Intestinal metaplasia but no dysplasia was also observed. Loose clusters of pancytokeratin-positive, CD68-negative signet ring cells contained intracytoplasmic mucicarmine-positive mucin. Negative p53, low Ki-67, and positive E-cadherin supported the diagnosis of reactive signet ring cells. Deeply infiltrating pancytokeratin-positive epithelial cells were not identified. Final diagnosis was acute and chronic calculous cholecystitis with mucosal erosion and reactive signet ring cell epithelial change. Nonneoplastic epithelial signet ring cells may represent a diagnostic pitfall in chronically inflamed and eroded columnar cell mucosa of the gallbladder. A panel of immunostains and evaluation for cytologic atypia and unequivocal invasion are most helpful in differentiating this unusual reactive epithelial change, which occurs in response to inflammation, erosion, and/or ischemia, from signet ring cell carcinoma.

Cytology Detects Endobronchial Metastasis from Appendiceal Signet-Ring Cell Carcinoma in the Absence of Radiographic Lung Masses: A Case Report

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S44-S44
Author(s):  
B W Taylor ◽  
K Hummel ◽  
Y Xu
Keyword(s):  
Case Report ◽  
Respiratory Distress ◽  
Cell Carcinoma ◽  
Signet Ring Cell Carcinoma ◽  
Signet Ring Cell ◽  
Signet Ring Cells ◽  
Endobronchial Metastasis ◽  
Signet Ring ◽  
Ring Cell ◽  
The Right

Abstract Introduction/Objective Endobronchial metastasis (EBM) is uncommon, with a reported prevalence of 2% in cases of non-lung primary malignancies. The most frequently observed carcinomas in EBM are from breast, colon, and renal origins. We present a rare case of endobronchial metastasis from a primary tumor of the appendix without lung masses by computed tomography (CT). Methods/Case Report An 83-year-old woman with signet-ring cell carcinoma of the appendix underwent right hemicolectomy and chemotherapy. Two years later, she returned with intractable nausea and vomiting, and respiratory distress. CT of the chest demonstrated diffuse bilateral pulmonary opacities without lung masses. CT of the abdomen showed peritoneal carcinomatosis. Cytology of ascitic fluid displayed metastasis of the patient’s known appendiceal tumor. Bronchoscopy found significant friable debris appearing to be tumor tissue and occluding multiple bronchioles in the right lung. A bronchoalveolar lavage (BAL) specimen from the right lung was sent for liquid-based cytology, which revealed a few atypical cells with eccentric nuclei and intracytoplasmic vacuoles, abundant macrophages, degenerated mixed inflammatory cells, and scattered bronchial epithelial cells. Cell block demonstrated signet-ring cells mimicking macrophages and infiltrating into small fragments of bronchiolar wall. The signet-ring cells were morphologically similar to those found in the ascitic fluid and the patient’s primary tumor, and were highlighted by mucicarmine stain and immunohistochemical stains for CDX-2 and CK20, but not CK7. Results (if a Case Study enter NA) N/A Conclusion Collectively, the findings supported the diagnosis of endobronchial metastasis of signet-ring cell carcinoma from the lower gastrointestinal tract, i.e. the patient’s known appendiceal primary. Our case demonstrates a rare endobronchial metastasis of a primary neoplasm of the appendix, an important diagnostic consideration when evaluating respiratory distress in patients with such cancer histories. We have described the significant role of BAL cytology to uncover endobronchial metastases without lung masses by CT, and illustrated the finding of signet-ring cells mimicking macrophages in a BAL cytology specimen.

Peculiar Artifacts Mimicking Carcinoma

2001 ◽  
Vol 125 (11) ◽  
pp. 1473-1476 ◽  
Author(s):  
Mark Li-cheng Wu ◽  
Sathima Natarajan ◽  
Klaus J. Lewin
Keyword(s):  
Cell Carcinoma ◽  
Signet Ring Cell Carcinoma ◽  
Signet Ring Cell ◽  
Clinical Correlation ◽  
Signet Ring Cells ◽  
Products Of Conception ◽  
Signet Ring ◽  
Ring Cell ◽  
Morphologic Analysis ◽  
Ancillary Studies

Abstract Artifacts that mimic malignancy may lead to diagnostic difficulty and can cause serious consequences. We present 2 cases received in consultation which demonstrated peculiar artifacts that closely mimicked carcinoma. In case 1, contaminating products of conception were confused with squamous cell carcinoma. In case 2, artifactual signet ring cells induced by procedural trauma were suspicious for signet ring cell carcinoma. In both cases, clinical correlation failed to completely exclude carcinoma, and limited tissue prevented use of ancillary studies. Our final resolution of these artifacts required lengthy and detailed morphologic analysis.

scholarly journals Signet-ring cell adenocarcinoma of unknown primary presenting with superior vena cava (SVC) syndrome: rare type of cancer

2019 ◽  
Vol 12 (12) ◽  
pp. e232269
Author(s):  
Ramon Bagaporo Larrazabal, Jr ◽  
Paula Victoria Catherine Cheng ◽  
Aileen David-Wang ◽  
Daryl Requiso
Keyword(s):  
Gastric Wall ◽  
Vena Cava ◽  
Lower Lobe ◽  
Signet Ring Cell ◽  
Unknown Primary ◽  
Wall Thickening ◽  
Outpatient Basis ◽  
Signet Ring ◽  
Ring Cell ◽  
Work Up

A 53-year-old man presented with a 3-month history of progressive, non-productive cough followed by occasional swelling of the face and upper extremities. Physical examination on admission revealed prominent superficial vessels at the neck and upper extremity swelling. Bronchoscopy revealed the superior segment of the right lower lobe was narrow but without visible mass; cell block and biopsy done revealed signet-ring cell carcinoma with an immunohistochemistry pattern favouring the primary site of malignancy as either gastric or of the pancreaticobiliary tree. However, CT scan of the abdomen and pelvis with triple contrast revealed only slight gastric wall thickening; the pancreas was unremarkable. The patient underwent radiotherapy with noted improvement of symptoms. He was then discharged with plans for further work-up on an outpatient basis. This work highlights the importance of a comprehensive histopathological and immunohistochemical work-up which can help predict a site of origin to be able to provide the appropriate management.

scholarly journals Lipomatous/Extensively Vacuolated Ependymoma with Signet-Ring Cell-Like Appearance: Analysis of a Case with Extensive Literature Review

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Miguel Fdo. Salazar ◽  
Martha Lilia Tena-Suck ◽  
Alma Ortiz-Plata ◽  
Citlaltepetl Salinas-Lara ◽  
Daniel Rembao-Bojórquez
Keyword(s):  
Latin American ◽  
Signet Ring Cell ◽  
Extensive Literature ◽  
Anaplastic Ependymoma ◽  
Ultrastructural Examination ◽  
Ki 67 ◽  
American Institution ◽  
Signet Ring ◽  
Ring Cell ◽  
Morphological Variants

“Lipomatous” and “extensively vacuolated” are descriptive captions that have been used to portray a curious subset of ependymomas distinctively bearing cells with a large vacuole pushing the nucleus to the periphery and, thus, simulating a signet-ring cell appearance. Here, we would like to report the first ependymoma of this kind in a Latin American institution. A 16-year-old boy experienced cephalea during three months. Magnetic resonance imaging scans showed a left paraventricular tumour which corresponded to anaplastic ependymoma. Intriguingly, it was also composed of cells with single or multiple hollow cytoplasmic vacuoles sometimes giving a signet-ring cell-like configuration. Immunolabeling of these showed membrane positivity for GFAP, PS100, and CD99, while Ki-67 expression was null. Ultrastructural examination of retrieved paraffin-embedded tissue showed the presence of scarce microlumina filled with microvilli but failed to demonstrate any content in such optically empty vacuoles as only scant granulofibrillary debris was observed. A schism prevails at present regarding these unusual morphological variants, being either “lipomatous” or “vacuolated” based mainly on the EMA immunoprofile. This, however, is a misappropriate approaching. Could it be that perhaps we are dealing with the same histopathological entity or it may simply happen that fixation and artefacts cannot allow for their proper identification?

scholarly journals Primary mucinous adenocarcinoma of the bladder with signet-ring cells: case report

2007 ◽  
Vol 125 (5) ◽  
pp. 297-299 ◽  
Author(s):  
Marcelo Lorenzi Marques ◽  
Gabriel Salum D'Alessandro ◽  
Daher Cezar Chade ◽  
Valéria Pereira Lanzoni ◽  
Samuel Saiovici ◽  
...  
Keyword(s):  
Case Report ◽  
Mucinous Adenocarcinoma ◽  
Rare Case ◽  
Bladder Tumor ◽  
Colorectal Adenocarcinoma ◽  
Signet Ring Cell ◽  
Signet Ring Cells ◽  
Signet Ring ◽  
Ring Cell ◽  
Primary Bladder

CONTEXT: Primary adenocarcinomas of the bladder are uncommon and usually occur by contiguity with or hematogenic dissemination of other adenocarcinomas such as colorectal, prostate and gynecological tract carcinomas. Mucinous and signet-ring cell histological patterns are even rarer and it is often difficult to morphologically distinguish them from metastatic colorectal adenocarcinoma. CASE REPORT: We present and discuss a rare case of primary mucinous adenocarcinoma of the bladder with signet-ring cells in a 57-year-old male patient. Other primary sites for the tumor had been excluded and, in the absence of digestive tract tumor and for confirmation that it was a primary bladder tumor, an immunohistochemistry study was performed.

Immunophenotypic Comparison of Neoplasms of the Appendix, Right Colon, and Left Colon in Search of a Site-Specific Phenotypic Signature

2019 ◽  
Vol 28 (1) ◽  
pp. 20-30 ◽  
Author(s):  
Hector Mesa ◽  
Juan C. Manivel ◽  
Wendy S. Larson ◽  
Susan K. Dachel ◽  
Andrew R. Reinink ◽  
...  
Keyword(s):  
Molecular Genetic ◽  
Proximal Colon ◽  
Signet Ring Cell ◽  
Low Grade ◽  
Histologic Type ◽  
Ki 67 ◽  
Site Specific ◽  
Signet Ring ◽  
Ring Cell ◽  
A Site

Aims. The proximal colon derives from the midgut endoderm, the distal one third derives from the hindgut endoderm, and the distal anal canal is of ectodermal origin. At least 5 molecular subtypes of colorectal carcinomas (CRC) have been identified, and some have a marked preferential right-sided location. Histologically, some CRC are much more common in the appendix. We hypothesized that these findings suggest the existence of diverse molecular genetic colonic subregions and compared the expression of classic and recently discovered colorectal markers in tumors at various locations to determine if a site-specific immunophenotypic signature could be identified. Methods and Results. Immunostains for CK7, CK20, MUC2, MUC5AC, MUC6, SATB2, DCR3/TNF6B, CDX2, Ki-67, and MMR proteins were performed on 17 appendiceal low-grade mucinous neoplasms and 6 crypt cell adenocarcinomas of the appendix, 15 right-sided and 15 left-sided mucinous adenocarcinomas, 17 right-sided and 15 left-sided conventional adenocarcinomas, and 5 signet ring cell adenocarcinomas (SRCCA). Statistically significant differences in the expression of MUC2, MUC5AC, MUC6, CK7, and SATB2 by site and/or histologic type were documented. MMR deficiency showed a significant correlation with MUC5AC and MUC6 expression. DCR3, CDX2, and CK20 expression was consistent throughout the colon. A CK7+/CK20+ phenotype was most common in appendiceal tumors and SRCCA. Conclusions. Statistically significant differences in the expression of some markers by histologic type and site were documented, supporting the existence of regional molecular genetic heterogeneity in the colon that result in site-specific epigenetic susceptibilities, tumor phenotypes, and immunophenotypes.

scholarly journals Signet-ring cells in the skin: a case of late-onset cutaneous metastasis of gastric carcinoma and a brief review of histological approach

2017 ◽  
Vol 8 (1) ◽  
Author(s):  
Özgür Gündüz ◽  
Mehmet Can Emeksiz ◽  
Pınar Atasoy ◽  
Mehtap Kıdır ◽  
Selim Yalçın ◽  
...  
Keyword(s):  
Clinical Course ◽  
Late Onset ◽  
Cutaneous Metastasis ◽  
Signet Ring Cell ◽  
Cutaneous Lesions ◽  
Signet Ring Cells ◽  
Internal Malignancy ◽  
Skin Cancers ◽  
Signet Ring ◽  
Ring Cell

Up to 10% of patients with visceral malignancies develop skin metastases during their clinical course and these metastases constitute about 2% of all skin cancers. Skin metastasis may be the first sign of a clinically silent visceral cancer or represent recurrence of an internal malignancy. In both situations, they are associated with poor prognosis, which can partly be attributed to underdiagnosis. In this paper, a case of relapsing gastric adenocarcinoma, which manifested itself as asymptomatic cutaneous papules and nodules on a patient’s head and neck, is reported and histopathological approach to the cutaneous lesions containing signet-ring cell is briefly reviewed.

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