Incidental Finding of Asymptomatic Saddle Pulmonary Embolism in a Patient with Poorly Differentiated Signet Ring Cell Adenocarcinoma

Context. Subtyping of periampullary adenocarcinoma into intestinal and pancreatobiliary subtypes has emerged as an important prognostic factor with potential therapeutic implications. This distinction on morphology alone is often difficult with significant interobserver variability. Objective. To analyze the usefulness of a panel of immunohistochemistry (IHC) markers as an aid to morphologic subtyping of periampullary adenocarcinoma. Design. A total of 172 periampullary adenocarcinomas were classified morphologically by 3 study pathologists. Interobserver agreement was assessed in each case. Cases were then typed using a predetermined IHC panel (comprising CK7, CK20, MUC1, and CDX2). Results. Morphologically, 66 (38.4%) cases were intestinal, 56 (32.6%) pancreatobiliary, 25 (14.5%) mixed, 16 (9.3%) poorly differentiated, 6 (3.5%) mucinous, and 3 (1.7%) signet ring cell adenocarcinoma. Concordant diagnosis was reached in 138 cases (80.2%) with moderate overall interobserver agreement (κ = 0.47). Concordance was higher in morphologically distinct mucinous (100%; κ = 0.94) and signet ring cell subtypes (100%; κ = 1.0) than in intestinal (84.6%; κ = 0.47) and pancreatobiliary (82.1%; κ = 0.43) types. Concordance was poor for mixed (64%; κ = 0.27) and poorly differentiated (68.8%; κ = 0.76) tumors. IHC subtyped 79 cases (46%) as pancreatobiliary, 73 (42.4%) as intestinal, and was inconclusive in 20 cases (11.6%). IHC helped classify 21 out of 25 (84%) mixed and 10 out of 16 poorly differentiated (62.5%) adenocarcinomas. Combination of histology and IHC classified 161 of the total 172 cases (93.6%). Conclusion. Use of an IHC panel aids in subtyping of periampullary adenocarcinomas, especially in tumors with mixed morphology and poor differentiation.

Download Full-text

Gastric Signet-Ring Cell Adenocarcinoma Presenting with Paraneoplastic Deep-Vein Thrombosis and Bilateral Pulmonary Embolism

The American Journal of Gastroenterology ◽

10.14309/00000434-201110002-00525 ◽

2011 ◽

Vol 106 ◽

pp. S203-S204

Author(s):

Juan Castro-Combs ◽

Pablo Marninez ◽

Ivan Carreras ◽

Jose Negrin ◽

Javier Vasallo

Keyword(s):

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Signet Ring Cell ◽

Vein Thrombosis ◽

Signet Ring Cell Adenocarcinoma ◽

Signet Ring ◽

Ring Cell ◽

Deep Vein

Download Full-text

Primary Signet-Ring Cell Carcinoma of the Urinary Bladder Successfully Managed with Radical Cystectomy in a Young Patient

Case Reports in Urology ◽

10.1155/2017/9121078 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Farzad Allameh ◽

Morteza Fallah Karkan ◽

Yalda Nilipour ◽

Azadeh Rakhshan

Keyword(s):

Radical Cystectomy ◽

Gastrointestinal Endoscopy ◽

Signet Ring Cell Carcinoma ◽

Pelvic Lymphadenectomy ◽

Signet Ring Cell ◽

Signet Ring Cell Adenocarcinoma ◽

Signet Ring ◽

Poorly Differentiated ◽

Ring Cell

Primary signet-ring cell adenocarcinoma of bladder is a rare neoplasm, usually seen in middle age adults. We report the case of an 18-year-old man who presented with intermittent gross hematuria. Computed tomography imaging showed multifilling defects in the bladder. The patient underwent a transurethral resection of the bladder tumor. Histological findings were consistent with poorly differentiated mixed mucinous and signet-ring cell adenocarcinoma. We ruled out other possible origins of tumor by gastrointestinal endoscopy and colonoscopy. The patient was treated with radical cystectomy with prostate and seminal vesicle sparing technique and orthotopic diversion using “W” ileum pouch with pelvic lymphadenectomy to the bifurcation of the aorta was done. Six-month follow-up of patient showed normal conditions without metastatic spread or any recurrence.

Download Full-text