Role of Immunohistochemistry in the Subtyping of Periampullary Adenocarcinoma

2019 ◽  
Vol 27 (6) ◽  
pp. 598-608
Author(s):  
Neha Bakshi ◽  
Shashi Dhawan ◽  
Samiran Nundy ◽  
Seema Rao ◽  
Prem Chopra ◽  
...  
Keyword(s):  
Interobserver Agreement ◽  
Signet Ring Cell ◽  
Periampullary Adenocarcinoma ◽  
Therapeutic Implications ◽  
Signet Ring Cell Adenocarcinoma ◽  
Signet Ring ◽  
Poor Differentiation ◽  
Poorly Differentiated ◽  
Ring Cell

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.

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

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
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.

An unusual case of gastric signet-ring cell adenocarcinoma metastasizing to the urinary bladder

2021 ◽  
pp. 205141582110237
Author(s):  
Amelia Su Hui Yeap ◽  
Yu Liang Lim ◽  
Arianto Yuwono ◽  
Daniel Zhan-Peng Yong ◽  
Wai Ming Yap ◽  
...  
Keyword(s):  
Urinary Bladder ◽  
Unusual Case ◽  
Signet Ring Cell ◽  
Signet Ring Cell Adenocarcinoma ◽  
Signet Ring ◽  
Ring Cell

Gastric Collision Tumor of MALT Lymphoma and Signet Ring Cell Adenocarcinoma: a Rare Preoperative Diagnosis

2021 ◽  
Author(s):  
Haythem Yacoub ◽  
Nour Ben Safta ◽  
Zein El Imene Abdelaali ◽  
Sarra Ben Rejeb ◽  
Syrine Bellakhal ◽  
...  
Keyword(s):  
Malt Lymphoma ◽  
Preoperative Diagnosis ◽  
Collision Tumor ◽  
Signet Ring Cell ◽  
Signet Ring Cell Adenocarcinoma ◽  
Signet Ring ◽  
Ring Cell

Radical Resection in Signet Ring Carcinoma of the Ampulla of Vater: Report of an 11-Year Survivor

2006 ◽  
Vol 72 (2) ◽  
pp. 193-195 ◽  
Author(s):  
Mark Bloomston ◽  
Michael Walker ◽  
Wendy L. Frankel
Keyword(s):  
Radical Resection ◽  
Ampulla Of Vater ◽  
Signet Ring Cell ◽  
Gastrointestinal Malignancies ◽  
Dismal Prognosis ◽  
Signet Ring ◽  
Painless Jaundice ◽  
Poor Differentiation ◽  
Poorly Differentiated

Carcinomas of the ampulla of Vater are uncommon tumors but have a better prognosis than typical pancreatic cancers. They tend to be well or moderately differentiated while the poorly differentiated variants are still quite aggressive. Signet ring features associated with poor differentiation traditionally confer a dismal prognosis in other gastrointestinal malignancies, particularly gastric cancer. Signet cell ring morphology has only been described in a few ampullary carcinomas with all cases reporting short follow-up. We describe a 58-year-old woman who presented with painless jaundice and a prominent ampulla of Vater by endoscopy. She underwent pancreaticoduodenectomy and was found to have a 1.0 x 0.8 cm poorly differentiated carcinoma with prominent signet ring cell features arising from the ampulla of Vater and invading into the periampullary duodenum but sparing the pancreatic parenchyma. No distant or nodal metastases were seen (pT2N0M0). No adjuvant therapy was given, and the patient remains free of disease with 134 months of follow-up.

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