488 Background: Signet ring cell carcinoma of the colon (SRCC) represents less than 1% of all colon carcinomas. We retrospectively examined the metastatic patterns and prognosis of SRCC in comparison to adenocarcinoma (AC) of the colon. Methods: A total of 763 patients diagnosed with SRCC and 42,875 patients with AC of the colon from 2010 to 2012 were identified from the Surveillance, Epidemiology and End Results (SEER) database. Age, race, gender, primary site, grade, stage, metastatic site and survival data were collected. Results: Out of 43,638 patients, 78.7% were white, 12.5% black and 8.8% other races. Median age of diagnosis was 67.5 years for SRCC as compared to 69.1 years for AC . SRCC was more likely to be grade III or IV (92% vs 21.6%; p < 0.001), to be found in the right colon (63.7% vs 49.4%; p < 0.001) and to present as advanced stage (40.2% vs 29.4% for stage III and 37.1% vs 22.3% for stage IV; p < 0.001). SRCC was more likely to present with metastases to the brain (11.0% vs 1.3%; p < 0.001) and bone (6.4% vs 4.1%; p < 0.001), while AC subjects were more likely to present with metastases to the liver (77.0% vs 22.1%; p < 0.001) and lung (21.2% vs 5.8%; p < 0.001). The 5 year overall survival rate (5-YSR) was 28.2% (CI, 24.5% to 32.4%) for SRCC compared to 50.8% (CI, 50.1% to 51.6%) for AC (Hazard ratio for death, 1.38; CI, 1.26 to 1.52; P < 0.001). The differences in stage specific 5-year survival rates for SRCC and AC were not statistically significant for stage I and stage II. However, SRCC had a lower 5-YSR for stage III (34.5% vs 55.4%) and stage IV (3.3% vs 10.8%). Conclusions: SRCC of the colon has worse survival rates for advanced stages when compared to AC. SRCC presents at earlier age, with advanced tumor grade and stage at diagnosis. The metastatic behavior of SRCC is different than AC with a higher incidence of brain and bone metastases at diagnosis.
Urticarial vasculitis as an initial manifestation of colonic carcinoma: a case report and review of the literature