Polyserositis revealing a signet ring cells gastric adenocarcinoma in a 27 years old male patient: A case report.

Gastric cancer remains one of the most common and deadly cancers worldwide, especially among old males. It is rare in the younger population (< 30 years old). We describe the case of a 27 years old male patient, presenting to the emergency department, with exsudative polyserositis, initially misdiagnosed and treated as a multifocal tuberculosis with no clinical improvement, later revealing a metastatic signet ring cells gastric adenocarcinoma.

Prognostic Significance of Signet Ring Cells in Gastric Cancer: The Higher Proportion, The Better Survival

BackgroundDue to the fact that the definition of gastric signet ring cell cancer (GSRC) was still controversial in the past decades, the prognosis affected by the proportion of signet ring cells within gastric cancer is uncertain. This study compared the clinicopathological features and prognosis of GSRC with the various proportions of signet ring cells.MethodsWe collected GSRC cases without metastasis who underwent curative (R0) resection between 2011 and 2018. Individuals who were in the low-proportion signet ring cell group (LSRC, &lt;50%) were matched to those who were in the high-proportion signet ring cell group (HSRC, &gt;50%) through propensity score matching (1:1). We used Cox proportional hazard regression to calculate the adjusted hazard ratios (HR) and 95% confidence intervals (CI) and explored interactions with gender and stage.ResultsWe had 1:1 matched individuals including 231 cases from the LSRC group and 231 cases from the HSRC group. Patients with HSRC had a significantly higher overall survival rate in the multivariable model (aHR = 0.56, 95%CI = 0.38, 0.84) compared with those with LSRC. The association of HSRC appeared to be more substantial among individuals at early stage and N0 stage (p-interaction &lt; 0.01).ConclusionsThis study confirms that GSRC with different proportions of signet ring cells could affect the survival of the patient. Further clinical studies should be developed in the future to provide an appropriate treatment strategy for GSRC.

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

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.

Mutations in Epigenetic Regulation Genes in Gastric Cancer

We have performed mutational profiling of 25 genes involved in epigenetic processes on 135 gastric cancer (GC) samples. In total, we identified 79 somatic mutations in 49/135 (36%) samples. The minority (n = 8) of mutations was identified in DNA methylation/demethylation genes, while the majority (n = 41), in histone modifier genes, among which mutations were most commonly found in KMT2D and KMT2C. Somatic mutations in KMT2D, KMT2C, ARID1A and CHD7 were mutually exclusive (p = 0.038). Mutations in ARID1A were associated with distant metastases (p = 0.03). The overall survival of patients in the group with metastases and in the group with tumors with signet ring cells was significantly reduced in the presence of mutations in epigenetic regulation genes (p = 0.036 and p = 0.041, respectively). Separately, somatic mutations in chromatin remodeling genes correlate with low survival rate of patients without distant metastasis (p = 0.045) and in the presence of signet ring cells (p = 0.0014). Our results suggest that mutations in epigenetic regulation genes may be valuable clinical markers and deserve further exploration in independent cohorts.

Gastric Adenocarcinoma With Signet Ring Cell: A Case Report of a 10-year-old Girl.

BackgroundGastric cancer is an extremely rare diagnosis in children and adolescents. Representing 5% of neoplasia’s in childhood. Gastric adenocarcinoma has a prevalence of below 0.05% of all childhood cancers. The objective of this clinical case report is to describe the clinical presentation of this rare cancer in children, including it as a differential diagnosis, and to look for genetic causes in order to perform genetic counseling. Case presentationA 10 year old girl, experience epigastric pain, vomit and weight loss in 2 months period. Previously treated with proton pump inhibitors (PPIs), however without improvement of symptoms. Physical exam revealed a slim appearance, and a firm, painful, palpable mass in the upper abdomen. Esophagogastroduodenoscopy revealed a mass with neoplastic appearance. Biopsy report described a poorly differentiated, diffuse pattern of signet ring cells, with positive immunohistochemical studies for the expression of MLH1, MSH6; PMS2. H. pylori was negative. Because this cancer presented during childhood, CDH1 gene was analyzed, however no findings of pathologic variants, point mutations, or duplications or deletions were found. The patient underwent hospice care and died 7 months after the initial diagnosis.Discussion/ConclusionThe majority of gastric tumors during childhood are benign. Gastric adenocarcinoma is a rare diagnosis in pediatric patients. Currently, there are few reports of children with this cancer. The rarity of gastric adenocarcinoma with signet ring cells in pediatric patients makes early diagnosis difficult to make with treatment options limited to the pediatric population due to rarity, and worse prognosis. Knowledge of this disease in children could help physicians to identify atypical clinical manifestations and warning signs in order to have this as a differential diagnosis. Currently, genetic studies are essential to guide the treatment plan and to make genetic counseling to the patient and family members.