DOCSLIB.ORG

The Clinicopathological Characteristics and Genetic Alterations of Signet-Ring Cell Carcinoma in Gastric Cancer

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Clinicopathological Characteristics and Genetic Alterations of Signet-Ring Cell Carcinoma in Gastric Cancer cancers Article The Clinicopathological Characteristics and Genetic Alterations of Signet-Ring Cell Carcinoma in Gastric Cancer Kuo-Hung Huang 1,2 , Ming-Huang Chen 3, Wen-Liang Fang 1,2,*, Chien-Hsing Lin 4, Yee Chao 2,3 , Su-Shun Lo 2,5, Anna Fen-Yau Li 2,6, Chew-Wun Wu 1,2 and Yi-Ming Shyr 1,2 1 Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 11217, Taiwan; [email protected] (K.-H.H.); [email protected] (C.-W.W.); [email protected] (Y.-M.S.) 2 School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan; [email protected] (Y.C.); [email protected] (S.-S.L.); [email protected] (A.F.-Y.L.) 3 Center of Immuno-Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei 11217, Taiwan; [email protected] 4 Genome Research Center, National Yang-Ming University, Taipei 11221, Taiwan; [email protected] 5 Department of Surgery, National Yang-Ming University Hospital, Yilan 26058, Taiwan 6 Department of Pathology, Taipei Veterans General Hospital, Taipei 11217, Taiwan * Correspondence: [email protected] Received: 12 July 2020; Accepted: 12 August 2020; Published: 17 August 2020 Abstract: Signet-ring cell carcinoma (SRC) in advanced gastric cancer (GC) is often associated with more invasiveness and a worse prognosis than other cell types. The genetic alterations associated with gastric carcinogenesis in SRC are still unclear. In this study, 441 GC patients receiving curative surgery for GC between 2005 and 2013 were enrolled. The clinicopathological characteristics and genetic alterations of GC patients with and without SRC were compared. Among the 441 GC patients, 181 had SRC. For early GC, patients with SRC had more tumors located in the middle and lower stomach, more infiltrating tumors and better overall survival (OS) rates than those without SRC. For advanced GC, patients with SRC had more scirrhous type tumors, more PIK3CA amplifications, fewer microsatellite instability-high (MSI-H) tumors, more peritoneal recurrences and worse 5-year OS rates than those without SRC. For advanced GC with SRC, patients with peritoneal recurrence tended to have PD-L1 expression. For advanced GC without SRC, patients with liver metastasis tended to have PD-L1 expression, PI3K/AKT pathway mutations, TP53 mutations and MSI-H tumors. For advanced GC, PD-L1 expression was associated with peritoneal recurrence in SRC tumors, while non-SRC tumors with liver metastasis were likely to have PI3K/AKT pathway mutations, TP53 mutations and PD-L1 expression; immunotherapy and targeted therapy may be beneficial for these patients. Keywords: signet-ring cell; genetic alterations; advanced GC; PD-L1; recurrence pattern; prognostic factor review; meta-analysis 1. Introduction Gastric cancer (GC) is the sixth most common cancer and the second most common cause of cancer death worldwide [1]. Signet-ring cell carcinoma (SRC) is characterized by malignant tumor cells with prominent mucin in the cytoplasm and eccentric crescent-shaped nuclei. According to the classification of the World Health Organization (WHO) [2], SRC is defined as being present in more than 50% of GC tumors. Compared to other types of GC, SRC tends to occur predominantly in those who are younger and female and has a higher frequency of lymph node metastasis and a poor prognosis [3]. Cancers 2020, 12, 2318; doi:10.3390/cancers12082318 www.mdpi.com/journal/cancers Cancers 2020, 12, 2318 2 of 17 A meta-analysis study [4] demonstrated that for early GC (T1), SRC was associated with a better prognosis than non-SRC, while for advanced GC (T2-T4), SRC had a worse prognosis than non-SRC, which was similar to the findings of our previous report [5]. We hypothesize that the genetic alterations between SRC and non-SRC in early and advanced GC may be different, and it deserves investigating whether these genetic alterations are associated with patient survival. To date, the molecular difference between SRC and non-SRC in GC is still unclear; further investigation of the genetic alterations may provide useful information to explain the phenomenon. The aim of the present study was to compare the clinicopathological characteristics and genetic alterations between patients with and without SRC in early and advanced GC. In addition, we investigated whether genetic alterations are associated with patient prognosis in SRC and non-SRC GC. 2. Results 2.1. Clinicopathological Features Among the 441 patients, 181 had SRC. Among the 260 non-SRC patients, there were 5 papillary adenocarcinomas (1.9%), 240 tubular adenocarcinomas (92.3%) and 15 mucinous adenocarcinomas (5.8%), and no patient was diagnosed with undifferentiated adenocarcinoma. We compared the clinicopathological characteristics between patients with and without SRC (Table1). Univariate analysis showed that patients with SRC were younger and more likely to be female and had more tumors located in the middle stomach, more scirrhous stromal reaction, a more infiltrating type, fewer microsatellite instability-high (MSI-H) tumors, more PIK3CA amplifications, less PD-L1 expression, fewer PI3K/AKT pathway mutations and more advanced Tumor, Node, Metastasis (TNM) stages than those without SRC. Multiple testing correction logistic regression demonstrated that patients with SRC were more likely to be female and had more scirrhous stromal reaction, a more infiltrating type, fewer MSI-H tumors and more PIK3CA amplifications than those without SRC. With regard to early GC (Table2), univariate analysis showed that patients with SRC were more likely to be female and had more tumors located in the middle stomach, a poorer differentiation and a more infiltrating type than those without SRC. Multiple testing correction logistic regression demonstrated that patients with SRC had more tumors located in the middle stomach and a more infiltrating type than those without SRC. With regard to advanced GC (Table3), patients with SRC were younger and more likely to be female and had more tumors located in the middle stomach, more scirrhous stromal reactions, a more infiltrating type, fewer MSI-H tumors, more PIK3CA amplifications, less PD-L1 expression, fewer ARID1A mutations and more advanced TNM stages than those without SRC. Multiple testing correction logistic regression demonstrated that patients with SRC had more scirrhous stromal reactions, fewer MSI-H tumors and more PIK3CA amplifications than those without SRC. With regard to the combined positive score (CPS) of PD-L1 expression, there was no significant difference in CPS between patients with SRC and without SRC (0.49 1.48 vs. 0.92 2.56, p = 0.166), ± ± which was observed in both early GC (0.40 1.13 vs. 0.43 1.30, p = 0.915) and advanced GC ± ± (0.54 1.65 vs. 1.09 2.87, p = 0.199). ± ± Cancers 2020, 12, 2318 3 of 17 Table1. Clinical profile of gastric cancer (GC) patients with and without signet-ring cell carcinoma (SRC). Multiple Testing Correction Logistic Univariate Analysis Regression Variables Non-SRC SRC Confidence n = 260 n = 181 p-Value Odds Ratio p-Value Interval n (%) n (%) Age <0.001 0.099 <65 years 82 (31.5) 96 (53.0) 1.00 65 years 178 (68.5) 85 (47.0) 0.65 0.394–1.083 ≥ Gender <0.001 0.013 Male 203 (78.1) 108 (59.7) 1.00 Female 57 (21.9) 73 (40.3) 2.02 1.163–3.493 Tumor size 0.165 <5cm 109 (41.9) 64 (35.4) 5 cm 151 (58.1) 117 (64.6) ≥ Tumor location <0.001 0.311 Upper stomach 55 (21.2) 25 (13.8) 1.00 Middle stomach 70 (26.9) 76 (42.0) 2.40 1.187–4.843 Lower stomach 133 (51.2) 71 (39.2) 1.07 0.543–2.097 Whole stomach 4.36 0.681–27.877 Stromal reaction type <0.001 <0.001 Medullary 47 (18.1) 18 (9.9) 1.00 Intermediate 181 (69.6) 57 (31.5) 0.54 0.237–1.216 Scirrhous 32 (12.3) 106 (58.6) 4.28 1.748–10.500 Ming’s classification <0.001 <0.001 Expanding 99 (38.1) 14 (7.7) 1.00 Infiltrating 161 (61.9) 167 (92.3) 3.96 1.938–8.105 Extent of lymphadenectomy 0.751 Limited (D1+) 57 (21.9) 42 (23.2) Extended (D2) 203 (78.1) 139 (76.8) Lymphovascular invasion 187 (71.9) 124 (68.5) 0.439 Lymphoid stroma 38 (14.6) 25 (13.8) 0.813 MSI status 0.001 0.008 MSI-L/S 229 (88.1) 175 (96.7) 1.00 MSI-H 31 (11.9) 6 (3.3) 0.23 0.076–0.684 HP infection 90 (34.6) 67 (37.0) 0.604 PIK3CA amplification 106 (40.8) 100 (55.2) 0.003 1.71 1.025–2.855 0.040 PD-L1 expression 68 (26.2) 28 (15.5) 0.007 0.68 0.352–1.299 0.240 Genetic mutation PI3K/AKT pathway 49 (18.9) 21 (11.6) 0.039 0.82 0.389–1.708 0.589 ARID1A 37 (14.2) 16 (8.8) 0.087 TP53 32 (12.3) 30 (16.6) 0.205 KRAS 9 (3.5) 1 (0.6) BRAF 3 (1.2) 0 Pathologic TNM Stage 0.022 0.774 I 60 (23.1) 28 (15.5) 1.00 II 80 (30.8) 46 (25.4) 1.13 0.516–2.456 III 120 (46.2) 107 (59.1) 1.29 0.607–2.741 GC—gastric cancer; SRC—signet-ring cell; MSI—microsatellite instability; MSI-H—microsatellite instability-high; MSI-L/S—microsatellite instability-low/stable; HP—Helicobacter pylori; EBV—Epstein–Barr virus; bold—statistically significant. Cancers 2020, 12, 2318 4 of 17 Table 2. Clinical profile in early GC patients with and without SRC.
Load more

Recommended publications
  • Primary Signet Ring Cell/Histiocytoid Carcinoma of the Eyelid: Somatic Mutations in CDH1 and Other Clinically Actionable Mutations Imply Early Use of Targeted Agents
    Case Report Primary Signet Ring Cell/Histiocytoid Carcinoma of the Eyelid: Somatic Mutations in CDH1 and Other Clinically Actionable Mutations Imply Early Use of Targeted Agents Lei-Chi Wang 1,2 , Tai-Chi Lin 3,4, Yi-Chen Yeh 1,5, Hsiang-Ling Ho 1,6,*, Chieh-Chih Tsai 3,4 and Teh-Ying Chou 1,2,6,7,* 1 Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; [email protected] (L.-C.W.); [email protected] (Y.-C.Y.) 2 Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan 3 Department of Ophthalmology, Taipei Veterans General Hospital, Taipei 11217 Taiwan; [email protected] (T.-C.L.); [email protected] (C.-C.T.) 4 School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan 5 Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan 6 Department of Biotechnology and Laboratory Science in Medicine, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan 7 Cancer Progression Research Center, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan * Correspondence: [email protected] (H.-L.H.); [email protected] (T.-Y.C.) Received: 12 January 2021; Accepted: 12 February 2021; Published: 16 February 2021 Abstract: Primary signet ring cell/histiocytoid carcinoma of the eyelid is a rare ocular malignancy and its diagnosis is often delayed. This neoplasm presents as an insidious, diffusely infiltrative mass in the periocular area that later infiltrates the orbit. An exenteration is usually indicated; however, nearly one-third of patients develop local recurrence or metastasis.
    [Show full text]
  • Signet Ring Cells and Efficacy of First-Line Chemotherapy in Advanced Gastric Or Oesogastric Junction Adenocarcinoma
    ANTICANCER RESEARCH 36 : 5543-5550 (2016) doi:10.21873/anticanres.11138 Signet Ring Cells and Efficacy of First-line Chemotherapy in Advanced Gastric or Oesogastric Junction Adenocarcinoma NATHALIE LEMOINE 1, ANTOINE ADENIS 2, OLIVIER BOUCHE 3, ALAIN DUHAMEL 4, ALEXANDRA HEURGUE 3, EMMANUELLE LETEURTRE 5, ERIC AMELA 2, JULIA SALLERON 4 and MOHAMED HEBBAR 1 1Department of Medical Oncology, University Hospital, Lille, France; 2Department of Digestive Oncology, Oscar Lambret Centre, Lille, France; 3Department of Digestive Oncology, University Hospital, Reims, France; 4Department of Biostatistics, EA2694, University Lille Nord de France, University Hospital, Lille, France; 5Department of Pathology, University Lille Nord de France, University Hospital, Lille, France Abstract. Aim: To evaluate the efficacy of first-line or metastatic disease at diagnostics (4). About 90% of gastric palliative chemotherapy, regarding the presence of signet tumours are adenocarcinomas that are divided into two types ring cells (SRC). Patients and Methods: Retrospective according to Lauren’s classification (5): intestinal and diffuse analysis of consecutive patients with locally advanced or types, with the latter including signet ring cell (SRC) metastatic gastric or oesogastric junction adenocarcinoma adenocarcinoma. SRC is a histological term used to describe who received first-line chemotherapy. Response to a form of mucin-secreting adenocarcinoma whose isolated chemotherapy, progression-free survival (PFS) and overall cells contain abundant cytoplasmic mucin, pushing the nucleus survival (OS) were compared between SRC and non-SRC to one side. The World Health Organization (WHO) (NSRC) groups. Results: Two hundred and three patients classification defines SRC when these mucin-rich isolated were treated, with 57 (28%) having SRC adenocarcinoma. cells represent more than 50% of the tumour cells (6).
    [Show full text]
  • Primary Classical Seminoma of Testis with Foci of Signet
    www.sciedu.ca/jbgc Journal of Biomedical Graphics and Computing, 2013, Vol. 3, No. 1 CASE REPORT Primary classical seminoma of testis with foci of signet-ring-cell morphology: A case report and review of the literature including ESMO guidelines on management of seminoma of testis Anthony Kodzo-Grey Venyo, Kweku Baiden-Amissah 1. Department of Urology, North Manchester General Hospital, Manchester, UK. 2. Royal Oldham Hospital Department of Histopathology Oldham, UK Correspondence: Anthony Kodzo-Grey Venyo. Address: North Manchester General Hospital Department of Urology, Manchester, United Kingdom. Email: [email protected]. Received: May 11, 2012 Accepted: June 5, 2012 Online Published: December 24, 2012 DOI: 10.5430/jbgc.v3n1p81 URL: http://dx.doi.org/10.5430/jbgc.v3n1p81 Abstract Background: Signet-ring-cell carcinoma is a rare variant of mucinous adenocarcinoma. Only about 3 cases of primary testicular cancer with signet-ring-cell morphology have been reported so far in the literature. There is lack of knowledge regarding the biological behaviour of this type of tumour affecting the testis. Seminoma of the testis is quite common and its biological behaviour is well known. When a classical seminoma of the testis is found to be contemporaneously associated with signet-ring-cell morphology, in view of the absence of any detailed literature on this rare clinical entity, the biological behaviour of such a tumour cannot be predicted. Objectives: To report a case of Classical Seminoma of the testis interspersed with seminoma cells with signet-ring morphology. To review the literature on signet-ring-cell carcinomas including carcinomas of testis with signet- ring- cell morphology.
    [Show full text]
  • Signet Ring Cell Carcinoma of the Gallbladder with Skin Metastasis: a Case Report Cilt Metastazı Yapan Safra Kesesinin Taşlı Yüzük Hücreli Karsinomu: Olgu Sunumu
    Olgu Sunumu/Case Report doi: 10.5146/tjpath.2010.01016 Signet Ring Cell Carcinoma of the Gallbladder with Skin Metastasis: A Case Report Cilt Metastazı Yapan safra Kesesinin Taşlı Yüzük hücreli Karsinomu: Olgu sunumu Erdal KaragÜlle1, Emin TÜrk1, Halil Kıyıcı2, Elif Karadelİ3, Gökhan Moray1 Departments of 1General Surgery, 2Pathology and 3Radiology, Başkent University, Faculty of Medicine, ANKARA, TURKEY ABSTRACT ÖZ The aim of this case report is to attract the attention of related Bu olgunun sunulmasının amacı nadir görülmesi sebebiyle ilgili clinicians to similar cases because of their rarity. We believe this case klinisyenlerin dikkatini çekmektir. Bu olgunun, literatürde ortaya and other similar cases in the literature could initiate studies that may çıkan diğer benzer vakalarla birlikte değerlendirilerek metastaz explain the pathways of metastasis. basamaklarını açıklayacak çalışmalara ön ayak olabileceği düşünülmüştür. A 50-year-old female patient underwent laparoscopic cholecystectomy because of symptomatic cholelithiasis. Postoperative pathologic 50 yaşındaki kadın hasta semptomatik kolelitiyazis nedeniyle examination of the specimen led to a diagnosis of signet ring carcinoma laparoskopik kolesistektomi ameliyatına alındı. Hastaya, ameliyat in the wall of gallbladder. After this incidental diagnosis, this patient sonrası patolojik incelemede insidental olarak saptanan safra underwent a second operation, which was a radical cholecystectomy. kesesinin taşlı yüzük hücreli karsinomu tanısı konuldu. Hasta 2. After pathological examination of the second operation material, we kez ameliyata alınarak radikal kolesistektomi yapıldı. Spesmenin decided to call this patient for periodic controls, as the tumor was patolojik incelemesi sonrası tümör evre I olduğu için takip kararı graded as stage I. A cutaneous lesion 33 months after the second verildi. Ameliyat sonrası 33.
    [Show full text]
  • Selective Targeting of Signet Ring Cell Adenocarcinomas T Abdullah Olgun
    Medical Hypotheses 133 (2019) 109380 Contents lists available at ScienceDirect Medical Hypotheses journal homepage: www.elsevier.com/locate/mehy Selective targeting of signet ring cell adenocarcinomas T Abdullah Olgun Istinye University, Faculty of Pharmacy, İstinye Üniversitesi Topkapı Kampüsü, (Maltepe Mah., Edirne Çırpıcı Yolu, No. 9 Zeytinburnu), İstanbul 34010, Turkey ARTICLE INFO ABSTRACT Keywords: Many epithelial tumors, especially signet-ring cell adenocarcinomas, produce huge amounts of mucin glyco- Signet-ring cell cancer proteins that fill cytoplasm and push nucleus to the periphery, giving a signet ring like structure to the cell. Mucin proteins Mucin proteins are very rich of l-threonine which is essential in humans. L-threonine content can reach up to 4-Fluoro L-threonine 35% of total amino acid composition of some mucin proteins. Therefore l-threonine can be the Achilles heel of Systemic radiotherapy signet ring cell adenocarcinomas which are one of the most malignant and agressive cancers. A modified bioisoster of l-threonine, 4-fluoro l-threonine (its fluorine can be radioactive or not), can be used to selectively kill signet ring cancer cells without harming normal cells or for diagnostic purposes. Background The hypothesis Some types of cancer cells produce large amounts of mucin protein. Mucin-rich cancer cells can be targeted using modified l-threonine These cells look like signet-rings under microscope due to the excess that can participate in protein synthesis. Radioactive l-threonine pro- mucin protein accumulated in their cytoplasm. Mucin pushes the nu- duced by substitution of its carbon, oxygen and hydrogen atoms with cleus to the periphery of the cell.
    [Show full text]
  • Should We Be Doing Cytoreductive Surgery with HIPEC for Signet Ring Cell Appendiceal Adenocarcinoma? a Study from the US HIPEC Collaborative
    Journal of Gastrointestinal Surgery https://doi.org/10.1007/s11605-019-04336-4 2019 SSAT PLENARY PRESENTATION Should We Be Doing Cytoreductive Surgery with HIPEC for Signet Ring Cell Appendiceal Adenocarcinoma? A Study from the US HIPEC Collaborative Nick C. Levinsky1 & Mackenzie C. Morris1 & Koffi Wima1 & Jeffrey J. Sussman1 & Syed A. Ahmad1 & Jordan M. Cloyd2 & Charles Kimbrough2 & Keith Fournier3 & Andrew Lee3 & Sean Dineen4 & Sophie Dessureault4 & Jula Veerapong5 & Joel M. Baumgartner5 & Callisia Clarke6 & Mohammad Y. Zaidi7 & Charles A. Staley7 & Shishir K. Maithel7 & Jennifer Leiting8 & Travis Grotz8 & Laura Lambert 9 & Ryan J. Hendrix9 & Sean Ronnekleiv-Kelly10 & Courtney Pokrzywa10 & Mustafa Raoof11 & Oliver S. Eng11 & Fabian M. Johnston12 & Jonathan Greer12 & Sameer H. Patel1 Received: 17 May 2019 /Accepted: 19 July 2019 # 2019 The Society for Surgery of the Alimentary Tract Abstract Background Appendiceal adenocarcinoma with signet ring cells (SCA) is associated with worse overall survival (OS), and it is unclear whether cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) should be pursued in this patient population. We assessed the prognostic implications of signet ring cells in patients with appendiceal adenocarcinoma and peritoneal carcinomatosis undergoing CRS-HIPEC. Methods The US HIPEC Collaborative, a 12-center, multi-institutional database of patients undergoing CRS-HIPEC, was reviewed for patients with SCA. Univariate and multivariate analyses were performed. Results Of 514 patients undergoing CRS-HIPEC for appendiceal adenocarcinoma, 125 (24%) had SCA. The SCA and non-SCA groups had similar baseline characteristics. SCA had worse OS compared with non-SCA (32.0 vs 91.4 months, p <0.001).In univariate analysis for only SCA cases, there was worse OS in patients with poorly differentiated tumors, positive lymph nodes, LVI, PCI > 20, or incomplete cytoreduction (CC-2/3).
    [Show full text]
  • Outcomes in Peritoneal Dissemination from Signet Ring Cell Carcinoma of the Appendix Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy
    Ann Surg Oncol (2019) 26:473–481 https://doi.org/10.1245/s10434-018-7007-3 ORIGINAL ARTICLE – GASTROINTESTINAL ONCOLOGY Outcomes in Peritoneal Dissemination from Signet Ring Cell Carcinoma of the Appendix Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Carlos Munoz-Zuluaga, MD1 , Armando Sardi, MD, FACS1 , Mary Caitlin King, BSc1, Carol Nieroda, MD1, Michelle Sittig, RN1 , Ryan MacDonald, PhD2, and Vadim Gushchin, MD FACS1 1The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD; 2Center for Clinical Excellence, Mercy Medical Center, Baltimore, MD ABSTRACT positive HGMCP-S (PFS: 3.4 vs 1.5 years, p = 0.03; OS: Background. Cytoreductive surgery and hyperthermic 5.6 vs 2.1 months, p = 0.021). intraperitoneal chemotherapy (CRS/HIPEC) is standard Conclusions. The aggressive histology of HGMCP-S is treatment for peritoneal dissemination from appendiceal associated with poor OS, has fewer abnormal TM, and is cancer (AC); however, its role in high-grade histopatho- more likely to have positive LN. However, CRS/HIPEC logic subtypes (high-grade mucinous carcinoma peritonei can achieve a 5-year survival of 25%, which may improve [HGMCP] and HGMCP with signet ring cells [HGMCP- to 51% with negative LN. S]) is controversial due to their aggressive behavior. This study analyzed clinical outcomes of high-grade AC after CRS/HIPEC. BACKGROUND Methods. A prospective database of CRS/HIPEC proce- dures for HGMCP performed from 1998–2017 was Appendiceal cancer (AC) is a rare malignancy, with reviewed. Perioperative variables and survival were only 1.2 cases per 100,000 people/year in the US.1 It typ- analyzed.
    [Show full text]
  • Original Article Metastatic Tumor of Male Genital System from Gastric Cancer: a Case Report and Review of Literature
    Int J Clin Exp Pathol 2017;10(8):8592-8598 www.ijcep.com /ISSN:1936-2625/IJCEP0058232 Original Article Metastatic tumor of male genital system from gastric cancer: a case report and review of literature Weigang Dai1,3*, Dawei Liu2*, Jidong Zuo1,3, Jinfu Tan1,3, Liang Wang1,3, Hui Wu1,3, Shirong Cai1,3, Yujie Yuan1,3 1Center of Gastrointestinal Surgery, 2Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P. R. China; 3Center of Gastric Cancer, Sun Yat-sen University, Guangzhou, P. R. China. *Equal con- tributors. Received May 25, 2017; Accepted July 26, 2017; Epub August 1, 2017; Published August 15, 2017 Abstract: Spermatic cord (SC) tumor metastatic from gastric cancer (GC) is rare. Here we report a case of left SC metastasis and meanwhile perform a literature review to characterize this rare disease. A 72-year-old male presented with a palpable painful mass in the left groin after one year and a half of remnant GC resection. SC metastasis of signet-ring cell adenocarcinoma was confirmed by trans-inguinal biopsy, and palliative chemoradio- therapy was initiated. The disease remained stable within follow-up 10 months. A total of 27 GC patients with male sex cord metastasis were reviewed according to a literature search from January 1955 to March 2016. In such a cohort, the mean age was 58.3 (range, 23-72) years. The average time interval between primary GC and genital metastasis was 43.2 (range, 2-120) months in 16 (59.3%) metachronous cases, while nine (33.3%) synchronous cases reported.
    [Show full text]
  • Current Concepts in Gastric Signet Ring Cell Carcinoma
    iMedPub Journals Annals of Clinical and Laboratory Research 2015 http://www.imedpub.com ISSN 2386-5180 Vol. 3 No. 3:29 Current Concepts in Gastric Signet Roshan Ara Ghoorun, Yi Liao, Chunyu Chen, Ring Cell Carcinoma Senmao Li, Feng Lin and Zuli Yang Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital of Sun Yat- Abstract sen University, Sun Yat-Sen University Background: Classified as “diffuse” by the Lauren’s classification gastric signet ring Guangzhou, P.R. China cell carcinoma is an adenocarcinoma with distinct features which separates it from other types of gastric cancer. Affecting mainly young female patients, gastric SRC is mainly due to the loss of E-cadherin and CDH1+. In this review we look into the Corresponding author: Zuli Yang pathogenesis, clinical features, diagnosis, treatment, and prognosis of gastric SRC. Materials and Methods: We reviewed the literature published until September [email protected] 2014 to identify studies of gastric SRC. Studies were identified by using the Medline and PubMed databases using the terms “gastric signet ring cell carcinoma”, “gastric Department of Gastrointestinal Surgery, signet ring cell cancer”, “signet ring cell cancer”, “signet ring cell carcinoma”. The Sixth Affiliated Hospital of Sun Yat- Researches on esophageal SRC, intestinal SRC were excluded in our study. sen University, Sun Yat-Sen University. 26 Results: A down-regulation of epithelial cadherin is essential for the initiation, Yuancun Erheng Road, Guangzhou 510655, and progression of gastric signet ring cell cancer cells. Once gastric cells lose P.R. China E-cadherin, they have an increase in motility due to epithelial-mesenchymal transition.
    [Show full text]
  • Primary Signet Ring Cell Carcinoma of the Urinary Bladder
    □ Case Report □ Primary Signet Ring Cell Carcinoma of the Urinary Bladder Sunghwan Jung1, Soojin Jung2, Kweonsik Min1,3, Jae-il Chung1, Korean Journal of Urology Sunghyup Choi1, Dongil Kang1,3 Vol. 50 No. 2: 188-191 February 2009 From the Departments of 1Urology and 2Pathology, Pusan Paik Hospital, Inje 3 University College of Medicine, Paik Institute for Clinical Research, Busan, Korea DOI: 10.4111/kju.2009.50.2.188 Primary signet ring cell carcinoma of the urinary bladder is a relatively rare histological variant of mucus-producing adenocarcinoma usually of Received：September 10, 2008 poor prognosis. We report two cases of primary bladder signet ring Accepted：September 19, 2008 carcinoma. The first patient underwent a radical cystectomy with ileal conduit (pT3bN1M0), radiotherapy, and chemotherapy (M-VAC regimen) Correspondence to: Dongil Kang and subsequently expired 37 months after surgery. The other was initially Department of Urology, Inje diagnosed with peritoneal metastasis from the primary bladder signet ring University Paik Hospital, 633-165, Gaegum-dong, cell carcinoma and was treated with partial cystectomy (pT3bNOM1). Busanjin-gu, Busan 614-735, Postoperative adjuvant therapy was not done because of patient‘s refusal. Korea (Korean J Urol 2009;50:188-191) TEL: 051-890-6384 FAX: 051-892-9887 E-mail: [email protected] Key Words: Carcinoma, signet ring cell; Urinary bladder Ⓒ The Korean Urological Association, 2009 Primary signet ring cell carcinoma of the urinary bladder is ring cell feature, with abundant mucin, confluent necrosis, and an extremely rare variant of adenocarcinoma that was first calcification. We performed a complete gastrointestinal endoscopic described by Saphir1 in 1955.
    [Show full text]
  • Signet-Ring Cell Or Mucinous Histology After Preoperative Chemoradiation and Survival in Patients with Esophageal Or Esophagogastric Junction Adenocarcinoma
    Vol. 11, 2229–2236, March 15, 2005 Clinical Cancer Research 2229 Signet-Ring Cell or Mucinous Histology after Preoperative Chemoradiation and Survival in Patients with Esophageal or Esophagogastric Junction Adenocarcinoma Lucian R. Chirieac,1 Stephen G. Swisher,2 Conclusions: Our study showed that patients with Arlene M. Correa,2 Jaffer A. Ajani,3 esophageal or EGJ adenocarcinoma who have signet-ring cell or mucinous histology benefited substantially from Ritsuko R. Komaki,4 Asif Rashid,1 preoperative chemoradiation and esophagectomy. Stanley R. Hamilton,1 and Tsung-Teh Wu1 Departments of 1Pathology, 2Thoracic and Cardiovascular Surgery, 3Gastrointestinal Medical Oncology and 4Division of Radiation Oncology, INTRODUCTION University of Texas M.D. Anderson Cancer Center, Houston, Texas Adenocarcinoma of the esophagus and esophagogastric junction (EGJ) is aggressive and has a poor prognosis (1–6). Esophagectomy has been the main approach for localized ABSTRACT esophageal carcinoma, although multimodality strategies, in- Purpose: The survival of patients with local-regional cluding preoperative chemoradiation followed by esophagec- adenocarcinoma of the esophagus or esophagogastric junction tomy, are accepted modalities of treatment (7). When surgical (EGJ) treated with preoperative chemoradiation is much resection is the primary therapy, the best predictor of overall better in patients with pathologic complete response than survival is pathologic stage (8–12). The outcome of patients those with residual tumor. Some adenocarcinomas have mixed after preoperative chemoradiation is much better if no residual patterns, including signet-ring cell and mucinous histology, carcinoma (stage 0) is found in the resected specimen, but the clinical significance of these subtypes is unknown. representing a pathologic complete response (13–21).
    [Show full text]
  • Endobronchial Metastasis of a Primary Transitional-Cell and Signet-Ring Cell Carcinoma of the Urinary Bladder
    Endobronchial Metastasis of a Primary Transitional-Cell and Signet-Ring Cell Carcinoma of the Urinary Bladder Nedim C¸ ekmen MD, Sonay Ac¸ikso¨z MD, Hacer Serdarog˘lu MD, O¨ zcan Erdemli MD, and Tansel Inan MD Endobronchial metastasis is generally a late finding of primary tumor or may be determined before the diagnosis of primary tumor. We present a rare case of primary transitional and signet-ring cell carcinoma of the urinary bladder that occurred with malignant pleural effusion and endobronchial metastasis. A 71-year-old man complained of dyspnea and hematuria. He was admitted to the intensive care unit (ICU) with a prediagnosis of acute respiratory failure. He had decreased respi- ratory sounds and fine rales bilaterally at the lung bases. Respiratory failure worsened, and he was placed on mechanical ventilation. Radiograph and computed tomogram revealed bilateral effusion and metastatic nodules in the lung parenchyma. Subsequent abdominal computed tomogram re- vealed a mass in the urinary bladder, and transurethral biopsy indicated transitional epithelial carcinoma (modified Bergvist grade IIIB, and World Health Organization/International Society of Urological Pathology higher-grade urothelial papillary carcinoma) and signet-ring cell carcinoma, with lymphovascular invasion, consistent with the pathology findings. Our treatment plan was radical cysto-prostatectomy, followed by chemotherapy and radiotherapy, but because of his very poor medical status, the operation was not performed. On the 5th ICU day he died from severe respiratory failure, despite intensive supportive therapy. This case highlights the need to rule out malignancies in other organs in patients admitted with severe respiratory symptoms. Key words: dyspnea; endobronchial metastasis; signet-ring cell bladder carsinoma.
    [Show full text]