Abstract
Signet ring cell carcinoma (SRCC) of the colorectum is very rare, comprising between <1% and 2.4% cases of colorectal cancer. Patients’ prognoses are poor. Several case reports had described as SRCC cases that are mucinous adenocarcinomas (MAC) with signet ring cells (SRC). In order to clearly delineate between MAC with SRC and SRCC, we performed a retrospective study at a national cancer referral center in which survival and clinicopathological characteristics between these two forms were compared and also SRCC were characterized by immunohistochemistry. We retrieved 32 cases that had been classified as either SRCC or MAC with SRC subtypes. It was noted that SRCC patients presented at older ages, demonstrated more advanced clinical stages, lymphovascular invasion, lymph node metastases, and higher carcinoembrionic levels than MAC with SRC patients. Regarding SRCC immunophenotype, 50% showed loss of CDX2 expression, 33% were CK20 negative, 41.7% were CK7 positive, and 25% were negative for both CK7 and CK20. For the MAC with SRC and SRCC groups, the median disease-specific survival (DSS) was 46.1 months (95% CI 36.9–55.25) and 22.4 months (95% CI 5.1–39.7 [p = 0.039]), respectively. The 3-year DSS was 80.7% and 28.6% (p = 0.017) for the MAC and SRCC patients, respectively. Univariate and multivariate analyses showed that SRCC was associated with decreased survival. SRCC had several clinicopathological features that permitted differentiation of MAC with SRC from SRCC patients, who had a poor DSS. A differential diagnosis for metastatic gastric cancer is only possible with a good clinicopathological correlation.
Similar content being viewed by others
References
Ferlay J, Shin H, Bray F, Forman D, Marhers C, Parkin D (2010) Estimates of worldwide burden of cancer in 2008: globocan 2008. Int J Cancer 127:2893–2917. doi:10.1002/ijc.25516
Chen JS, Hsieh PS, Chiang JM, Yeh CY, Tsai WS, Tang R, Changchien CR, Wu RC (2010) Clinical outcome of signet ring cell carcinoma and mucinous adenocarcinoma of the colon. Chang Gung Med J 33:51–57
Sultan I, Rodriguez-Galindo C, El-Taani H, Pastore G, Casanova M, Gallino G, Ferrari A (2010) Distinct features of colorectal cancer in children and adolescents: a population based study of 159 cases. Cancer 116:758–765. doi:10.1002/cncr.24777
Laufman H, Saphir O (1951) Primary linitis plastic type of carcinoma of the colon. Arch Surg 62:79–91
Hamilton SR, Bosman FT, Boffetta P et al (2009) Carcinoma of the colon and rectum. In: Bosman FT, Carneiro F, Hruban R, Theise ND (eds) WHO classification of Tumours of the digestive system. IARC, Lyon, pp 134–146
Psathakis D, Schiedeck TH, Krug F, Oevermann E, Kujath P, Bruch HP (1999) Ordinary colorectal adenocarcinoma vs. primary colorectal signet-ring cell carcinoma: study matched for age, gender, grade, and stage. Dis Colon Rectum 42:1618–1625
Ooi BS, Ho YH, Eu KW, Seow Choen F (2001) Primary colorectal signet-ring cell carcinoma in Singapore. ANZ J Surg 71:703–706
Lee WS, Chun HK, Lee WY, Yun SH, Cho YB, Yun HR, Park SH, Song SY (2007) Treatment outcomes in patients with signet ring cell carcinoma of the colorectum. Am J Surg 194:294–298
Tung SY, Wu CS, Chen PC (1996) Primary signet ring cell carcinoma of colorectum: an age- and sex-matched controlled study. Am J Gastroenterol 91:2195–2199
Messerini L, Palomba A, Zampi G (1995) Primary signet-ring cell carcinoma of the colon and rectum. Dis Colon Rectum 38:1189–1192
Makino T, Tsujinaka T, Mishima H, Ikenaga M, Sawamura T, Nakamori S, Fujitani K, Hirao M, Kashiwazaki M, Masuda N, Mano M (2006) Primary signet-ring cell carcinoma of the colon and rectum: report of eight cases and review of 154 Japanese cases. Hepato-Gastroenterology 53:845–849
Poston RN, Sidhu YS (1986) Diagnosing tumors on routine surgical sections by immunohistochemistry: use of cytokeratin, common leucocyte, and other markers. J Clin Pathol 39:514–523
Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A (eds) (2010) American joint committee on cancer cancer staging manual. Springer, Chicago
Kang SH, Chung WS, Hyun CL, Moon HS, Lee ES, Kim SH, Sung JK, Lee BS, Jeong HY (2012) A rare case of a signet ring cell carcinoma of the colon mimicking a juvenile polyp. Gut Liver 6:129–131. doi:10.5009/gnl.2012.6.1.129
Sun KK, Yang D, Gan M, Wu XY (2015) Descending colo-colonic intussusception secondary to signet ring cell carcinoma: a case report. Oncol Lett 9:1380–1382
Marone J, Patel S, Page M, Cheriyath P (2012) Signet cell carcinoma of the colon in a 17-year-old child. J Surg Case Rep 2012:3. doi:10.1093/jscr/2012.9.3
Kim JH, Park SJ, Park MI, Moon W, Kim SE (2013) Early-stage primary signet ring cell carcinoma of the colon. World J Gastroenterol 19:3895–3898. doi:10.3748/wjg.v19.i24.3895
Prabhu R, Kumar N, Krishna S, Shenoy R (2014) Primary colonic signet ring cell carcinoma in a young patient. BMJ Case Rep. doi:10.1136/bcr-2013-200587
Misawa R, Kobayashi M, Ito M, Kato M, Uchikawa Y, Takagi S (2008) Primary colonic signet ring cell carcinoma presenting carcinocythemia: an autopsy case. Case Rep Gastroenterol 2:301–307. doi:10.1159/000155146
Park PY, Goldin T, Chang J, Markman M, Kundranda MN (2015) Signet-ring cell carcinoma of the colon: a case report and review of the literature. Case Rep Oncol 8:466–471. doi:10.1159/000441772
Yang S, Liu G, Zheng S, Dong K, Ma Y, Xiao X (2015) Signet-ring cell carcinoma of the colon: a case report of a 9-year-old boy. Oncol Lett 10:1632–1634
Lee HS, Soh JS, Lee S (2015) Clinical features and prognosis of Resectable primary colorectal signet-ring cell carcinoma. Intest Res 13:332–338. doi:10.5217/ir.2015.13.4.332
Inamura K, Yamauchi M, Nishihara R, Kim SA, Mima K, Sukawa Y, Li T, Yasunari M, Zhang X, Wu K, Meyerhardt JA, Fuchs CS, Harris CC, Qian ZR, Ogino S (2015) Prognostic significance and molecular features of signet-ring cell and mucinous components in colorectal carcinoma. Ann Surg Oncol 22:1226–1235. doi:10.1245/s10434-014-4159-7
Chu PG, Weiss LM (2004) Immunohistochemical characterization of signet-ring cell carcinomas of the stomach, breast, and colon. Am J Clin Pathol 121:884–892
Goldstein NS, Long A, Kuan SF, Hart J (2000) Colon signet ring cell adenocarcinoma: immunohistochemical characterization and comparison with gastric and typical colon adenocarcinomas. Appl Immunohistochem Mol Morphol 8:183–188
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of Interest
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Rights and permissions
About this article
Cite this article
Pozos-Ochoa, L.I., Lino-Silva, L.S., León-Takahashi, A.M. et al. Prognosis of Signet Ring Cell Carcinoma of the Colon and Rectum and their Distinction of Mucinous Adenocarcinoma with Signet Ring Cells. A Comparative Study. Pathol. Oncol. Res. 24, 609–616 (2018). https://doi.org/10.1007/s12253-017-0283-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12253-017-0283-6