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Colon tumor

Carcinoma

Signet ring carcinoma of colon


Reviewers: Charanjeet Singh, M.D. (see Reviewers page)
Revised: 25 February 2012, last major update January 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

General
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● Also known as linitis plastica type carcinoma
● 1% of colonic carcinoma
● May affect younger patients than classic colorectal carcinoma (Am J Gastroenterol 1996;91:2195)
● Metastases to lymph nodes, peritoneal surface (malignant ascites) and ovary; liver less commonly (ANZ J Surg 2001;71:703)
● Usually high stage / poor prognosis (Dis Colon Rectum 2005;48:1161, Dis Colon Rectum 1999;42:1176)
● Proximal signet ring cancers are a distinct subpopulation with a favorable oncologic outcome (Int J Colorectal Dis 2012;27:371)
● May originate from serrated polyps, which are typically flat and endoscopically inconspicuous, based on both being located in the right colon, BRAF mutation positive and microsatellite stable (Am J Surg Pathol 2009;33:1823)

Case reports
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● 30 year old woman with disease mimicking inflammatory bowel disease (Dig Liver Dis 2005;37:537)
● 38 year old woman with ulcerative colitis and incidental carcinoma (Hepatogastroenterology 1999;46:236)
● 45 year old man with multiple skin metastases (Kaohsiung J Med Sci 2002;18:359)
● 57 year old with metastases to stomach (Mod Pathol 1989;2:265)
● 67 year old man with early stage disease (World J Gastroenterol 2006;121:3446)
● 72 year old woman with peritoneal dissemination (J Gastroenterol 2002;37:550)
● Foci within adenoma #1 (Arch Pathol Lab Med 1999;123:957), #2 (Arch Pathol Lab Med 2003;127:1509)

Gross description
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● Diffuse infiltration of bowel wall; rarely presents as polyp

Gross images
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Pedunculated polyp with long stalk

Micro description
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● Diffuse growth of signet ring cells (> 50% of tumor cells) with little glandular formation
● Cells have intracellular mucin that displaces nucleus to side
● Often linitis plastica appearance

Micro images
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Glands are distended with mucin


Rectal primary and gastric metastases


Various images

Positive stains
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● CK20, MUC2, villin, CDX2, MUC5AC (Am J Clin Pathol 2004;121:884, Appl Immunohistochem Mol Morphol 2000;8:183)
● Variable MUC1 and HepPar1

Negative stains
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● CK7, ER

Differential diagnosis
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● Metastatic gastric, breast or bladder carcinoma (Dig Liver Dis 2006;38:609)
● Metastatic mucinous carcinoma (Pathol Res Pract 2004;200:707)
● Benign signet ring change with pseudomembranous colitis (Pathol Res Pract 1998;194:197, Am J Surg Pathol 1996;20:599)

End of Colon tumor > Carcinoma > Signet ring carcinoma of colon


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