Prostate - Signet ring carcinoma

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Prostate

Other carcinomas

Signet ring carcinoma

Reviewers: Komal Arora, M.D., (see Reviewers page)
Revised: 16 November 2012, last major update March 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

General
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● <50 cases identified in English language literature (Mayo Clin Proc 2010;85:1130)
● Highly malignant

Case reports
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● 60 year old man (Case of Week #258)

Treatment
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● Similar to traditional adenocarcinoma - hormonal therapy, radiation, surgery

Micro description
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● Solid, acinar, single-line patterns
● Primarily composed of tumor cells with signet ring pattern (at least 25%) due to intracellular accumulation of mucin compressing the nucleus into a crescent shape

Micro images
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Various images

Positive stains
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● PSA (variable in some studies), AE1/AE3, CAM 5.2, Ki-67 (mean 8%), PAS-diastase, mucicarmine (50%), Alcian blue (60%), α-methylacyl coenzyme A racemase (P504S) and cytokeratin 5/6

Negative stains
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● Bcl2 (rare cells positive), CEA (80%)

Electron microscopy
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● Intracytoplasmic lumina lined by microvilli

Differential diagnosis
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● Artifactual changes in lymphocytes post TURP: no classic adenocarcinoma, CD45+, negative for mucin, PSA, PAP (Am J Surg Pathol 1986;10:795)
● Benign signet ring change: no classic adenocarcinoma, negative for mucin, PSA, PAP (Am J Surg Pathol 2002;26:1066)
● GI primary: much more common; no typical prostatic adenocarcinoma, positive GI workup (abdominal CT, colonoscopy, esophagogastroduodenoscopy); PSA-, PAP-
● Mucinous carcinoma with signet ring cells: >25% of tumor is extracellular mucin and <25% of tumor cells feature signet rings

References
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● Arch Pathol Lab Med 1992;116:99, Am J Surg Pathol 1988;12:453, Mod Pathol 1998;11:552

End of Prostate > Other carcinomas > Signet ring carcinoma

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