Stomach
Carcinoma
Diffuse (poorly cohesive) type adenocarcinoma

Author: Elliot Weisenberg, M.D. (see Authors page)

Revised: 8 December 2016, last major update August 2012

Copyright: (c) 2003-2016, PathologyOutlines.com, Inc.

PubMed Search: diffuse type gastric adenocarcinoma
Cite this page: Diffuse (poorly cohesive) type adenocarcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/stomachdiffuse.html. Accessed December 11th, 2016.
Definition / General
  • Infiltrative growth of poorly differentiated discohesive malignant cells
  • Also called linitis plastica or signet ring adenocarcinoma (defined as predominantly or exclusively signet ring cells)
  • Mean age 48 years, M = F
  • More common in young; incidence unchanged over past 50 years (in contrast to reduction in intestinal type)
  • In U.S. in 2012, similar incidence as intestinal type
  • Appears to arise from different pathway than intestinal type (Am J Surg Pathol 1996;20(S1):S8)
  • No known risk factors except rarely hereditary diffuse gastric cancer (rare, autosomal dominant, related to mutations in E-cadherin gene (CDH1); may have early "in situ" component
Case Reports
  • 15 year old girl with gastric bleeding and multiple negative biopsies, no family history of cancer (signet ring cell gastric carcinoma, contributed by Dr. Oleksandr Grygoruk, see images below)
  • 35 year old woman exposed to Chernobyl explosion with upper abdominal pain (Case of the Week #275)
Gross Description
  • Linitis plastica: broad region of gastric wall or entire stomach is extensively infiltrated by malignancy, creating a thickened, rigid, leather bottle-like stomach; may cause pyloric obstruction
Gross Images

Images hosted on other servers:

Various images

Micro Description
  • Gastric-type mucus cells, usually do NOT form glands, infiltrate as individual cells or small clusters, may be transmural
  • Appear to arise from middle layer of mucosa
  • Intestinal metaplasia usually not present
  • Numerous signet ring cells seen (mucin pushes nucleus to periphery)
  • Submucosal fibrosis present, variable mucosal ulceration
  • Hypertrophic muscularis propria
  • May have marked desmoplastic and inflammatory reaction
Micro Images

Scroll to see all images.


Images hosted on PathOut server:


Case of the Week #275:

Left to right: H&E, CAM 5.2, CEA




Contributed by Dr. Oleksandr Grygoruk, Boris Hospital and Medical Center, Kiev (Ukraine):

15 year old girl: signet ring cell gastric carcinoma

15 year old girl: signet ring cell gastric carcinoma

15 year old girl: signet ring cell gastric carcinoma

15 year old girl: signet ring cell gastric carcinoma (Ki67)

15 year old girl: signet ring cell gastric carcinoma (PAS)




Images hosted on other servers:

Various images



Positive Stains
Negative Stains
Differential Diagnosis