Stomach
Carcinoma
Diffuse (poorly cohesive) type adenocarcinoma


Topic Completed: 1 August 2012

Revised: 22 August 2019

Copyright: 2003-2019, PathologyOutlines.com, Inc.

PubMed Search: diffuse type gastric adenocarcinoma

Elliot Weisenberg, M.D.
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Cite this page: Weisenberg E. Diffuse (poorly cohesive) type adenocarcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/stomachdiffuse.html. Accessed October 17th, 2019.
Definition / general
  • Infiltrative growth of poorly differentiated discohesive malignant cells
  • Also called linitis plastica or signet ring cell 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: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 )
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

Microscopic (histologic) 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
Microscopic (histologic) images

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
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