Signet ring cell carcinoma

Editorial Board Member: Catherine E. Hagen, M.D.
Editor-in-Chief: Debra L. Zynger, M.D.
Raul S. Gonzalez, M.D.

Last author update: 7 April 2021
Last staff update: 22 December 2021

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PubMed Search: Signet ring cell carcinoma[TI] colon[TIAB]

Raul S. Gonzalez, M.D.
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Cite this page: Gonzalez RS. Signet ring cell carcinoma. website. Accessed June 3rd, 2023.
Definition / general
  • Rare subtype of colorectal carcinoma (< 1%) officially recognized by the WHO (Ann Surg 2013;258:775)
  • > 50% of the tumor must have signet ring cell morphology to be classified as signet ring cell carcinoma
Essential features
  • Sometimes called linitis plastica but this typically refers to signet ring cell carcinoma of stomach
  • Can occur anywhere in colon, though rectum is a less common location
Clinical features
Prognostic factors
Case reports
Clinical images

Images hosted on other servers:

Pedunculated polyp

Stenotic rectal carcinoma

Discolored lesion

Gross description
  • May diffusely infiltrate colon wall, rather than forming an exophytic mass
  • Can rarely arise within a polyp
Microscopic (histologic) description
  • Proliferation of signet ring cells with intracellular mucin that displaces nucleus to side
  • Pools of extracellular mucin often present as well
  • Diffuse tissue infiltration less common than in gastric signet ring cell carcinoma
  • May rarely be in situ or confined to a polyp (J Surg Res 2010;163:250)
  • No gland formation in signet ring cell component, although it may be present elsewhere in the same lesion
Microscopic (histologic) images

Contributed by Raul S. Gonzalez, M.D.

Signet ring cell carcinoma

Negative stains
Molecular / cytogenetics description
Sample pathology report
  • Ascending colon, resection:
    • Signet ring cell carcinoma, poorly differentiated (see synoptic report)
Differential diagnosis
Board review style question #1

    Colorectal carcinomas with signet ring cells may display which of the following features?

  1. Concurrent BRAF and KRAS mutations
  2. Inability to breach the basement membrane
  3. Loss of CDX2 by immunohistochemistry
  4. Microsatellite instability
Board review style answer #1
D. Microsatellite instability

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Reference: Signet ring cell carcinoma
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