Presentation of signet ring cell type at carcinoma ventriculi of the patient aged 20 years old

Afrim Avdaj, Ugur Gozalan, Nexhmi Hyseni, Hatim Baxhaku, Sherif Krasniqi, Shpejtim Rramanaj

American Hospital, Pristina, Kosovo.
Department of Pediatric Surgery, University Clinical Center, Prishtina, Kosovo;.
Division of Surgery, Regional Hospital “Primarius Daut Mustafa”, Prizren, Kosova.
Division of Surgery, Regional Hospital “Primarius Daut Mustafa”, Prizren, Kosova;.

DOI: 10.4236/crcm.2013.26096                

Abstract

Introduction: Diffuse variant of GC is composed of gastric-type mucous cells, which generally do not form glands, but rather permit the mucosa and wall as scattered individual cells or small clusters in an “infiltrative” growth pattern. These cells appear to arise from the middle layer of the mucosa, and the presence of intestinal metaplasia is not a prerequisite. In this version, mucin formation expands the malignant cells and pushes the nucleus to the periphery, creating a “signet ring” conformation. If the signetring cells are more than 50% of the tumor, the tumor is classified as signetring cell carcinoma [1]. This case is important for reporting because we encountered for the first time such a carcinoma type, due to the new age and its atypical presentation. Case Presentation: We report a case of a 20 years Albanian old patient with Signet Ring Cell Type of Gastric CA. The patient was brought at the urgency with severe abdominal pain, nausea and peritoneal irritation. Clinical examination has been made in emergency, where we conclude the signs of peritoneal irritation, from native Ro no signs of pneumoperitoneum, while laboratory tests found a slight anemia (erythrocytes 3.36, HCT 25, HGB 8.6). Two hours later we repeated the native RTG and there were present the signs of pneumoperitoneum. It was indicated urgent surgical in-tervention. Intraoperatively, we found Ulcer duodenal perforation and undertook the operation procedures by Roscoe Graham technique. Conclusions: At this age, it is rare, and it is difficult to detect in its early stages, because the signs and symptoms are often non-existent, non-specific, or mimic as an ulcer. The most common symptoms are early heartburn indigestion, abdominal pain or discomfort, vomiting, constipation, diarrhea or to feel of filling after a small meal, loss of appetite, weakness and fatigue. Less common symptoms are anemia and weight loss.

Keywords

Signet Ring Cell Type; Gastric Adenenocarcinoma; Diffuse Variant of GC

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Liu, C. and Crawford, J. (2004) Gastric carcinoma. In Robins and Cotran, Eds., Pathologic Basis of Disease, 7th Edition, Elsevier & Saunders, 822-827.
[2]	Golembeski, C.P. and Genta, R.M. (2013) Signet-ring cell carcinoma in gastric biopsies: Expecting the unexpected. Journal of Clinical Pathology, 66, 136-139. doi:10.1136/jclinpath-2012-201102
[3]	Ghoshal, U., Tripathi, S., Kumar, S., Mittal, B., Chourasia, D., Kumari, N., Krishnani, N. and Ghoshal, U.C. (2013) Genetic polymorphism of cytochrome P450 (CYP) 1A1, CYP1A2, and CYP2E1 genes modulate susceptibility to gastric cancer in patients with Helicobacter pylori infection. India Gastric Cancer.
[4]	Kim, S.H., Lee, S.T., Jeon, B.J., Kim, I.H., Kim, S.W., Lee, S.O., Kim, D.G. and Park, H.S. (2012) Signet-ring cell carcinoma mimicking gastric gastrointestinal stromal tumor confirmed by endoscopic ultrasound-guided trucut biopsy. Clinical Endoscopy, 45, 421-424. doi:10.5946/ce.2012.45.4.421
[5]	Huh, C.W., Jung da, H., Kim, J.H., Lee, Y.C., Kim, H., Kim, H., Yoon, S.O., Youn, Y.H., Park, H., Lee, S.I., Choi, S.H., Cheong, J.H. and Noh, S.H. (2013) Signet ring cell mixed histology may show more aggressive behavior than other histologies in early gastric cancer. Journal of Surgical Oncology, 107, 124-129. doi:10.1002/jso.23261
[6]	Fekete, G.L., Cotoi, O.S. and Fekete, J.E. (2012) Multiple nodular cutaneous metastases as the first clinical sign of signet ring cell gastric carcinoma: Case report. Acta Dermatovenerologica Croatica, 20, 34-37.
[7]	Siddavaram, N. (2012) Carcinoma of the stomach: A review of epidemiology, pathogenesis, molecular genetics and chemoprevention. World Journal of Gastrointestinal Oncology, 4, 156-169. doi:10.4251/wjgo.v4.i7.156
[8]	Yonezawa, S., Kitajima, S., Higashi, M., Osako, M., Horinouchi, M., Yokoyama, S., Kitamoto, S., Yamada, N., Tamura, Y., Shimizu, T., Tabata, M. and Goto, M. (2012) A novel anti-MUC1 antibody against the MUC1 cytoplasmic tail domain: Use in sensitive identification of poorly differentiated cells in adenocarcinoma of the stomach. Gastric Cancer, 15, 370-381. doi:10.1007/s10120-011-0125-2
[9]	Kaneda, A., Matsusaka, K., Aburatani, H. and Fukayama, M. (2012) Epstein-Barr virus infection as an epigenetic driver of tumorigenesis. Cancer Research, 72, 3445-3450. doi:10.1158/0008-5472.CAN-11-3919
[10]	Hallinan, J.T. and Venkatesh, S.K. (2013) Gastric carcinoma: Imaging diagnosis, staging and assessment of treatment response. Cancer Imaging, 13, 212-227. doi:10.1102/1470-7330.2013.0023
[11]	Osman, M.A., Bloom, G.S. and Tagoe, E.A. (2013) Helicobacter pylori-induced alteration of epithelial cell signaling and polarity as a possible mechanism of the etiology and disparity of gastric carcinoma. Cytoskeleton (Hoboken), 70, 349-359.
[12]	Fatih, S., Evin, B., Deniz, T., Mustafa, O., Fuat, D. and Suheyla, S. (2013) Clinicopathological features and outcomes of patients with gastric cancer: A single-center experience. World Journal of Gastroenterology, 19, 2154-2161. doi:10.3748/wjg.v19.i14.2154
[13]	Jiang, H., Zhang, H., Tian, L., Zhang, X. and Xue, Y. (2013) The difference in clinic-pathological features between signet ring cell carcinoma and gastric mucinous adenocarcinoma. Tumor Biology. doi:10.1007/s13277-013-0812-1
[14]	Yamada, S., Ritchim, P., Charkrabandhu, T. and Jongraksat, W. (2012) Combination 5-fluoruracil/cisplatinum versus 5-fluoruracil/leucovorin adjuvant chemotherapy efficacy for R0 gastric resection in locally invasive gastric cancer. Journal of the Medical Association of Thailand, 95, 1517-1523.
[15]	Liao, N., Chen, S., Ye, X., Zhong, J., Wu, N., Dong, S., Yang, B. and Liu, D. (2013) Antioxidant and anti-tumor activity of a polysaccharide from freshwater clam, Corbicula fluminea. Food & Function, 4, 539-548. doi:10.1039/c2fo30178d
[16]	Lee, I.S., Yook, J.H., Kim, T.H., Kim, H.S., Kim, K.C., Oh, S.T. and Kim, B.S. (2013) Prognostic factors and recurrence pattern in node-negative advanced gastric cancer. European Journal of Surgical Oncology, 39, 136-140. doi:10.1016/j.ejso.2012.10.008