Srpski arhiv za celokupno lekarstvo 2024 Volume 152, Issue 3-4, Pages: 196-200
https://doi.org/10.2298/SARH230824014P
Full text (
789 KB)
Signet-ring colorectal carcinoma
Popović Dušan 
(University of Belgrade, Faculty of Medicine, Belgrade, Serbia + Dr Dragiša Mišović - Dedinje Clinical-Hospital Center, Department for Gastroenterology and Hepatology, Clinic for Internal Medicine, Belgrade, Serbia), pduschan@gmail.com
Panić Nataša (Dr Dragiša Mišović - Dedinje Clinical-Hospital Center, Department for Gastroenterology and Hepatology, Clinic for Internal Medicine, Belgrade, Serbia)
Knežević Alen (Dr Dragiša Mišović - Dedinje Clinical-Hospital Center, Department for Gastroenterology and Hepatology, Clinic for Internal Medicine, Belgrade, Serbia)
Milenković Zoran (Dr Dragiša Mišović - Dedinje Clinical-Hospital Center, Department for Gastroenterology and Hepatology, Clinic for Internal Medicine, Belgrade, Serbia)
Filipović Branka (University of Belgrade, Faculty of Medicine, Belgrade, Serbia + Dr Dragiša Mišović - Dedinje Clinical-Hospital Center, Department for Gastroenterology and Hepatology, Clinic for Internal Medicine, Belgrade, Serbia)
Introduction. Colorectal cancer is the third most common cancer worldwide. Signet-ring carcinoma is an extremely rare subtype of colorectal cancer, with frequency ranges 0.3–4.6%. The diagnosis of this type of cancer is based on pathohistological analysis. Case outline. A 58-year-old patient was admitted due to abdominal pain and abdominal swelling. The physical findings indicated abdomen above the level of the chest, soft, painfully sensitive in the left hemiabdomen, with positive clinical signs of ascites. Laboratory analyzes indicated positive inflammatory syndrome, elevation of D-dimer and CA-19-9. Ascites analysis showed the presence of malignant cells. Computed tomography revealed hepatomegaly, liver steatosis, as well as multiple secondary deposits in the liver, ascites, and peritoneal implants. Colonoscopy showed ulceration of the right colon, which was covered with fibrin. The pathohistological findings indicated poorly differentiated, invasive adenocarcinoma of the signet ring carcinoma type. The patient was treated with analgesics, diuretics, proton pump inhibitors, beta 2 blockers, angiotensin-converting enzyme inhibitors, low-molecular-weight heparin, antibiotics, and supportive therapy. The patient was discharged after 10 days of hospitalization. He was presented to the multidisciplinary team, which decided on further symptomatic therapy. Conclusion. Signet-ring colon cancer is a rare, aggressive tumor with a poor prognosis. Although it is most often localized in the stomach, it is necessary to think about the colorectal localization of this tumor in the differential diagnosis of patients with colonic complaints, especially if they have “alarm symptoms” and if they are younger.
Keywords: colorectal cancer, signet-ring carcinoma, peritoneal carcinomatosis, ascites, colonoscopy
Show references
Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer Statistics, 2021. CA Cancer J Clin. 2021;71(1):7-33. [DOI: 10.3322/caac.21654] [PMID: 33433946]
Santucci C, Carioli G, Bertuccio P, Malvezzi M, Pastorino U, Boffetta P, et al. Progress in cancer mortality, incidence, and survival: a global overview. Eur J Cancer Prev. 2020;29(5):367-81. [DOI: 10.1097/CEJ.0000000000000594] [PMID: 32740162]
Zhu L, Ling C, Xu T, Zhang J, Zhang Y, Liu Y, et al. Clinicopathological Features and Survival of Signet-Ring Cell Carcinoma and Mucinous Adenocarcinoma of Right Colon, Left Colon, and Rectum. Pathol Oncol Res. 2021;27:1609800. [DOI: 10.3389/pore.2021.1609800] [PMID: 34276258]
Fadel MG, Malietzis G, Constantinides V, Pellino G, Tekkis P, Kontovounisios C. Clinicopathological factors and survival outcomes of signet-ring cell and mucinous carcinoma versus adenocarcinoma of the colon and rectum: a systematic review and meta-analysis. Discov Oncol. 2021;12(1):5. [DOI: 10.1007/s12672-021-00398-6] [PMID: 35201441]
Mauri G, Sartore-Bianchi A, Russo AG, Marsoni S, Bardelli A, Siena S. Early-onset colorectal cancer in young individuals. Mol Oncol. 2019;13(2):109-31. [DOI: 10.1002/1878-0261.12417] [PMID: 30520562]
Benesch MGK, Mathieson A. Epidemiology of Signet Ring Cell Adenocarcinomas. Cancers (Basel). 2020;12(6):1544. [DOI: 10.3390/cancers12061544] [PMID: 32545410]
Arifi S, Elmesbahi O, Amarti Riffi A. Primary signet ring cell carcinoma of the colon and rectum. Bull Cancer. 2015;102(10):880- 8. [DOI: 10.1016/j.bulcan.2015.07.005] [PMID: 26412710]
Enblad M, Egerszegi PP, Birgisson H, Sjoblom T, Glimelius B, Folkesson J. Signet Ring Cell Colorectal and Appendiceal Cancer: A Small Signet Ring Cell Component Is Also Associated with Poor Outcome. Cancers (Basel). 2023;15(9):2497. [DOI: 10.3390/cancers15092497] [PMID: 37173961]
Henry M, Delavari N, Webber J. Undiagnosed Case of Signet Ring Cell Colorectal Carcinoma: A Case Report and Review of the Literature. Clin Colorectal Cancer. 2020;19(3):e83-e86. [DOI: 10.1016/j.clcc.2020.04.005] [PMID: 32586730]
Laufman H, Saphir O. Primary linitisplastica type of carcinoma of the colon. AMA Arch Surg. 1951;62(1):79-91. [DOI: 10.1001/archsurg.1951.01250030082009] [PMID: 14789350]
An Y, Zhou J, Lin G, Wu H, Cong L, Li Y, et al. Clinicopathological and Molecular Characteristics of Colorectal Signet Ring Cell Carcinoma: A Review. Pathol Oncol Res. 2021;27:1609859. [DOI: 10.3389/pore.2021.1609859] [PMID: 34381313]
Somerset A, Edelman DA, Webber J. Signet-Ring Cell Colon Cancer in a Teenager: A Case Report. Cureus. 2021;13(1):e12632. [DOI: 10.7759/cureus.12632] [PMID: 33585120]
Willauer AN, Liu Y, Pereira AAL, Lam M, Morris JS, Raghav KPS, et al. Clinical and molecular characterization of early-onset colorectal cancer. Cancer. 2019;125(12):2002-10. [DOI: 10.1002/cncr.31994] [PMID: 30854646]
Yang S, Liu G, Zheng S, Dong K, Ma Y, Xiao X. Signet-ring cell carcinoma of the colon: A case report of a 9-year-old boy. Oncol Lett. 2015;10(3):1632-4. [DOI: 10.3892/ol.2015.3403] [PMID: 26622723]
Li H, Huang K, Wang H, Wang L, Yang M, Wang L, et al. Immature enteric ganglion cells were observed in a 13-year-old colon signet ring cell carcinoma patient: A case report and literature review. Medicine (Baltimore). 2017;96(25):e7036. [DOI: 10.1097/MD.0000000000007036] [PMID: 28640080]
Thibodeau R, Jafroodifar A, Bakrukov D, Alkukhun L, Mirchia K, Majmudar A, et al. Intussusception secondary to signet ring cell adenocarcinoma in adolescent. Radiol Case Rep. 2021;16(5):1198- 203. [DOI: 10.1016/j.radcr.2021.02.027] [PMID: 33815641]
Fu KI, Sano Y, Kato S, Saito H, Ochiai A, Fujimori T, et al. Primary signet-ring cell carcinoma of the colon at early stage: a case report and a review of the literature. World J Gastroenterol. 2006;12(21):3446-9. [DOI: 10.3748/wjg.v12.i21.3446] [PMID: 16733868]
Makino T, Tsujinaka T, Mishima H, Ikenaga M, Sawamura T, Nakamori S, et al. Primary signet-ring cell carcinoma of the colon and rectum: report of eight cases and review of 154 Japanese cases. Hepatogastroenterology. 2006;53(72):845-9. [PMID: 17153438]
Franko J, Le VH, Tee MC, Lin M, Sedinkin J, Raman S, et al. Signet ring cell carcinoma of the gastrointestinal tract: National trends on treatment effects and prognostic outcomes. Cancer Treat Res Commun. 2021;29:100475. [DOI: 10.1016/j.ctarc.2021.100475] [PMID: 34655861]
Sonoda H, Kawai K, Yamaguchi H, Murono K, Kaneko M, Nishikawa T, et al. Lymphogenous metastasis to the transverse colon that originated from signet-ring cell gastric cancer: A case report and review of the literature. Clin Res Hepatol Gastroenterol. 2017;41(6):e81-e86. [DOI: 10.1016/j.clinre.2017.04.002] [PMID: 28526245]
Popovic D, Zec S, Rankovic I, Glisic T, Milovanovic T. Upper and lower gastrointestinal endoscopy in patients with iron deficiency anemia. Srp Arh Celok Lek. 2020;148(1-2):31-6. [DOI: 10.2298/SARH190325088P]
Belli S, Aytac HO, Karagulle E, Yabanoglu H, Kayaselcuk F, Yildirim S. Outcomes of surgical treatment of primary signet ring cell carcinoma of the colon and rectum: 22 cases reviewed with literature. Int Surg. 2014;99(6):691-8. [DOI: 10.9738/INTSURG-D-14-00067.1] [PMID: 25437572]
Gaskin DA, Reid A, O’Shea M, Gaskin PS. A Rare Case of Signet Ring Cell Colon Cancer Presenting as Adult Colorectal Intussusception. Case Rep Pathol. 2022;2022:5271611. [DOI: 10.1155/2022/5271611] [PMID: 35178263]
Kepil N, Batur S, Goksel S. Immunohistochemical and genetic features of mucinous and signet-ring cell carcinomas of the stomach, colon and rectum: a comparative study. Int J Clin Exp Pathol. 2019;12(9):3483-91. [PMID: 31934194]
Giacchero A, Aste H, Baracchini P, Conio M, Fulcheri E, Lapertosa G, et al. Primary signet-ring carcinoma of the large bowel. Report of nine cases. Cancer. 1985;56(11):2723-6. [DOI: 10.1002/1097-0142(19851201)56:11<2723::aidcncr2820561137> 3.0.co;2-n] [PMID: 2996745]
Farraj FA, Sabbagh H, Aridi T, Fakhruddin N, Farhat F. Signet Ring Cell Carcinoma of the Colon in Young Adults: A Case Report and Literature Review. Case Rep Oncol Med. 2019;2019:3092674. [DOI: 10.1155/2019/3092674] [PMID: 31612089]
Khan M, Korphaisarn K, Saif A, Foo WC, Kopetz S. Early-Onset Signet-Ring Cell Adenocarcinoma of the Colon: A Case Report and Review of the Literature. Case Rep Oncol Med. 2017;2017:2832180. [DOI: 10.1155/2017/2832180] [PMID: 28326211]
Tamhankar AS, Ingle P, Engineer R, Bal M, Ostwal V, Saklani A. Signet ring colorectal carcinoma: Do we need to improve the treatment algorithm? World J Gastrointest Oncol. 2016;8(12):819-25. [DOI: 10.4251/wjgo.v8.i12.819] [PMID: 28035252]
Prabhu A, Brandl A, Wakama S, Sako S, Ishibashi H, Mizumoto A, et al. Retrospective Analysis of Patients with Signet Ring Subtype of Colorectal Cancer with Peritoneal Metastasis Treated with CRS & HIPEC. Cancers (Basel). 2020;12(9):2536. [DOI: 10.3390/cancers12092536] [PMID: 32906609]