Midwestern University, Mountain Vista Medical Center Mesa, AZ, United States
Preeyanka Sundar, MD, MPH1, Suma Harsha Kosuru, MBBS2, Matthew Hillam, DO1, Tushar Gohel, MD, CNSC3 1Midwestern University, Mountain Vista Medical Center, Mesa, AZ; 2Mountain Vista Medical Center, Aldie, VA; 3Reddy GI Associates, Gilbert, AZ; Midwestern University, Mountain Vista Medical Center, Mesa, AZ
Introduction: Signet ring cell carcinoma (SRCC) is a rare variant of pancreatic adenocarcinoma found in < 1% of pancreatic cancers with only a few cases reported in the literature. Here we delineate insiduous onset of synchornous pancreatic and gastric SRCC.
Case Description/Methods: A 52-year-old female never-smoker, with no family history of cancer syndromes or gastrointestinal cancers, presented epigastric abdominal pain of three-month duration. CT showed a 2.3x2cm pancreas lesion in body of pancreas and gastric body 3.8x2cm polypoid soft tissue lesion with ulceration. EGD was unremarkable. EUS with fine needle biopsy (FNA) of the pancreatic neck were negative for malignancy, only rare bland appearing mucinous epithelium in a background of inflammation and fat necrosis. EUS with FNA two months later upon hospital admission for worsening abdominal pain were positive for synchronous gastric and pancreatic adenocarcinoma with signet ring features. Palliative chemotherapy with FOLFIRINOX was pursued.
Discussion: More than 96% of all SRCC have intragastric origins. Characteristic is the large intra-cytoplasmic mucin vacuoles that expand in the malignant cells. The nucleus of the cell subsequently is pushed to periphery, creating a ‘signet ring’ configuration. When ≥50% of the tumor is composed of cells of this type, it is classified as a SRCC. EUS FNA has high diagnostic specificity, but limitations related to the specimen, and repeated biopsies can increase accuracy. SRCC has a poor prognosis, and early diagnosis is crucial.
Figure: A-B, Signet ring cells featured in pancreas, large intra-cytoplasmic mucin vacuoles that expand in the malignant cells. The nucleus of the cell subsequently is pushed to periphery, creating a ‘signet ring’ configuration.
Disclosures:
Preeyanka Sundar indicated no relevant financial relationships.
Suma Harsha Kosuru indicated no relevant financial relationships.
Matthew Hillam indicated no relevant financial relationships.
Tushar Gohel indicated no relevant financial relationships.
Preeyanka Sundar, MD, MPH1, Suma Harsha Kosuru, MBBS2, Matthew Hillam, DO1, Tushar Gohel, MD, CNSC3. P1042 - Never Where You Want It: A Rare Variant of Signet Ring Cell Carcinoma Synchronously in Stomach and Pancreas, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
