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Signet-Ring Cell Carcinoma of the Colon: A Case Report and Review of the Literature

BACKGROUND: Colorectal adenocarcinoma (CRC) is the third leading cause of death in the United States. One of the histologic subtypes of CRC is signet-ring cell carcinoma (SRCC), which has a distinct molecular and tumor biology from that of adenocarcinoma. Primary SRCC diagnosed at an early stage is...

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Autores principales: Park, Peter Y., Goldin, Teresa, Chang, John, Markman, Maurie, Kundranda, Madappa N.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: S. Karger AG 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4649730/
https://www.ncbi.nlm.nih.gov/pubmed/26600781
http://dx.doi.org/10.1159/000441772
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author Park, Peter Y.
Goldin, Teresa
Chang, John
Markman, Maurie
Kundranda, Madappa N.
author_facet Park, Peter Y.
Goldin, Teresa
Chang, John
Markman, Maurie
Kundranda, Madappa N.
author_sort Park, Peter Y.
collection PubMed
description BACKGROUND: Colorectal adenocarcinoma (CRC) is the third leading cause of death in the United States. One of the histologic subtypes of CRC is signet-ring cell carcinoma (SRCC), which has a distinct molecular and tumor biology from that of adenocarcinoma. Primary SRCC diagnosed at an early stage is very rare as most cases are detected at an advanced stage. Therefore, overall prognosis of SRCC is poor. CASE PRESENTATION: A 36-year-old female presented to her primary care physician with new-onset progressive right lower quadrant pain without any significant past medical or family history. Computed tomography scan of the abdomen and pelvis with contrast showed a 4.9 × 3.5 × 3.1 cm, lobulated, septated cystic mass arising from the cecum. The mass demonstrated wall enhancement and contained focal areas of coarse calcification. There was nodal involvement either locally or distally. The patient underwent right hemicolectomy, and pathology revealed a high-grade mucinous carcinoma with signet-ring cell variant invading through the muscularis propria and into the subserosal adipose tissue. The margins were negative for tumor, and no lymphovascular or perineural invasion was noted. None of the 14 resected pericolonic lymph nodes was positive for malignancy. Hence, she was staged as pT3, pN0, pMx-stage IIA. The appendix was not involved. Microsatellite instability testing showed the preservation of MLH1, PMS2, MSH2 and MSH6 proteins by IHC and PCR. Carcinoembryonic antigen level was within normal limits. Due to the patient's young age, aggressive histology and microsatellite-stable status, adjuvant fluropyrimidine (5-FU)-based therapy with the single agent capecitabine was initiated. The patient completed 6 months of adjuvant therapy and has been disease free for approximately 18 months. CONCLUSION: Primary SRCC of the cecum is a rare disease. Given the poor prognosis of these patients, early-stage disease with microsatellite-stable patients should be considered for adjuvant 5-FU-based therapy in an attempt to prevent recurrence.
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spelling pubmed-46497302015-11-23 Signet-Ring Cell Carcinoma of the Colon: A Case Report and Review of the Literature Park, Peter Y. Goldin, Teresa Chang, John Markman, Maurie Kundranda, Madappa N. Case Rep Oncol Published online: November, 2015 BACKGROUND: Colorectal adenocarcinoma (CRC) is the third leading cause of death in the United States. One of the histologic subtypes of CRC is signet-ring cell carcinoma (SRCC), which has a distinct molecular and tumor biology from that of adenocarcinoma. Primary SRCC diagnosed at an early stage is very rare as most cases are detected at an advanced stage. Therefore, overall prognosis of SRCC is poor. CASE PRESENTATION: A 36-year-old female presented to her primary care physician with new-onset progressive right lower quadrant pain without any significant past medical or family history. Computed tomography scan of the abdomen and pelvis with contrast showed a 4.9 × 3.5 × 3.1 cm, lobulated, septated cystic mass arising from the cecum. The mass demonstrated wall enhancement and contained focal areas of coarse calcification. There was nodal involvement either locally or distally. The patient underwent right hemicolectomy, and pathology revealed a high-grade mucinous carcinoma with signet-ring cell variant invading through the muscularis propria and into the subserosal adipose tissue. The margins were negative for tumor, and no lymphovascular or perineural invasion was noted. None of the 14 resected pericolonic lymph nodes was positive for malignancy. Hence, she was staged as pT3, pN0, pMx-stage IIA. The appendix was not involved. Microsatellite instability testing showed the preservation of MLH1, PMS2, MSH2 and MSH6 proteins by IHC and PCR. Carcinoembryonic antigen level was within normal limits. Due to the patient's young age, aggressive histology and microsatellite-stable status, adjuvant fluropyrimidine (5-FU)-based therapy with the single agent capecitabine was initiated. The patient completed 6 months of adjuvant therapy and has been disease free for approximately 18 months. CONCLUSION: Primary SRCC of the cecum is a rare disease. Given the poor prognosis of these patients, early-stage disease with microsatellite-stable patients should be considered for adjuvant 5-FU-based therapy in an attempt to prevent recurrence. S. Karger AG 2015-11-04 /pmc/articles/PMC4649730/ /pubmed/26600781 http://dx.doi.org/10.1159/000441772 Text en Copyright © 2015 by S. Karger AG, Basel http://creativecommons.org/licenses/by-nc/4.0/ This article is licensed under the Creative Commons Attribution-NonCommercial-4.0 International License (CC BY-NC) (http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes requires written permission.
spellingShingle Published online: November, 2015
Park, Peter Y.
Goldin, Teresa
Chang, John
Markman, Maurie
Kundranda, Madappa N.
Signet-Ring Cell Carcinoma of the Colon: A Case Report and Review of the Literature
title Signet-Ring Cell Carcinoma of the Colon: A Case Report and Review of the Literature
title_full Signet-Ring Cell Carcinoma of the Colon: A Case Report and Review of the Literature
title_fullStr Signet-Ring Cell Carcinoma of the Colon: A Case Report and Review of the Literature
title_full_unstemmed Signet-Ring Cell Carcinoma of the Colon: A Case Report and Review of the Literature
title_short Signet-Ring Cell Carcinoma of the Colon: A Case Report and Review of the Literature
title_sort signet-ring cell carcinoma of the colon: a case report and review of the literature
topic Published online: November, 2015
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4649730/
https://www.ncbi.nlm.nih.gov/pubmed/26600781
http://dx.doi.org/10.1159/000441772
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