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A Rare Case of Primary Gastric Signet Ring Cell Carcinoma: a Review of Guidelines for the Management of Gastric Cancer

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Abstract

Gastric carcinoma is the fifth most common and the third leading cause of cancer deaths worldwide. The incidence of diffuse-type gastric cancer, of which signet ring cell carcinoma is a subtype, is rising in the world. Due to non-specific gastritis-like symptoms, difficulty in assessing true tumor characteristics owing to its horizontal spread, and non-distinguishable endoscopic appearance from other gastric pathologies, the diagnosis of this subtype is challenging. We present a case of a 67-year-old woman with progressively worsening abdominal pain who came for an endoscopic ultrasound evaluation of an incidentally noted pancreatic cyst on a previous MRI. During endoscopy, a 1-cm gastric ulcer was noted along the lesser curvature of the gastric body. Biopsy confirmed a diagnosis of gastric signet ring cell carcinoma (SRCC) with CDX-2 and keratin positivity. The patient underwent total gastrectomy with Roux-en-Y reconstruction. Gross specimen revealed a diffuse SRCC invading the muscularis propria, along with lymphovascular and perineural invasion. In the context of our case, we discuss the morphological features of SRCC and the effectiveness of treatment options based on existing literature. Early accurate diagnosis and staging play an important role in determining treatment options as well as the clinical course of gastric SRCC.

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Authors and Affiliations

  1. Universidad de El Salvador, San Salvador, El Salvador

    Ronald Mauricio Blanco Montecino

  2. S M Kirov Military Medical Academy: Voenno-Medicinskaa Akademia Imeni S M Kirova Ministerstva Oborony Rossijskoj Federacii, Saint Petersburg, Russia

    Mikhail Sukhorosl

  3. Windsor University School of Medicine, Cayon, Saint Kitts and Nevis

    Mayi Ann Francis

  4. Andhra Medical College, Visakhapatnam, India

    Neeraj Kancherla

  5. Ebonyi State University, Isieke, Nigeria

    Ogbonnaya Akuma

  6. Caribbean Medical University, Curacao Campus, Willemstad, Curaçao

    Nkiruka Lauretta Nwangene

  7. Gandhi Medical College, 8-2-601/B/3 G2, Ashoka Silent Valley, Road Number 10, Banjara Hills, Hyderabad, TS, 500034, India

    Shreyas Nandyal

  8. Nalanda Medical College and Hospital, Patna, India

    Rohan Raj

  9. Chamberlain University, Chicago, IL, USA

    Chinaza Mercy Akuma

  10. Montefiore, Bronx, NY, USA

    Tamer Zahdeh

  11. Bangalore Medical College and Research Institute: Bangalore Medical College, Bengaluru, India

    Sharanya Kaushik

  12. University of Illinois Chicago, Chicago, IL, USA

    Adil M. Khan

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  1. Ronald Mauricio Blanco Montecino
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  2. Mikhail Sukhorosl
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Correspondence to Shreyas Nandyal.

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Montecino, R.M.B., Sukhorosl, M., Francis, M.A. et al. A Rare Case of Primary Gastric Signet Ring Cell Carcinoma: a Review of Guidelines for the Management of Gastric Cancer. Indian J Surg Oncol 15, 153–159 (2024). https://doi.org/10.1007/s13193-023-01852-3

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