Primary colorectal signet ring cell carcinoma is a rare but distinctive malignancy of the large bowel. More than 96% of signet ring cell carcinomas arise in the stomach, with the rest arising from other primary organs. Therefore, a secondary infiltration or metastasis to the colon and rectum must be excluded before a definite diagnosis of primary colorectal signet ring cell carcinoma can be established.
This research, performed by a team led by Professor Hsien Lin Sim, is described in an article to be published on April 7, 2008 in the World Journal of Gastroenterology.
The patient presented with a clinical picture of primary rectal signet ring cell carcinoma with peritoneal dissemination and gastric secondaries. Immunohistochemical studies were attempted to differentiate between a gastric and colonic primary. Both specimens were positive for cytokeratins 7 (CK 7) and cytokeratins 20 (CK 20).
Immunostaining profiles for CK 7 and CK 20 have been used to characterize and differentiate signet ring cell carcinoma of breast, stomach and colon. It has been suggested a colon primary is supported if the neoplastic cells have CK 7(-)/CK 20(+) staining pattern, and a gastric primary is supported if they have a CK 7(+)/CK 20(-) staining pattern.
To date, a primary rectal signet ring cell carcinoma with peritoneal dissemination and gastric secondaries had not been described. This case certainly illustrated the aggressive nature of signet ring cell carcinoma. Dr Sim and her colleagues from the Department of Surgery, Alexandra Hospital, proposed that immunohistochemistry may not be 100% accurate in predicting the primary source of signet ring cell carcinoma.
Reference: Sim HL, Tan KY, Poon PL, Cheng A. Primary rectal signet ring cell carcinoma with peritoneal dissemination and gastric secondaries. World J Gastroenterol 2008;14(13):2118-2120 http://www.wjgnet.com/1007-9327/14/2118.asp
Correspondence to: Hsien Lin Sim, Department of Surgery, Alexandra Hospital, 378 Alexandra Road, 159964, Singapore. selina_sim@hotmail.com Telephone: +65-98636841 Fax: +65-64041478
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World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H pylori infection. It provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health ISI JCR 2003-2000 IF: 3.318, 2.532, 1.445 and 0.993. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. The WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the title China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.
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World Journal of Gastroenterology