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Dawande PP, Akhtar F, Wankhade RS, Bankar NJ. Signet Ring Cell Carcinoma at the Ampulla of Vater: A Very Rare Diagnosis. Cureus 2022; 14:e30403. [DOI: 10.7759/cureus.30403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/17/2022] [Indexed: 11/07/2022] Open
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Kerawala AA, Jamal A, Saleem L. Signet ring cell cancer of Ampulla of Vater-first ever case reported in a teenager and a review of literature. Rare Tumors 2021; 13:20363613211007767. [PMID: 33912327 PMCID: PMC8047084 DOI: 10.1177/20363613211007767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/15/2021] [Indexed: 11/15/2022] Open
Abstract
Ampullary cancers are rare accounting for 0.2% of all gastrointestinal cancers. Signet ring is a rare variant of adenocarcinoma, characterized by having more than 50% of mucin secreting cells and clinically having a worse prognosis. We present the case of a teenage girl with this tumor, the youngest ever reported in medical literature. An 18 years old girl with no significant past medical history presented to our clinic with symptoms of upper abdominal pain and jaundice. Her upper GI endoscopy showed an ampullary lesion which was biopsied—diagnosing it as adenocarcinoma. She underwent a pancreato-duodenectomy (Whipple’s procedure) with Child’s reconstruction and a feeding jejunostomy. Her final histopathology report was documented as infiltrating adenocarcinoma of Signet Ring variety arising from the Ampulla of Vater. Being such a rare entity, there is a lack of randomized trials advising the optimum treatment for such cases. Till then anecdotal experiences will drive the optimum management of this rare disease.
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Affiliation(s)
| | - Abid Jamal
- Cancer Foundation Hospital, Karachi, Pakistan
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Schawkat K, Manning MA, Glickman JN, Mortele KJ. Pancreatic Ductal Adenocarcinoma and Its Variants: Pearls and Perils. Radiographics 2020; 40:1219-1239. [PMID: 32678699 DOI: 10.1148/rg.2020190184] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Pancreatic ductal adenocarcinoma (PDAC), an epithelial neoplasm derived from the pancreatic ductal tree, is the most common histologic type of pancreatic cancer and accounts for 85%-95% of all solid pancreatic tumors. As a highly lethal malignancy, it is the seventh leading cause of cancer death worldwide and is responsible for more than 300 000 deaths per year. PDAC is highly resistant to current therapies, affording patients a 5-year overall survival rate of only 7.2%. It is characterized histologically by its highly desmoplastic stroma embedding tubular and ductlike structures. On images, it typically manifests as a poorly defined hypoenhancing mass, causing ductal obstruction and vascular involvement. Little is known about the other histologic subtypes of PDAC, mainly because of their rarity and lack of specific patterns of disease manifestation. According to the World Health Organization, these variants include adenosquamous carcinoma, colloid carcinoma, hepatoid carcinoma, medullary carcinoma, signet ring cell carcinoma, undifferentiated carcinoma with osteoclast-like giant cells, and undifferentiated carcinoma. Depending on the subtype, they can confer a better or even worse prognosis than that of conventional PDAC. Thus, awareness of the existence and differentiation of these variants on the basis of imaging and histopathologic characteristics is crucial to guide clinical decision making for optimal treatment and patient management.
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Affiliation(s)
- Khoschy Schawkat
- From the Division of Abdominal Imaging, Department of Radiology (K.S., K.J.M.), and Department of Pathology (J.N.G.), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02115; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland (K.S.); and American Institute for Radiologic Pathology, Silver Spring, Md, and MedStar Georgetown University Hospital, Washington, DC (M.A.M.)
| | - Maria A Manning
- From the Division of Abdominal Imaging, Department of Radiology (K.S., K.J.M.), and Department of Pathology (J.N.G.), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02115; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland (K.S.); and American Institute for Radiologic Pathology, Silver Spring, Md, and MedStar Georgetown University Hospital, Washington, DC (M.A.M.)
| | - Jonathan N Glickman
- From the Division of Abdominal Imaging, Department of Radiology (K.S., K.J.M.), and Department of Pathology (J.N.G.), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02115; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland (K.S.); and American Institute for Radiologic Pathology, Silver Spring, Md, and MedStar Georgetown University Hospital, Washington, DC (M.A.M.)
| | - Koenraad J Mortele
- From the Division of Abdominal Imaging, Department of Radiology (K.S., K.J.M.), and Department of Pathology (J.N.G.), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02115; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland (K.S.); and American Institute for Radiologic Pathology, Silver Spring, Md, and MedStar Georgetown University Hospital, Washington, DC (M.A.M.)
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Ikeda C, Makino N, Matsuda A, Kakizaki Y, Ishizawa T, Kobayashi T, Sugahara S, Nishiduka M, Tsunoda M, Haga J, Tsunoda R, Ueno Y. Signet-ring cell carcinoma of the ampulla of Vater: a case diagnosed via repeated biopsies. Clin J Gastroenterol 2020; 13:607-614. [PMID: 31981088 PMCID: PMC7395027 DOI: 10.1007/s12328-020-01097-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/17/2020] [Indexed: 02/06/2023]
Abstract
Signet-ring cell carcinoma of the ampulla of Vater is a rare tumor. A 74-year-old woman presented with epigastric pain and was diagnosed with cholangitis. Her liver enzyme levels were elevated. Computed tomography showed an enhanced area in the periampullary region and marked common bile duct dilatation. On endoscopic retrograde cholangiopancreatography (ERCP), the ampulla exhibited a normal appearance without ulcer or mass. Histological biopsy confirmed the absence of malignancy. During follow-up, the patient again presented with acute cholangitis multiple times and underwent ERCP each time. The ampulla had the appearance of a reddish and erosive mucosa. Although biopsy was repeated, histological examination did not show any malignancy. After a total of 13 biopsies, the patient was diagnosed with ampullary carcinoma of non-exposed protruded type following the third ERC-guided biopsy. Careful follow-up and frequent endoscopic biopsies are important in cases of papillary carcinoma of non-exposed protruded type with normal ampullary mucosa on initial endoscopy because this condition is challenging to diagnose with a single biopsy.
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Affiliation(s)
- Chisaki Ikeda
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, 2-2-2 Iidanishi, Yamagata, Yamagata, 990-8595, Japan.
| | - Naohiko Makino
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, 2-2-2 Iidanishi, Yamagata, Yamagata, 990-8595, Japan
| | - Akiko Matsuda
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, 2-2-2 Iidanishi, Yamagata, Yamagata, 990-8595, Japan
| | - Yasuharu Kakizaki
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, 2-2-2 Iidanishi, Yamagata, Yamagata, 990-8595, Japan
| | - Tetsuya Ishizawa
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, 2-2-2 Iidanishi, Yamagata, Yamagata, 990-8595, Japan
| | - Toshikazu Kobayashi
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, 2-2-2 Iidanishi, Yamagata, Yamagata, 990-8595, Japan
| | - Shinpei Sugahara
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, 2-2-2 Iidanishi, Yamagata, Yamagata, 990-8595, Japan
| | - Mayo Nishiduka
- Department of Gastroenterology, Yonezawa City Hospital, 6-36 Aioichou, Yonezawa, Yamagata, 992-8502, Japan
| | - Michihiko Tsunoda
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, 2-2-2 Iidanishi, Yamagata, Yamagata, 990-8595, Japan
| | - Junichiroh Haga
- Department of Surgery, Yonezawa City Hospital, 6-36 Aioichou, Yonezawa, Yamagata, 992-8502, Japan
| | - Rikiya Tsunoda
- Department of Pathology, Yonezawa City Hospital, 6-36 Aioichou, Yonezawa, Yamagata, 992-8502, Japan
| | - Yoshiyuki Ueno
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, 2-2-2 Iidanishi, Yamagata, Yamagata, 990-8595, Japan
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Tuncel D, Basturk O, Bradley KT, Kim GE, Xue Y, Reid MD, Balci S, Erbarut I, Adsay V. Poorly Cohesive (Signet Ring Cell) Carcinoma of the Ampulla of Vater. Int J Surg Pathol 2019; 28:236-244. [PMID: 31612756 DOI: 10.1177/1066896919880968] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
In the ampulla of Vater, carcinomas with "diffuse-infiltrative"/"signet ring cell" morphology, designated as "poorly cohesive carcinoma" (PCC) in the WHO classification, are very rare and poorly characterized. Nine cases with a classical PCC morphology constituting >50% of the tumor were identified. Mean age was 64.8 years (vs 64.6 in ampullary carcinomas [ACs]) and 6 were males, 3 females. The mean invasive tumor size was 2.5 cm (vs 1.9 in ACs). Other morphologic patterns displayed included cord-like infiltration (n=2), plasmacytoid cells (n=2), and microglandular component (n=4), including goblet cell adenocarcinoma-like foci. None of the cases were associated with dysplasia. By immunohistochemistry, the carcinomas did not show intestinal differentiation (CDX2 0/9, CK20 1/9, MUC2 3/9), MUC1 was positive in 4/9, MUC5AC was positive in 7/8. E-cadherin loss was noted in 4/9. All cases were advanced stage (6/9-pT3, 3/9-pT4) (vs 43% in ACs). Lymph node metastases were identified in 44% (vs 45% in AC). Six patients (67%) died of disease at a median of 25 months, 3 were alive at 13, 15, and 60 months. Overall median survival was significantly worse than that of intestinal-type ACs (26 vs 122 months, P = .006) and trended toward worse than pancreatobiliary type (26 vs 42 months, P = .1). In conclusion, PCCs constitute 2.45% of all ACs. These present as advanced tumors and express upper-gastrointestinal immunoprofile with frequent MUC5AC labeling, which may be helpful in identifying subtle infiltration in the surface mucosa since MUC5AC is not expressed in the ampullary mucosa. Patients have poor prognosis.
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Affiliation(s)
| | - Olca Basturk
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Grace E Kim
- University of California San Francisco, CA, USA
| | - Yue Xue
- Emory University, Atlanta, GA, USA
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de Klein GW, van Baarlen J, Mekenkamp LJ, Liem MSL, Klaase JM. Signet Ring Cell Carcinoma of the Ampulla of Vater: A Rare Histopathological Variant. Case Rep Gastroenterol 2018; 12:194-201. [PMID: 29805366 PMCID: PMC5968303 DOI: 10.1159/000488903] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 03/01/2018] [Indexed: 11/19/2022] Open
Abstract
Signet ring cell carcinoma (SRCC) of the ampulla of Vater is an extremely rare tumor. Our case describes a 45-year-old female presenting with jaundice and pruritus. Computed tomography, endoscopy, and endoscopic retrograde cholangiopancreatography showed a tumor of the ampulla of Vater without distant metastasis. Histological biopsy confirmed a malignant tumor with SRCC characteristics and immunohistochemical staining revealed a mixed type profile (both intestinal and pancreatobiliary characteristics). A pylorus-preserving pancreatoduodenectomy was performed and the patient recovered without complications. Pathology results concluded a pT2N0 ampullary SRCC. SRCC of the ampulla of Vater is known to be highly malignant. After 13 months of follow-up, our patient showed no signs of recurrence.
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Affiliation(s)
- Guus W de Klein
- Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Joop van Baarlen
- Laboratorium Pathologie Oost-Nederland (LabPON), Hengelo, The Netherlands
| | - Leonie J Mekenkamp
- Department of Internal Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Mike S L Liem
- Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Joost M Klaase
- Department of Surgery, Universitair Medisch Centrum Groningen, Groningen, The Netherlands
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