Diagnosis of primary pure signet-ring cell carcinoma of the cervix

Primary signet ring cell carcinoma of the cervix: case report and literature review

Objective

To report an infrequent case of primary signet ring cell carcinoma of the cervix (PSRCC), review the literature and evaluate the clinicopathological characteristics.

Material and methods

A 51-year-old female patient, with 3 years of disease characterised by gynaecologic bleeding and pelvic pain. On examination, cervix replaced by tumour and infiltrated parametria; with cytology and histology of adenocarcinoma with cells in a signet ring pattern. Disease extension studies were negative. Classified as PSRCC stage IIIB, chemotherapy and radiotherapy were indicated, but the patient died a month later. The bibliographic search included publications up to July 2023.

Results

32 cases with a mean age of 47.6 years were identified. The most frequent symptoms were uterine bleeding and abdominal and pelvic pain. The initial stages were treated surgically, some with adjuvant chemotherapy and/or radiotherapy, with favourable responses; a difference from advanced cases. The average survival was 17.6 months.

Conclusion

PSRCC is rare, with 32 cases reported according to the review. The expression with immunohistochemical and molecular techniques for the human papilloma virus can help confirm the gynaecological primary, but its diagnosis is one of exclusion, since its morphological pattern is related to other primaries, mainly digestive.

Primary signet ring cell carcinoma of the cervix: About an uncommon case report

BACKGROUND

Cervix mucinous adenocarcinomas have been defined by WHO classification into different subtypes: gastric, intestinal and ring signet cell. Ring signet cell subtype represent a diagnostic challenge due to the small number of cases described in the literature. We report hereby the 31st case worldwide, which is all the more exceptional as its atypical clinical presentation with mainly urological clinical signs represented a real diagnostic challenge.

CASE PRESENTATION

We present the uncommon case of a multiparous, menopausal 68 years-old-woman, who presented in our department for pelvic pain evolving for 4 months associated with dysuria. Gynecological examination showed a bulging mass on the anterior vaginal wall with mucoid urinary discharge. Perineal ultrasound and pelvic MRI showed an anterior vaginal mass arising from the anterior vaginal wall, invading the bladder, urethra and respecting vagina's upper third and the rectum associated with multiple metastatic left iliac lymph nodes. Anatomopathological analysis revealed a moderately differentiated mucinous adenocarcinoma with a signet-ring cell appearance. IHC stain for P16, marker for high-risk HPV, was strongly positive. Due to the advanced stage, the patient was not a candidate for upfront surgery and received definitive chemoradiation with palliative intent. The patient succumbed to her disease after only one month of chemotherapy.

CONCLUSIONS

Primary signet ring cell carcinoma of the cervix is rare and associated with a poor outcome. Prognosis is related to the clinical stage. Differentiate primary from metastatic signet cell carcinoma is compulsory. IHC is very helpful but not decisive and the diagnosis is often made by exclusion.

Primary signet ring cell carcinoma of the uterine cervix: A case report

RATIONALE

Primary signet ring cell carcinoma of the uterine cervix is extremely rare and the clinical characteristics and prognosis are not well known and there are no specific guidelines for treatment.

PATIENT CONCERNS

A 43-year-old woman was referred to our hospital for abnormal uterine bleeding lasting 1 month.

DIAGNOSES

Histological examination revealed a signet ring cell carcinoma of the uterine cervix. After evaluation of extragenital origin, the patient was diagnosed International Federation of Gynecology and Obstetrics stage IIIC1 primary signet ring cell carcinoma or the uterine cervix.

INTERVENTION

The patient was prescribed concomitant chemo-radiation followed by intracavitary brachytherapy.

OUTCOMES

She showed no evidence of disease after treatment but, it recurred after 7 months of last treatment.

LESSONS

Different approaches to diagnosis and treatment of this rare disease are needed and molecular pathological studies related to the onset of the disease are required.

Clinicopathological characteristics of patients with mucinous adenocarcinoma of the uterine cervix: A retrospective study of 21 cases

OBJECTIVES

Few studies in the literature take into account the WHO's 2014 redefinition of the characteristics of mucinous adenocarcinoma of the uterine cervix. Our objective was to describe the characteristics of a group of these patients.

MATERIAL AND METHODS

This was a retrospective descriptive study of patients diagnosed between 1 January 2005 and 31 May 2016 in three hospitals in Lyon, France. All the cases of cervical adenocarcinoma were reanalysed by an expert in gynaecological pathology to retain the mucinous subtypes as defined in the 2014 WHO classification. We analysed their clinical and pathological characteristics.

RESULTS

Among the 82 cases of cervical adenocarcinoma, 21 (26%) were diagnosed as mucinous. Ten were gastric type, of which four were in the extremely well differentiated form of minimal deviation adenocarcinomas, six were intestinal type, two were signet-ring cell type, and three were not otherwise specified. The patients' mean age was 42 years and 18 patients were premenopausal. The revealing symptom was metrorrhagia in eight cases (38%) and mucinous vaginal discharge in four (19%). Fifteen (72%) of the cervical smear were abnormal. Five (31%) of the 16 patients with gastric or intestinal type adenocarcinoma had a specific radiological presentation: multiple cysts of the uterine isthmus, visible on ultrasound and with T2 hyperintensity on MRI.

CONCLUSION

Mucinous adenocarcinoma is a rare form of cervical cancer that can be confused with other pathological types. It can be detected using cervical smears and should be suspected in cases of mucinous discharge and characteristic MRI features.

[Focus on mucinous adenocarcinoma of the uterine cervix]

Cancer of the uterine cervix is the fourth most common cancer in women worldwide, and the fourth leading cause of cancer death in women. Squamous cell carcinoma is the first type of cervical cancer (about 75% of cases), and adenocarcinoma the second. Adenocarcinoma of the uterine cervix were redefined in the 2014 WHO classification. Endocervical adenocarcinoma, usual type, is the mose common. Mucinous adenocarcinoma were classified by this classification into different subtypes: gatric type, intestinal type and signet-ring cell type. This literature review shows the caracteristics of these various subtypes of cervical cancer, little known. These are physiopathological, clinical, cytological histological, pronostic caracteristics, and their treatments.

Primary signet ring cell carcinoma of the cervix: A case report with review of the literature

OBJECTIVE

Primary cervical signet ring cell carcinoma (PCSRCC) is extremely rare. In this paper, we describe a case presenting with PCSRCC.

CASE REPORT

The 48-year-old woman visited the gynecological department because of postmenopausal bleeding. A cervical mass was discovered through pelvic examination, and the biopsy results indicated a poorly differentiated adenocarcinoma with a signet ring cell pattern. Colonoscopy revealed external compression of the rectum without intraluminal mucosal lesions. Abdominal computed tomography revealed a suspicious malignant lesion at the cervicorectal junction and multiple metastases. Debulking surgery was performed and the final pathology report documented a FIGO stage IVb PCSRCC involving multiple sites.

CONCLUSION

Complete tumor survey and staging are critical to differentiate primary from metastatic signet cell carcinoma of the cervix. Immunohistochemical studies cannot provide precise information. Because cases are rare, it is difficult to determine the proper treatment guidelines and prognosis.

Primary signet ring cell carcinoma of the cervix: A case report with review of the literature

OBJECTIVE

Primary cervical signet ring cell carcinoma (PCSRCC) is extremely rare. In this paper, we describe a Case presenting with PCSRCC.

CASE REPORT

The 48-year-old woman visited the gynecological department because of postmenopausal bleeding. A cervical mass was discovered through pelvic examination, and the biopsy results indicated a poorly differentiated adenocarcinoma with a signet ring cell pattern. Colonoscopy revealed external compression of the rectum without intraluminal mucosal lesions. Abdominal computed tomography revealed a suspicious malignant lesion at the cervicorectal junction and multiple metastases. Debulking surgery was performed and the final pathology report documented a FIGO stage IVb PCSRCC involving multiple sites.

CONCLUSION

Complete tumor survey and staging are critical to differentiate primary from metastatic signet cell carcinoma of the cervix. Immunohistochemical studies cannot provide precise information. Because cases are rare, it is difficult to determine the proper treatment guidelines and prognosis.

Cervical Carcinoma With Divergent Neuroendocrine and Gastrointestinal Differentiation

Neuroendocrine carcinomas of the uterine cervix are rare tumors with aggressive behavior. They comprise <4% of cervical carcinomas. They may coexist with both adenocarcinoma and squamous cell carcinoma of cervix. Signet ring carcinoma of cervix is a rarer entity and less than 20 cases have been described in the literature. We present a case of a 34-year-old female who presented with systemic thrombosis, splenic mass and a cervical mass which on biopsy showed divergent differentiation of primitive large cell neuroendocrine carcinoma with signet ring cells. The cervical tumor was positive for human papilloma virus 16/18 by in situ hybridization, confirming cervical origin of the tumor. This unusual presentation and morphology needs to be recognized and appropriately evaluated when patients present with tumors of unknown origin in metastatic sites.

Primary signet ring cell carcinoma of the cervix: A case report and review of the literature

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To date, only 18 cases with primary signet cell carcinoma of the cervix has been reported.

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Differentiation of primary tumour from metastatic signet cell carcinoma carries significant important while treatment and prognosis differ significantly.

Introduction

Primary signet cell carcinoma of the cervix has been reported only in 18 cases to date.

Presentation of case

A 48-year-old woman was seen at our Gynecologic Oncology Unit, because she complained postcoital bleeding during the last three months. She had 1–2 cm cervical mass, originating from the endocervical canal. A biopsy revealed a signet ring cell-type adenocarcinoma. Suspected primary sites were excluded after gastroscopy, colonoscopy and mammography. The patient underwent a laparoscopic type-3 radical hysterectomy with bilateral salpingo–oophorectomy, pelvic lymph node dissection and paraaortic lymph node dissection with a presumed diagnosis of primary signet ring cell carcinoma of the cervix. Microscopically, the tumour consisted of 70% signet ring cell type and 30% endocervical adenocarcinoma. She did not receive any adjuvant treatment. Follow-up at 18 months after surgery showed no evidence of recurrence.

Discussion

Nineteenth case of a primary signet ring cell carcinoma of the cervix was presented. Immunohistochemical studies and HPV DNA positivity may help in diagnosis.

Conclusion

It is crucial to differentiate primary tumour from metastatic signet cell carcinoma, while treatment and prognosis differ significantly.