Primary signet ring cell carcinoma of the prostate treated by radical cystoprostatectomy and chemoradiotherapy

Prostate Adenocarcinoma with Signet-Ring Cells and Features of Mucin: A Clinical Case and Literature Review

Introduction: Signet-ring cells are typically associated with mucin-secreting epithelium; thus, they are most commonly found in the gastrointestinal tract, but not exclusively. Primary signet-ring cell carcinoma of the prostate is a rare and poorly differentiated, aggressive acinar adenocarcinoma variant with a grim prognosis. Clinical Case: In June of 2023, a 54-year-old Caucasian male presented with a complaint of lower urinary tract obstructive symptoms with occasional macrohematuria, non-specific body aches, and shortness of breath. A prostate specimen obtained in transurethral resection of the prostate was sent for histopathological examination. After a series of extraprostatic diagnostic workups, including fibrogastroduodenoscopy, colonoscopy computed tomography imaging, and immunohistochemical studies, the patient was diagnosed with primary prostatic signet-ring cell adenocarcinoma stage IV. Unfortunately, due to the advanced stage of the disease, PE, and third-degree thrombocytopenia, the patient was not a candidate for chemotherapy and died of cardiopulmonary insufficiency later that week. Discussion: Prostatic signet-ring cell carcinoma accounts for 0.02% of all prostate adenocarcinoma cases. Due to its nature and epidemiology, a diligent extraprostatic investigation has to be carried out. The disease often presents with unremarkable clinical symptoms and variable serum prostate-specific antigen results, which may contribute to its late diagnosis. Inconsistent immunohistochemical findings and an unpredictable response to hormonal treatment together pose both diagnostic and therapeutic challenges that negatively affect the prognosis. Conclusions: This study highlights the importance of a multidisciplinary approach and the need for diagnostic and therapeutic consensus within the research community in search of the primary site of the disease, which may positively influence the prognosis.

Primary signet ring cell carcinoma of prostate: A rare case report and review of literature

Primary signet ring cell carcinoma (PSRCC) of the prostate is an extremely rare variant of prostatic adenocarcinoma. A PubMed search of the English language literature from January 2000 to June 2020 using the keywords "signet ring cell carcinoma" and "prostate," identified 20 cases of PSRCC of the prostate. On the basis of the combined data from this study and the literature review, 21 such patients were evaluated for clinical characteristics, histologic diagnoses, special and immunohistochemical staining, and treatment. The mean age at the diagnosis was 68.47 years (range 50-85 years). The prostate-specific antigen (PSA) levels varied from 0.19 to 6658 ng/mL, with a mean of 509.15 ng/mL. Most (50%) presented with Stage 3 cancer. The most common Gleason grade group was 5 (Gleason score 9 to 10), seen in 61.5%. The extent of signet ring cell involvement of the specimen when reported was documented as more than 20% of the tumor-containing signet ring cells, with a range of 25%-90%. For pathologic diagnosis, the most common special stains performed were periodic acid-Schiff and Alcian blue, and among the immunohistochemical stains, the most common were PSA, CK20, and prostate-specific acid phosphatase. A detailed clinicoradiological and pathological workup is essential to rule out primary from other common sites, in view of its grave prognosis and lack of an established treatment protocol.

Primary signet ring cell carcinoma of the pancreas with a good response to chemotherapy: case report and literature review

PURPOSE

Although pancreatic cancer is a common malignancy, signet ring cell carcinoma of the pancreas is a very rare histologic type with only 6 cases reported so far. We present a patient with primary signet ring cell carcinoma of the pancreas and a good response to neoadjuvant chemotherapy.

CASE REPORT

A 67-year-old woman presented at a regional hospital with a 2-week history of painless progressive jaundice. Abdominal computed tomography showed a tumor in the head of the pancreas, 4.5 cm in largest diameter. Since endoscopic biopsy and biliary stenting were not available, the patient had undergone palliative choledochoduodenostomy and tru-cut needle biopsy of the lesion. Histopathology revealed primary signet ring cell carcinoma of the pancreas. The tumor was considered borderline resectable and 3-month neoadjuvant chemotherapy with gemcitabine alone was administered due to the low creatinine clearance rates. Follow-up abdominal scan demonstrated very good response to chemotherapy and significant tumor regression to 1.5 cm in largest diameter. Radical cephalic duodenopancreatectomy was performed.

CONCLUSION

Significant tumor downsizing in our patient clearly demonstrates good response to neoadjuvant gemcitabine monotherapy. The optimal preoperative chemotherapy leading to tumor reduction and disease control in patients with borderline resectable and locally advanced pancreatic carcinoma is controversial, necessitating further randomized studies including combined chemoradiotherapy and multidrug combination regimens.