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Martinelli G, Stanca S, Bosco F, Zini L, De Masi F, Alì G. Massive lymphatic embolism in gallbladder signet ring cell carcinoma: An autopsy finding. Clin Res Hepatol Gastroenterol 2024; 48:102330. [PMID: 38552735 DOI: 10.1016/j.clinre.2024.102330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 03/23/2024] [Accepted: 03/27/2024] [Indexed: 04/08/2024]
Affiliation(s)
- Giulia Martinelli
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy
| | - Stefano Stanca
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy
| | - Francesca Bosco
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy
| | - Leonardo Zini
- Otolaryngology, Audiology and Phoniatrics Unit, University of Pisa, 56126 Pisa, Italy
| | - Francesco De Masi
- Neuroanesthesiology Section, University Hospital of Pisa, 56126 Pisa, Italy
| | - Greta Alì
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy.
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2
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Emile SH, Horesh N, Garoufalia Z, Rogers P, Gefen R, Dasilva G, Wexner SD. Characteristics and outcomes of rectal cancer in patients with inflammatory bowel disease: a single-center experience. Updates Surg 2024; 76:119-126. [PMID: 37814150 DOI: 10.1007/s13304-023-01660-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 09/23/2023] [Indexed: 10/11/2023]
Abstract
The increased risk of colorectal cancer (CRC) in patients with inflammatory bowel disease (IBD) has been well documented in the literature. The present study aimed to assess the characteristics and outcomes of rectal cancer in patients with IBD. This study was a retrospective review of a prospectively maintained IRB-approved database at Cleveland Clinic Florida. Rectal cancer patients with or without IBD treated with curative surgery between 2016 and 2020 were compared for demographics, disease characteristics, and pathologic and oncologic outcomes. The primary outcomes were 3-year overall survival (OS) and disease-free survival (DFS). Secondary outcomes were clinicopathologic outcomes including disease stage, tumor histology and histologic features, and treatments received. 238 patients with rectal cancer were included, 15 (6.3%) of whom had IBD. IBD patients were significantly younger (52.9 vs 60.3 years, p = 0.033), presented more often with cT1-2 tumors (64.3% vs 30.4%, p = 0.008), and signet-ring cell pathology (14.3% vs 2%, p = 0.02). IBD patients received neoadjuvant chemoradiation less often (40% vs 72.6%, p = 0.029) and had shorter time between diagnosis and surgery (7.5 vs 25 weeks, p = 0.013) than did non-IBD patients. Both groups had similar OS (36 vs 34.7 months, p = 0.431) and DFS (36 vs 32.9 months, p = 0.121). IBD patients with rectal cancer tend to present at a younger age, with a less invasive disease, and signet-ring carcinomas, and receive neoadjuvant treatment less often than non-IBD patients. Based on low level of evidence, IBD and non-IBD rectal cancer patients might have similar survival.
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Affiliation(s)
- Sameh Hany Emile
- Ellen Leifer Shulman and Steven Shulman Digestive Disease, Cleveland Clinic Florida, Center, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
- Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt
| | - Nir Horesh
- Ellen Leifer Shulman and Steven Shulman Digestive Disease, Cleveland Clinic Florida, Center, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
- Department of Surgery and Transplantation, Sheba Medical Center, Ramat-Gan, Israel
| | - Zoe Garoufalia
- Ellen Leifer Shulman and Steven Shulman Digestive Disease, Cleveland Clinic Florida, Center, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Peter Rogers
- Ellen Leifer Shulman and Steven Shulman Digestive Disease, Cleveland Clinic Florida, Center, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Rachel Gefen
- Ellen Leifer Shulman and Steven Shulman Digestive Disease, Cleveland Clinic Florida, Center, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
- Department of General Surgery, Faculty of Medicine, Hadassah Medical Organization, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Giovanna Dasilva
- Ellen Leifer Shulman and Steven Shulman Digestive Disease, Cleveland Clinic Florida, Center, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Steven D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease, Cleveland Clinic Florida, Center, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA.
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Kishi K, Adachi K, Sakamoto U, Yuki T, Kushiyama Y, Miura H, Okimoto E, Ishimura N, Ishihara S. Gastric Flat Elevated Undifferentiated Signet-ring Cell Mucosal Cancer Lesion Detected in a Case without Helicobacter pylori Infection. Intern Med 2023; 62:3469-3472. [PMID: 37062733 PMCID: PMC10749807 DOI: 10.2169/internalmedicine.1033-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/26/2023] [Indexed: 04/18/2023] Open
Abstract
Protruded signet-ring cell carcinoma (SRCC) is extremely rare. We herein report a rare case of flat elevated gastric SRCC in a patient without Helicobacter pylori infection. Esophagogastroduodenoscopy of a woman in her 50s revealed a flat, whitish lesion in the gastric body with elevation. Histological results of an endoscopically biopsied specimen led to a diagnosis of SRCC. Resection using endoscopic submucosal dissection was performed, and histology results revealed that the tumor was localized in the lamina propria. The size was 10×6 mm, and a protrusion had been formed by SRCC enlargement without destruction of the surface epithelium structure.
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Affiliation(s)
- Kanako Kishi
- Health Center, Shimane Environment and Health Public Corporation, Japan
| | - Kyoichi Adachi
- Health Center, Shimane Environment and Health Public Corporation, Japan
| | - Utae Sakamoto
- Health Center, Shimane Environment and Health Public Corporation, Japan
| | - Takafumi Yuki
- Department of Gastroenterology, Matsue Red Cross Hospital, Japan
| | | | - Hiroshi Miura
- Department of Pathology, Matsue Red Cross Hospital, Japan
| | - Eiko Okimoto
- Second Department of Internal Medicine, Shimane University Faculty of Medicine, Japan
| | - Norihisa Ishimura
- Second Department of Internal Medicine, Shimane University Faculty of Medicine, Japan
| | - Shunji Ishihara
- Second Department of Internal Medicine, Shimane University Faculty of Medicine, Japan
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Wongrukmit S, Ngamphaiboon N, Kiranantawat K, Suwanthanma W, Plumworasawat S, Boonsakan P, Pongtippan A, Phanachet P, Warodomwichit D, Shantavasinkul PC. Unusual manifestation of gastric adenocarcinoma presenting with lymphedema, chylothorax, and chylous ascites. Clin J Gastroenterol 2023; 16:822-828. [PMID: 37737943 DOI: 10.1007/s12328-023-01851-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 08/18/2023] [Indexed: 09/23/2023]
Abstract
A 62-year-old Thai man with a 2-year history of bilateral lymphedema and an unprovoked left axillary vein thrombosis presented with progressive leg, scrotal, and abdominal swelling, and shortness of breath. He denied any gastrointestinal symptoms. His lymphedema had initially been diagnosed as chronic filariasis due to positive blood tests for anti-filarial antibodies; however, treatment with anti-filarial drugs failed to improve his symptoms. Subsequently, he underwent surgical lymphaticovenular anastomosis with scrotal reduction, which proved to be of limited symptomatic relief. Later investigations revealed bilateral chylothorax and chylous ascites, with the presence of metastatic adenocarcinoma. Histopathological examination of the patient's skin and scrotum biopsy from his previous surgery revealed invasion of the lymphatics by neoplastic cells with signet ring cell formation. Gastroscopy uncovered a gastric mass, and biopsy confirmed the diagnosis of stage IV gastric adenocarcinoma with signet ring cell. He later received palliative chemotherapy. For the management of chyle leakage, he was prescribed a very low-fat diet and supplemented with parenteral nutrition. Despite treatment, he developed cutaneous metastasis and was transitioned to best supportive care. The patient passed away 14 months after diagnosis.
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Affiliation(s)
- Siree Wongrukmit
- Division of Nutrition and Biochemical Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand
| | - Nuttapong Ngamphaiboon
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kidakorn Kiranantawat
- Division of Plastic and Maxillofacial Surgery, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Weerapat Suwanthanma
- Division of General Surgery, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sirithep Plumworasawat
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Paisarn Boonsakan
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Atcharaporn Pongtippan
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pariya Phanachet
- Division of Nutrition and Biochemical Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand
| | - Daruneewan Warodomwichit
- Division of Nutrition and Biochemical Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand
| | - Prapimporn Chattranukulchai Shantavasinkul
- Division of Nutrition and Biochemical Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand.
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Sano Y, Yoshida K, Hibi E, Sekiya A, Watanabe Y, Shibata D. A rare case of signet ring cell carcinoma with diffuse cutaneous systemic sclerosis: A case report. J Obstet Gynaecol Res 2023; 49:2549-2552. [PMID: 37344106 DOI: 10.1111/jog.15715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/30/2023] [Indexed: 06/23/2023]
Abstract
Systemic sclerosis, an autoimmune disease characterized by fibrosis and vasculopathy of the skin and other multiple organs has been associated with an increased risk of malignancy. We present the case of a 74-year-old woman who had diffused cutaneous systemic sclerosis and uterine cervical cancer. The patient was initially diagnosed with stage IIB squamous cell carcinoma and concurrent chemoradiotherapy was planned. However, cisplatin could not be administered due to acute renal failure, so the patient was treated solely with radiotherapy. However, complications of systemic sclerosis progressed rapidly, and the patient died 63 days later from pulmonary edema. An autopsy later revealed that uterine cervix had primary signet ring cell carcinoma. We suspected that this patient had a combination of signet ring cell carcinoma and squamous cell carcinoma, with squamous cell carcinoma disappearing after radiotherapy. This case highlighted the importance of systemic management for cancers associated with systemic sclerosis.
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Affiliation(s)
- Yuriko Sano
- Department of Obstetrics and Gynecology, Chubu Rosai Hospital, Nagoya, Japan
| | - Kosuke Yoshida
- Department of Obstetrics and Gynecology, Chubu Rosai Hospital, Nagoya, Japan
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Erina Hibi
- Department of Obstetrics and Gynecology, Chubu Rosai Hospital, Nagoya, Japan
| | - Atsushi Sekiya
- Department of Obstetrics and Gynecology, Chubu Rosai Hospital, Nagoya, Japan
| | - Yuriko Watanabe
- Department of Obstetrics and Gynecology, Chubu Rosai Hospital, Nagoya, Japan
| | - Daijiro Shibata
- Department of Obstetrics and Gynecology, Chubu Rosai Hospital, Nagoya, Japan
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Lam R, Tarangelo N, Wang R, Horibe M, Grimshaw AA, Jain D, Haffar S, Bazerbachi F, Kunz PL, Li DK. Microangiopathic Hemolytic Anemia Is a Late and Fatal Complication of Gastric Signet Ring Cell Carcinoma: A Systematic Review and Case-Control Study. Oncologist 2022; 27:751-759. [PMID: 35589098 PMCID: PMC9438916 DOI: 10.1093/oncolo/oyac093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/08/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Microangiopathic hemolytic anemia (MAHA) is a rare paraneoplastic syndrome that has been reported in patients with gastric signet ring cell carcinoma (SRCC). Clinical and prognostic features of MAHA in this setting have been poorly described. MATERIALS AND METHODS We conducted a systematic review in 8 databases of gastric SRCC complicated by MAHA and performed a case-control study assessing factors associated with survival in patients with gastric SRCC and MAHA in our pooled cohort compared with age-, sex-, and stage-matched cases of gastric SRCC from the Surveillance, Epidemiology, and End Results (SEER) database. Descriptive analyses were performed and multivariable Cox-proportional hazards regression modeling was used to determine factors associated with overall survival. RESULTS All identified patients (n = 47) were symptomatic at index presentation, commonly with back/bone pain, and dyspnea. Microangiopathic hemolytic anemia was the first manifestation of gastric SRCC in 94% of patients. Laboratory studies were notable for anemia (median 7.7 g/dL), thrombocytopenia (median 45.5 × 103/μL), and hyperbilirubinemia (median 2.3 mg/dL). All patients with MAHA had metastatic disease at presentation, most often to the bone, bone marrow, and lymph nodes. Median survival in patients with gastric SRCC and MAHA was significantly shorter than a matched SEER-derived cohort with metastatic gastric SRCC (7 weeks vs 28 weeks, P < .01). In multivariate analysis, patients with MAHA were at significantly increased risk of mortality (HR 3.28, 95% CI 2.11-5.12). CONCLUSION Microangiopathic hemolytic anemia is a rare, late-stage complication of metastatic gastric SRCC and is associated with significantly decreased survival compared with metastatic gastric SRCC alone.
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Affiliation(s)
- Robert Lam
- Section of Digestive Diseases, Yale School of Medicine, New Haven, CT, USA
| | - Nicholas Tarangelo
- Section of Digestive Diseases, Yale School of Medicine, New Haven, CT, USA
| | - Rong Wang
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Masayasu Horibe
- Division of Gastroenterology and Hepatology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Alyssa A Grimshaw
- Harvey Cushing/John Hay Whitney Medical Library, Yale School of Medicine, New Haven, CT, USA
| | - Dhanpat Jain
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Samir Haffar
- Gastroenterology Department, Syrian Specialty Hospital, Damascus, Syrian Arab Republic
| | - Fateh Bazerbachi
- CentraCare, Interventional Endoscopy Program, Saint Cloud Hospital, St. Cloud, MN, USA
| | - Pamela L Kunz
- Section of Medical Oncology, Department of Medicine, Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA
| | - Darrick K Li
- Corresponding author: Darrick K. Li, MD, PhD, P.O. Box 208019, New Haven, CT 06520-8019, USA. Tel: +1 203 785 7312; Fax: +1 203 785 7273;
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Rossio R, Pagliaro E, Artoni A, Baronciani L, Russo R, Mocellin MC, Lopez G, Peyvandi F. Pulmonary tumour thrombotic microangiopathy in a young man: clinical and immunohistochemical characterisation of a rare complication of gastric signet-ring cell carcinoma. Blood Transfus 2021; 19:506-509. [PMID: 33871349 PMCID: PMC8580786 DOI: 10.2450/2021.0016-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/26/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Raffaella Rossio
- General Medicine, “Angelo Bianchi Bonomi” Haemophilia and Thrombosis Centre, Fondazione IRCCS Ca’ Granda Ospedale Maggiore, Policlinico of Milan, Milan, Italy
| | - Erica Pagliaro
- General Medicine, “Angelo Bianchi Bonomi” Haemophilia and Thrombosis Centre, Fondazione IRCCS Ca’ Granda Ospedale Maggiore, Policlinico of Milan, Milan, Italy
| | - Andrea Artoni
- General Medicine, “Angelo Bianchi Bonomi” Haemophilia and Thrombosis Centre, Fondazione IRCCS Ca’ Granda Ospedale Maggiore, Policlinico of Milan, Milan, Italy
| | - Luciano Baronciani
- General Medicine, “Angelo Bianchi Bonomi” Haemophilia and Thrombosis Centre, Fondazione IRCCS Ca’ Granda Ospedale Maggiore, Policlinico of Milan, Milan, Italy
| | - Riccarda Russo
- Adult Anaesthesia and Intensive Care, Fondazione IRCCS Ca’ Granda Ospedale Maggiore, Policlinico of Milan, Milan, Italy
| | - Maria C. Mocellin
- Therapeutic Apheresis Centre, Department of Transfusion Medicine and Haematology Fondazione IRCCS Ca’ Granda Ospedale Maggiore, Policlinico of Milan, Milan, Italy
| | - Gianluca Lopez
- Pathology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore, Policlinico of Milan, Milan, Italy
| | - Flora Peyvandi
- General Medicine, “Angelo Bianchi Bonomi” Haemophilia and Thrombosis Centre, Fondazione IRCCS Ca’ Granda Ospedale Maggiore, Policlinico of Milan, Milan, Italy
- Department of Pathophysiology and Transplantation, State University of Milan, Milan, Italy
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Zhou L, Jiang Z, Gu W, Han S. STROBE-clinical characteristics and prognosis factors of gastric cancer in young patients aged ≤30 years. Medicine (Baltimore) 2021; 100:e26336. [PMID: 34190151 PMCID: PMC8257836 DOI: 10.1097/md.0000000000026336] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 05/27/2021] [Indexed: 01/04/2023] Open
Abstract
We aimed to determine the clinical characteristics and prognosis factors of young patients with gastric cancer (GC).A total of 101 young patients with GC referred to Zhengzhou University People's Hospital, Henan province, China between January 1st, 2003 and June 1st, 2015 were retrospectively reviewed. The medical records included ages, genders, marital status, family history of tumors, comorbidity, Helicobacter pylori (H.pylori) infection, fibrinogen, prealbumin, alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), tumor location, tumor size, TNM stage, differentiation of the tumor, WHO type, treatment method and prognostic factors effect were further assessed.The mean age of GC patients in our group was 26.0 years. The incidence was slightly higher in females (female: male = 1.1:1). Some patients had the family history of tumor and H.pylori infection (2.0%, 6.9%). The tumor sizes were mainly under 5 cm (52.4%) and the most locations were in the antrum (43.5%) and body (42.5%). A large number of patients were diagnosed as adenocarcinomas (66.3%) and the main histological of GC was poor differentiated (72.3%). Moreover, a high proportion of patients were diagnosed at the stages III-IV (61.4%), and most patients received surgery combined chemotherapy (63.4%), however, the survival outcome was poor. In univariate Cox analysis, tumor sizes, TNM stage were significantly associated with overall survival (OS) and the multivariate Cox analysis demonstrated that TNM stage was significantly associated with OS.GC in young patients has its unique biological and clinical features. A large majority of young patients were diagnosed at their advanced stages with poor prognostic. TNM stage was an independent prognostic factor for young patients with GC, early GC screening in young people should be actively promoted.
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Abstract
Chylothorax is the accumulation of lipid pleural effusion. Few reports have described chylothorax caused by gastric cancer. A 45-year-old woman presented with progressive lymphedema and bilateral chylothorax. Although repetitive thoracentesis was performed to relieve her dyspnea, swelling of her axillary lymph nodes became significant. Positron emission tomography/computed tomography demonstrated the accumulation of 18F-fluorodeoxyglucose in these nodes, and a lymph node biopsy showed signet ring cell carcinoma. The primary site was a 0-IIc type lesion in the gastric body that was only detected by upper gastrointestinal endoscopy. The patient was diagnosed with advanced gastric cancer 3.5 months after presentation for chylothorax.
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Affiliation(s)
- Naoko Nagano
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Manabu Suzuki
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Kentaro Tamura
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Sakurako Kobayashi
- Department of Gastroenterology, National Center for Global Health and Medicine, Japan
| | - Yasushi Kojima
- Department of Gastroenterology, National Center for Global Health and Medicine, Japan
| | - Go Naka
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Motoyasu Iikura
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Shinyu Izumi
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Yuichiro Takeda
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Haruhito Sugiyama
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
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10
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Romano JP, Rodriguez E, Lamberto FN, Parrilla MM, Benitez MP, Díaz Aguiar P. [Myelophthisis and gastric cancer. An unusual association]. Medicina (B Aires) 2019; 79:295-298. [PMID: 31487252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
The infiltration of the bone marrow y non-hematopoietic cells is called myelophthisis. In patients with gastric cancer, this invasion is extremely infrequent and the survival is usually less than three months. We present the case of a 35-year-old man with bone marrow involvement secondary to diffuse gastric carcinoma of signet ring cells.
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Affiliation(s)
- Juan Pablo Romano
- Servicio de Clínica Médica, Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina e-mail:
| | - Edwin Rodriguez
- Servicio de Clínica Médica, Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - Facundo N Lamberto
- Servicio de Clínica Médica, Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - María Marta Parrilla
- Servicio de Anatomía Patológica, Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - María Pilar Benitez
- Servicio de Hematología, Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - Pablo Díaz Aguiar
- Servicio de Clínica Médica, Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
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Santos VM, Carneiro MV, Soares VVP, Silva SA, Yano VM, Garcia CJFS. An elderly man with gastric cancer, Saint's triad and Heyde's syndrome. Rev Gastroenterol Peru 2018; 38:289-292. [PMID: 30540734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This case study describes a 71-year-old man with signet-ring cell gastric adenocarcinoma and malignant sigmoidal polyp; and typical features of Saint's triad and Heyde syndrome. He had digestive bleeding, two types of hernia, diverticulosis, arterial hypertension, malignant polyp, and antecedent of smoking, lung tuberculosis, and surgical correction of aortic valve stenosis. There is a hypothetical inverse relationship between herniosis and development of malignancy; however, the patient herein described presented gastric and sigmoidal cancers. Gastrointestinal malignancies are sometimes associated with paraneoplastic entities, isolated or manifested as syndromes, but neither Saint's triad or Heyde syndrome have been included. This patient persisted clinically stable during the preoperative period, but suddenly died; Trousseau's syndrome would be the most probable mechanism of sudden death in this setting. Case reports can stimulate further studies to get additional knowledge about unusual entities.
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Affiliation(s)
- Vitorino M Santos
- Armed Forces Hospital. Brasília-DF, Brazil; Catholic University of Brasília. Brasília-DF, Brazil
| | - Marcos V Carneiro
- Armed Forces Hospital. Brasília-DF, Brazil; Catholic University of Brasília. Brasília-DF, Brazil
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Abstract
The incidence of Helicobacter pylori-negative gastric cancer is very low. A 60-year-old man was referred to Tokai University Hospital from a local clinic because of eosinophilia. The laboratory data revealed prominent eosinophilia, with a white blood cell count of 7,900 /μL and increased eosinophil granulocyte level of 1,659 /μL. After an examination for secondary eosinophilia, esophagogastroduodenoscopy showed an enlarged gastric fold in the corpus, suggesting type 4 gastric cancer. Repeated esophagogastroduodenoscopy (EGD) and a re-biopsy demonstrated poorly differentiated adenocarcinoma and signet ring cell carcinoma. The patient was negative for Helicobacter pylori infection according to the serum anti-Helicobacter pylori antibody, culture and histopathological findings.
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Affiliation(s)
- Atsushi Takagi
- Division of General Internal Medicine, Tokai University School of Medicine, Japan
| | - Hideki Ozawa
- Division of General Internal Medicine, Tokai University School of Medicine, Japan
| | - Masayuki Oki
- Division of General Internal Medicine, Tokai University School of Medicine, Japan
| | - Hidetaka Yanagi
- Division of General Internal Medicine, Tokai University School of Medicine, Japan
| | | | - Naoya Nakamura
- Department of Pathology, Tokai University School of Medicine, Japan
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13
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Corvini M, Koorji A, Sgroe E, Nguyen U. Primary Lung Signet Ring Cell Carcinoma Presenting as a Cavitary Pancoast Tumor in a 32-Year-Old Man. J Osteopath Med 2018; 118:416-419. [PMID: 29800025 DOI: 10.7556/jaoa.2018.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Signet ring cell carcinoma, a subtype of adenocarcinoma, is a rare cause of primary lung cancer. The authors report a case of primary lung signet ring cell carcinoma presenting as a cavitary Pancoast tumor in a 32-year-old male smoker. Beyond the rarity of primary lung signet ring cell carcinoma itself, the youth of the patient, his smoking status, the presence of cavitation, and the location of the tumor in the superior sulcus make it especially atypical.
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Walczak-Gałęzewska M, Szulińska M, Pupek-Musialik D, Bogdański P. Gastroscopy findings in a patient with signet ring cell carcinoma and late‑onset hereditary hemochromatosis. Pol Arch Intern Med 2018; 128:132-133. [PMID: 29511150 DOI: 10.20452/pamw.4213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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15
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Suna N, Öztaş E, Kuzu UB, Kayaçetin E, Aydoğ G, Köksal AŞ. Pleural effusion in acute pancreatitis, not always related. Acta Gastroenterol Belg 2017; 80:434-435. [PMID: 29560681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Nuretdin Suna
- Department of Gastroenterology, Faculty of Medicine, Başkent University, Ankara, Turkey
| | - Erkin Öztaş
- Department of Gastroenterology, Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey
| | - Ufuk Barış Kuzu
- Department of Gastroenterology, Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey
| | - Ertuğrul Kayaçetin
- Department of Gastroenterology, Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey
| | - Gülden Aydoğ
- Department of Pathology,Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey
| | - Aydın Şeref Köksal
- Department of Gastroenterology, Sakarya University School of Medicine, Sakarya, Turkey
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Nguyen S, Ouvrier D, Massalou D, Viau P, Chevallier A, Patouraux S, Passeron T, Lacour JP, Montaudié H. [Lymphedema of the lower limbs: Initial manifestation of gastric linitis plastica]. Ann Dermatol Venereol 2017. [PMID: 28647380 DOI: 10.1016/j.annder.2017.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Primary lymphedemas are constitutional abnormalities of the lymphatic system. Secondary lymphedemas occur after damage to the lymphatic system, mainly after cancer treatments or tumour mass compression. There are many other causes, including filariasis, which is nonetheless very rare in France. PATIENTS AND METHODS A 52-year-old man presented with a two-month history of increased size of the left leg. He was asymptomatic and in good general condition. Clinical examination revealed non-pitting lymphedema and ipsilateral hydrocele without loco-regional compressive lymph node. Initial extensive explorations were unremarkable. Lymphoscintigraphy revealed low tracer fixation in the left leg. The symptoms continued to worsen, with exacerbation and bilateralization of the lymphedema. Two months later, axillary lymph nodes appeared corresponding to metastasis from a signet-ring cell carcinoma. Despite two lines of chemotherapy, the patient died 8 months later due to multiple metastatic disease. DISCUSSION Our case is remarkable because the lymphedema was not related to extrinsic compression and was the first symptom of gastric cancer. In the absence of compression, endo-lymphatic micro-metastases could constitute the causative process. Acquired lymphedema of the lower limbs must be recognized as a potential early symptom of gastric carcinoma and should therefore prompt further investigations.
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Affiliation(s)
- S Nguyen
- Service de dermatologie, hôpital Archet 2, CHU de Nice, 151, route de Saint-Antoine-de-Ginestière, 06200 Nice, France
| | - D Ouvrier
- Service d'oncologie digestive, CHU de Nice, Archet 2, 151, route de Saint-Antoine-de-Ginestière, 06200 Nice, France
| | - D Massalou
- Chirurgie générale d'urgence, Pasteur 2, université de Nice, CHU de Nice, 30, voie Romaine, 06000 Nice, France; UMRT24, IFSTTAR, laboratoire de biomécanique appliquée, Aix-Marseille université, boulevard Pierre-Dramard, 13005 Marseille, France
| | - P Viau
- Service de médecine nucléaire, Archet 1, CHU de Nice, 151, route de Saint-Antoine-de-Ginestière, 06200 Nice, France
| | - A Chevallier
- Laboratoire central d'anatomie et cytologie pathologiques, Archet 2, CHU de Nice, 151, route de Saint-Antoine-de-Ginestière, 06200 Nice, France
| | - S Patouraux
- Laboratoire central d'anatomie et cytologie pathologiques, Pasteur 1, CHU de Nice, 30, voie Romaine, 06001 Nice, France
| | - T Passeron
- Service de dermatologie, hôpital Archet 2, CHU de Nice, 151, route de Saint-Antoine-de-Ginestière, 06200 Nice, France
| | - J-P Lacour
- Service de dermatologie, hôpital Archet 2, CHU de Nice, 151, route de Saint-Antoine-de-Ginestière, 06200 Nice, France
| | - H Montaudié
- Service de dermatologie, hôpital Archet 2, CHU de Nice, 151, route de Saint-Antoine-de-Ginestière, 06200 Nice, France.
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17
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Affiliation(s)
- Helena Temido
- Serviço de Medicina Interna A. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Filipe Vilão
- Serviço de Medicina Interna A. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Francisco Parente
- Serviço de Medicina Interna A. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
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18
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Ben Khelil M, Chkirbene Y, Azzouz H, Haouet S, Hamdoun M. Two cases of sudden death due to pulmonary tumor thrombotic microangiopathy caused by occult gastric carcinoma. Pathologica 2016; 108:160-163. [PMID: 28195256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
We present two cases of occult gastric carcinoma associated to a large pulmonary tumors thrombosis microangiopathy (PTTM). The first case is a 28 years-old man. He was dead due to a respiratory failure. Autopsy showed a whitish indurated mass invading the stomach wall. Histological findings showed a primary "signet ring" gastric adenocarcinoma with pulmonary carcinomatosis and multiple PTTM and a heart metastasis. The second case is a 24 years-old pregnant woman. The main symptoms were nausea and stomach discomfort and they were seen as pregnancy signs. She was dead because of respiratory failure, 10 hours after a vaginal delivery. Autopsy showed the absence of any cause of death related to the delivery and the presence of a whitish indurated mass in the stomach. Histological findings showed a primary "signet ring" gastric adenocarcinoma, with pulmonary carcinomatosis and multiple PTTM.
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Affiliation(s)
- M Ben Khelil
- Department of Forensic Medicine, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine, University Tunis-Elmanar, Tunis, Tunisia
| | - Y Chkirbene
- Department of Forensic Medicine, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine, University Tunis-Elmanar, Tunis, Tunisia
| | - H Azzouz
- Departement of Pathology, La Rabta Hospital, Tunis, Tunisia
| | - S Haouet
- Departement of Pathology, La Rabta Hospital, Tunis, Tunisia
- Faculty of Medicine, University Tunis-Elmanar, Tunis, Tunisia
| | - M Hamdoun
- Department of Forensic Medicine, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine, University Tunis-Elmanar, Tunis, Tunisia
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19
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Grosse A. Diagnosis of colonic amebiasis and coexisting signet-ring cell carcinoma in intestinal biopsy. World J Gastroenterol 2016; 22:8234-8241. [PMID: 27688666 PMCID: PMC5037093 DOI: 10.3748/wjg.v22.i36.8234] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 07/07/2016] [Accepted: 08/01/2016] [Indexed: 02/06/2023] Open
Abstract
Amebiasis is uncommon in developed countries. Several case reports in the literature emphasize that both the presenting symptoms and the radiological findings of colonic amebiasis closely resemble more common conditions, such as idiopathic inflammatory bowel disease and gastro-intestinal malignancy. We describe a unique case of colonic amebiasis (amebomas) coexisting with signet-ring cell carcinoma of the ileocecal valve, the cecum and the appendix. Endoscopically, the ulcerated tumor was indistinguishable from the ulcerations and pseudotumors (amebomas) detected in the ascending colon. Histological examination of biopsy specimens revealed the pathognomonic features of protozoa with ingested erythrocytes in combination with signet-ring cell infiltration. The author concludes that amebiasis may not only mimic carcinoma but, rarely, may coexist with carcinoma in the same patient. Clinicians and pathologists should be aware of this possibility in order not to delay diagnosis and treatment of malignant disease.
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20
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Abstract
BACKGROUND Intracranial hypertension (IH) is a neurological disorder characterized by increased intracranial pressure. It is a poorly understood syndrome that most commonly manifests nonspecific symptoms such as stroke-like headache, vision changes, nausea, vomiting, and papilledema. IH has been reported in young cancer patients but never in association with gastric signet-ring cell carcinoma. METHODS Here, we discuss the case of an 18-year-old girl with gastric signet-ring cell carcinoma in which IH was the primary symptom accompanied by the even rarer symptom of cutaneous metastases. We also present a review of the relevant literature. The patient experienced frequent headaches, vomiting, and blurred vision but showed no abnormal findings on cranial imaging studies. Further examination showed multiple skin nodules on the abdomen. Then pathological and immunohistochemical examination of gastroscopic specimens and the biopsied subcutaneous nodules were done. RESULTS Pathological and immunohistochemical examination of gastroscopic specimens and the biopsied subcutaneous nodules confirmed gastric signet-ring cell carcinoma with skin metastases. CONCLUSION To our knowledge, this is the first reported case of gastric signet-ring cell carcinoma primarily presenting IH and accompanied by subcutaneous metastases. This case emphasizes the importance of excluding malignancy from the differential diagnosis of IH.
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Affiliation(s)
| | | | | | - Baorong Zhang
- Department of Neurology, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
- Correspondence: Baorong Zhang, Department of Neurology, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, People's Republic of China (e-mail: )
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21
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Yuza K, Sakata J, Soma D, Ando T, Hirose Y, Ishikawa H, Miura K, Tatsuda K, Ohashi T, Takizawa K, Nagahashi M, Kameyama H, Kobayashi T, Kosugi SI, Wakai T. [Signet-Ring Cell Carcinoma of the Ampulla of Vater--Report of a Case]. Gan To Kagaku Ryoho 2015; 42:1767-1769. [PMID: 26805166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A 62-year-old man presented with pruritus caused by obstructive jaundice. He was diagnosed with carcinoma of the ampulla of Vater and underwent pylorus-preserving pancreaticoduodenectomy. Histologic examination revealed signet-ring cell carcinoma without nodal metastasis. The patient underwent a partial resection of the small bowel for small bowel obstruction 38 months after the initial resection. Histologic examination disclosed signet-ring cell carcinoma at the surface of the resected small bowel, and the diagnosis of peritoneal recurrence was confirmed. He received oral S-1(100 mg/day) every other day for 14 months until bowel obstruction caused by peritoneal carcinomatosis became apparent. The patient died of the disease 58 months after the initial resection.
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Affiliation(s)
- Kizuki Yuza
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences
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Machida T, Tanaka J, Terashima T. [A case of ascending colon signet-ring cell careinoma discovered after treatment for acute cholecystitis]. Gan To Kagaku Ryoho 2014; 41:1683-1685. [PMID: 25731295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A 81-year-old woman confined to full bed rest due to the effects of a stroke 7 years prior, was brought to our hospital with acute cholecystitis in late April 2013. After PTGBD, her condition improved and she was discharged in early June. However, she was urgently hospitalized at the beginning of August with melena and a fever. A detailed examination revealed aspiration pneumonia, which was resolved with a course of antibiotics. A colonoscopy, conducted to find the cause of the melena, revealed a circumferential type 2 tumor in the ascending colon, and a fiberscope was unable to pass through the stenosis. A biopsy confirmed a diagnosis of signet-ring cell carcinoma. Using abdominal computed tomography, thickening of the ascending colon wall, suggesting infiltration to the periphery, was visible. The adjacent lymph nodes were enlarged, but there were no clear signs of liver metastasis. Cancerous peritonitis was suspected due to the presence of ascitic fluid. Considering the overall condition of the patient, surgery was not performed, and colonic stent was not placed due to the proximity of the stenosis to the ileocecal valve. The patient's family chose best supportive care. The patient's condition worsened and she died 3 months after leaving the hospital.
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Ohno Y, Kumagi T, Kuroda T, Koizumi M, Azemoto N, Yamanishi H, Oda M, Hirooka M, Abe M, Ikeda Y, Matsuura B, Onji M, Soga Y, Mizuno Y, Sugita A, Hiasa Y. Signet-ring cell carcinoma of the gallbladder complicated by pulmonary tumor thrombotic microangiopathy. Intern Med 2014; 53:1125-9. [PMID: 24881735 DOI: 10.2169/internalmedicine.53.1939] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Biliary drainage was performed in a 71-year-old man with obstructive jaundice of unknown origin; however, he died due to acute pulmonary failure. At autopsy, proliferation of adenocarcinoma cells was observed in the gallbladder mucosa transitioning from isolated signet-ring cell carcinoma (SRCC) to the subserosa and bile ducts without growth toward the gallbladder lumen. Furthermore, fibrocellular intimal proliferation, tumor emboli and organized thrombi were observed in the small pulmonary arteries. The final diagnosis was gallbladder carcinoma complicated by SRCC associated pulmonary tumor thrombotic microangiopathy (PTTM). PTTM may present as rapidly progressive dyspnea, and a high level of clinical suspicion is required to make the differential diagnosis.
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Affiliation(s)
- Yoshinori Ohno
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Japan
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Makino S, Okada K, Wada Y, Kato R, Takeoka T, Yanagisawa T, Okamura S, Fukuchi N, Ebisui C, Murata K, Yokouchi H, Kinuta M, Nakagomi N, Tamai M. [A case of jejunum cancer diagnosed by anemia]. Gan To Kagaku Ryoho 2013; 40:1720-1722. [PMID: 24393900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The patient was an 85-year-old woman who was referred to a nearby clinic complaining of shortness of breath. Blood test showed anemia, and she was referred to our hospital for identification of the source of bleeding. Upper and lower endoscopy were performed and revealed no abnormalities. Computed tomography (CT) was performed and showed a >7- cm thickening in the wall of her small intestine. The presence of small bowel cancer was suspected. Oral double-balloon endoscopy was performed and showed a near-circumferential ulcerative lesion in the jejunum that was causing small bowel stenosis. A biopsy yielded a diagnosis of signet-ring cell carcinoma. We performed a partial resection of the patient's jejunum. The histopathological diagnosis of the resected specimen (according to the Union for International Cancer Control [UICC]TNM Classification of Malignant Tumours, seventh edition) was poorly differentiated adenocarcinoma, signet-ring cell carcinoma, mucinous carcinoma, T2 (MP), N0, H0, P0, stage I. 7 months after surgery, the patient is alive without recurrence. The incidence of small intestinal cancer is generally reported to be 1% to 2% of all gastrointestinal malignancies. We report a rare case in which cancer of the small intestine was identified during investigation of anemia.
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25
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Hansen MS, Chi SL, Cummings T, Woodward JA. Uncorrectable ptosis: primary cutaneous signet-ring cell carcinoma. Dermatol Online J 2013; 19:19615. [PMID: 24050289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 09/13/2013] [Indexed: 06/02/2023] Open
Abstract
Primary cutaneous signet-ring cell carcinoma (PCSRCC) is a rare but aggressive tumor. Our case highlights a 60-year-old man who presented with eyelid ptosis, for which he underwent multiple surgical procedures over a 3-year period prior to referral to our clinic. These procedures were complicated by scarring, delayed healing, and poor cosmetic outcome. In addition, the patient was noted to develop progressive enophthalmos. These concerning signs led to a CT scan and subsequent eyelid biopsy, which revealed a diagnosis of PCSRCC. Further management has involved an MRI and orbitotomy with biopsy revealing widespread extension of the carcinoma. Exenteration was performed to reduce the likelihood of metastasis. There are few documented case reports of PCSRCC of the eyelid in the literature. Of the 33 published cases of PCSRCC, 27 cases involve the eyelids and the other 6 cases involve the axilla. The unique clinical features of this case will be discussed, in particular the presentation as ptosis, an otherwise commonplace complaint in the oculoplastics clinic. The surgical course and histopathologic findings will be presented. The literature regarding PCSRCC will be reviewed including demographics, management, and prognosis. Although rare, PCSRCC follows an aggressive course with characteristically delayed diagnosis. Early identification and treatment likely offer a better prognosis. Thus, description of the clinical presentation of this rare tumor may aid in recognition and earlier treatment.
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26
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Velciov S, Hoinoiu B, Hoinoiu T, Popescu A, Gluhovschi C, Grădinaru O, Popescu M, Moţiu F, Timar R, Gluhovschi GH, Sporea I. Aspects of renal function in patients with colorectal cancer in a gastroenterology clinic of a county hospital in Western Romania. Rom J Intern Med 2013; 51:164-171. [PMID: 24620629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Colorectal cancer represents the third cause of cancer. Since its detection in due time is important resolution, appropriate monitoring is mandatory. The present study deals with the relationship between colorectal cancer and renal function, as well as other associated risk factors. Chronic kidney disease (CKD) represents a risk factor of cancer, both in non-dialysed patients and especially in dialysed patients and in patients with renal transplant. It can get aggravated with cancer in general and particularly with colorectal cancer, partly related to the toxins that cannot be appropriately eliminated because of renal functional disturbances. At the same time, immunosuppressive therapy used for treating glomerular or secondary nephropathies represents an important risk factor of cancer. Some patients with colorectal cancer were found to present also impaired renal function, a fact whose significance is still little known. The object of the present paper is an analysis of the case records of a clinic of gastroenterology on the relationship between colorectal cancer and renal functional impairment. We found in the patients with colorectal cancer under study a glomerular filtration rate (GFR calculated with the EPI formula) of < 60 ml/min/1.73m2 in 31/180 patients, respectively 17.22% of the cases, a value that is similar to that in specialised literature. We also analysed associated risk factors that could be related to renal function impairment in these patients: age, gender, anaemia, diabetes mellitus and hypertension. These could represent, together with the colorectal cancer of the investigated patients, risk factors affecting on the one hand renal function, and on the other hand, potentially increasing the risk of cancer. Correction of these risk factors would have beneficial effects on patients. The relationship between renal functional impairment, respectively CKD, and colorectal cancer is to be regarded from the point of view of complex reciprocity: the impairment of the renal function is a factor of risk of colorectal cancer and colorectal cancer can influence renal function of these patients. This report of reciprocity based on important pathogenic mechanisms also interrelates with factors of risk consecutive to both renal function impairment and colorectal cancer.
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27
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Reda M, El Majzoub N, Eloubeidi MA. Medical image. Acanthosis nigricans maligna. N Z Med J 2013; 126:104-105. [PMID: 23824031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Mariam Reda
- American University of Beirut Medical Center, P.O. Box 11-0236 Riad El Solh 110 72020 Beirut, Lebanon
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Abstract
The development of aortic thrombosis without the presence of atheroscrelosis, dissection, or aneurysms is rare. A cancer-related hypercoagulable state is a well-known risk factor for venous thrombosis, however, atrial thrombosis has rarely been reported in cancer patients. Cisplatin-based chemotherapy is known to cause various side-effects. Detecting aortic thrombosis is important because it is a fatal condition. We herein present the first reported case of endo-aortic thrombosis occurring during cisplatin-based chemotherapy for gastric cancer.
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Kayatani H, Matsuo K, Ueda Y, Matsushita M, Fujiwara K, Yonei T, Yamadori I, Shigematsu H, Andou A, Sato T. Pulmonary tumor thrombotic microangiopathy diagnosed antemortem and treated with combination chemotherapy. Intern Med 2012; 51:2767-70. [PMID: 23037471 DOI: 10.2169/internalmedicine.51.7682] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 29-year-old man developed a persistent dry cough. Chest high-resolution computed tomography (HRCT) revealed centrilobular ultrafine granular shadows scattered in all lung fields. A lung biopsy with video-assisted thoracoscopic surgery revealed findings compatible with pulmonary tumor thrombotic microangiopathy (PTTM). However, the primary tumor was not identified. Combination chemotherapy with S-1 and cisplatin decreased his cough and improved the chest HRCT findings. The illness, however, gradually became difficult to control. He eventually developed pulmonary hypertension and died. Typically, an antemortem diagnosis of PTTM cannot be made. In this case, the diagnosis of PTTM and combination chemotherapy improved the chest HRCT findings, respiratory symptoms, and prognosis.
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Affiliation(s)
- Hiroe Kayatani
- Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan.
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30
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Yasui H, Akamatsu T, Nakamura Y, Inui N, Suda T, Chida K, Meguro S, Baba S. [A case of pulmonary tumor thrombotic microangiopathy induced by early gastric cancer]. Nihon Kokyuki Gakkai Zasshi 2011; 49:122-127. [PMID: 21400909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A 56-year-old man with chief complaints of dry cough and dyspnea was admitted. He had severe hypoxemia, and his chest radiographs showed enhancement of pulmonary artery opacities with multiple defects on pulmonary blood flow scintigraphy. Enhanced computed tomography (CT) revealed swelling of the mediastinum and hilar lymph nodes, but no apparent thrombi in the pulmonary arteries was seen. A biopsy specimen of a left neck lymph node showed poorly differentiated adenocarcinoma, including signet-ring cell carcinoma components, but the origin was unclear. Despite receiving chemotherapy, his respiratory condition worsened, and he died 3 days after admission. Routine autopsy failed to clarify the tumor origin, but a detailed dissection of specimens confirmed early gastric cancer. Additionally, pathology of the pulmonary arteries was compatible with pulmonary tumor thrombotic microangiopathy (PTTM). PTTM is a rare condition characterized by the presence of diffuse thrombotic microthrombi and fibrocellular intimal proliferation in the pulmonary vasculature. Accompanied with early gastric cancer, this is an extremely rare but important case of PTTM.
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Affiliation(s)
- Hideki Yasui
- Department of Respiratory Medicine, Hamamatsu University School of Medicine, Hamamatsu University Hospital
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Sarikaya D, Varan O, Ozen G, Dogan E, Altundag K. Late recurrence of granulosa cell tumor of the ovary with synchronous gastric signet-ring cell carcinoma. J BUON 2010; 15:799-800. [PMID: 21229651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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33
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Kountourakis P, Ardavanis A. Visual and hearing loss due to colorectal meningeal carcinomatosis: a case-based review. Clin Adv Hematol Oncol 2010; 8:567-568. [PMID: 20966894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Bruce BB, Tehrani M, Newman NJ, Biousse V. Deafness and blindness as a presentation of colorectal meningeal carcinomatosis. Clin Adv Hematol Oncol 2010; 8:564-566. [PMID: 20966893 PMCID: PMC3674494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We present a unique case of a patient with deafness and blindness secondary to carcinomatous meningitis from colorectal adenocarcinoma with accompanying radiologic and pathologic images and a brief review of the relevant literature.
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Affiliation(s)
- Beau B Bruce
- Department of Ophthalmology, Emory University, Atlanta, GA 30322, USA.
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35
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Chinen K, Tokuda Y, Fujiwara M, Fujioka Y. Pulmonary tumor thrombotic microangiopathy in patients with gastric carcinoma: an analysis of 6 autopsy cases and review of the literature. Pathol Res Pract 2010; 206:682-9. [PMID: 20554399 DOI: 10.1016/j.prp.2010.05.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2010] [Revised: 05/01/2010] [Accepted: 05/10/2010] [Indexed: 11/18/2022]
Abstract
Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare clinicopathological entity causing severe pulmonary hypertension (PH). Its histological features include widespread tumor emboli of the small arteries and arterioles of the lung, associated with thrombus formation and fibrocellular and fibromuscular intimal proliferation. Although PTTM has drawn increased attention as a fatal complication of gastric carcinoma (GC), comprehensive studies are still lacking. In order to clarify clinical and pathological features of GC-induced PTTM, recent autopsy cases were analyzed with a review of the literature. Of 36 autopsy cases with GC, 6 (16.7%) were affected by PTTM. Four were male and 2 female, with a mean age of 72.7 years. Three patients presented with PTTM-related clinical manifestations and died of PTTM. They showed clear morphological evidence of PH. The other 3 patients had PTTM as an incidental finding irrespective of clinical manifestations or PH. No patient was diagnosed antemortem as PTTM. All PTTM cases were associated with advanced GC, with a histology of adenocarcinoma of poorly differentiated type (n=4) or signet-ring cell type (n=2). Expression of tissue factor and vascular endothelial growth factor was confirmed immunohistochemically in tumor cells in all cases. The results were all in line with previous studies. In addition, the current study revealed vascular lesions characteristic of PTTM morphology to be present exclusively in the lung. In conclusion, our study shows a 16.7% incidence of PTTM in GC patients, with half of them developing PH and dying of PTTM, confirming a clinical significance as a non-negligible lethal complication of GC. In addition to many known clinicopathological characteristics of PTTM, the current study pointed to some PTTM issues requiring clarification, including the pathogenesis of the exclusive pulmonary distribution of vascular lesions of PTTM. Since details remain to be elucidated, interdisciplinary research is a high priority with a close collaboration between pathologists and clinicians in order to overcome this lethal condition.
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Affiliation(s)
- Katsuya Chinen
- Department of Pathology, Kyorin University School of Medicine, Mitaka-city, Tokyo 181-8611, Japan.
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36
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Rosenblum H, Bar-Dayan Y, Dovrish Z, Lew S, Weisenberg N, Neumann A, Klein T, Amital H. The endless differential diagnosis of acute obstructive renal failure: unusual challenges for the sharp-sighted clinician. Isr Med Assoc J 2010; 12:280-282. [PMID: 20929080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Obstruction of urine outflow can result from mechanical blockade as well as from functional defects. In adults, urinary tract obstruction is due mainly to acquired defects, such as pelvic tumors, calculi, and urethral stricture. In childhood it is mostly due to congenital malformations. In this article we present two rare cases of acute obstructive renal failure that presented with hydronephrosis. These cases underline the wide range of causes that may lead to this clinical feature.
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Affiliation(s)
- Hemda Rosenblum
- Department of Medicine D, Meir Medical Center, Kfar Saba, Israel
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37
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Yasuda C, Yakushiji Y, Tokunaga O, Hara H, Nishino I. [Case of systemic myositis and subacute sensory neuropathy concomitant with signet-ring cell carcinoma]. Rinsho Shinkeigaku 2010; 50:246-251. [PMID: 20411807 DOI: 10.5692/clinicalneurol.50.246] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
A 72-year-old woman referred to our hospital because of slowly progressive (over 2 years) muscle weakness and paresthesias of the lower limbs. On neurological examination, weakness and muscle atrophies were noted in the distal upper limbs as well as the proximal lower limbs. She had also paresthesias of the legs. The level of creatinine phosphokinase (CK) was 126 IU/l. The magnetic resonance imaging demonstrated gadolinium enhancement of the nerve roots at the L4-S2 vertebrate levels. Nerve conduction study showed decreased compound muscle action potential and motor conduction velocity of tibial and peroneal nerves. Biopsy of the left biceps brachii muscle showed variations in fiber size, endomysial mononuclear cell infiltration and the findings like a rimmed vacuole. Although almost of her findings were in accord with clinical features of inclusion body myositis, strong inflammatory cellular influences allowed us to administer corticosteroid therapy. Because her weakness was well responded to steroid therapy, polymyositis was considered as differential diagnosis. Then, further examinations were investigated to search any occult neoplasm, and detected the early gastric cancer. Total gastrectomy was performed later, and the pathological diagnosis was made as a signet-ring cell carcinoma. To our knowledge, this is the first report of systemic myositis and subacute sensory neuropathy concomitant with signet-ring cell carcinoma. These symptoms might be occurred as a result of paraneoplastic syndrome associated with satellite effects of the signet-ring cell carcinoma.
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Zhang BL, Xu RL, Zheng X, Qin YW. A case with cardiac tamponade as the first sign of primary gastric signet-ring cell carcinoma treated with combination therapy. Med Sci Monit 2010; 16:CS41-CS44. [PMID: 20357721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND This report presents a rare patient with cardiac tamponade as the first manifestation of primary gastric signet-ring cell carcinoma. CASE REPORT A 56-year-old woman with emergent dyspnea, anterior chest oppression, and hypotension was diagnosed as having cardiac tamponade due to massive pericardial effusion. The endoscopic examination of the stomach disclosed gastric cancer in the posterior wall of the antrum and the biopsy showed signet-ring cell carcinoma. The gastric cancer was complicated by malignant pericardial effusion and pleural effusion as well as metastasis to the peripheral lymph nodes and bones. The patient was treated with percutaneous pericardiocentesis followed by systemic chemotherapy (oxaliplatin and sequential 5-fluorouracil plus leucovorin). The pericardial effusion gradually disappeared and there was no cardiac tamponade occurrence. The patient has survived more than 6 months so far. CONCLUSIONS Cardiac tamponade may originate from a primary gastric signet-ring cell carcinoma. Pericardiocentesis followed by systemic chemotherapy may be effective in controlling such advanced gastric signet-ring cell carcinoma.
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Affiliation(s)
- Bi-li Zhang
- Department of Cardiology, Affiliated Changhai Hospital of the Second Military Medical University, Shanghai, 200433, China
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Chong VH. Diagnosing functional abdominal disorders: evaluations are mandatory in those with warning symptoms. J Gastrointestin Liver Dis 2010; 19:109-110. [PMID: 20361091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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40
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Hayashi Y, Kato T, Tanaka Y, Yamada M, Koumura A, Kimura A, Hozumi I, Inuzuka T. Markedly ring-enhanced optic nerves due to metastasis of signet-ring cell gastric carcinoma. Intern Med 2010; 49:517. [PMID: 20190499 DOI: 10.2169/internalmedicine.49.3081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Yuichi Hayashi
- Department of Neurology and Geriatrics, Gifu University Graduate School of Medicine.
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Yalta T, Elagoz S, Uyar M, Topuz O, Ozer H, Tuncer E. Signet ring cell adenoma of the thyroid: a very rare entity. Med Princ Pract 2010; 19:76-8. [PMID: 19996625 DOI: 10.1159/000252840] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Accepted: 05/01/2009] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To report a case of signet ring cell adenoma of the thyroid which is an extremely rare thyroid lesion. CLINICAL PRESENTATION AND INTERVENTION A 25-year-old female patient presented with a goiter and dysphagia that had been present for the last 1 year before admission. Physical examination revealed a palpable solitary nodule in the right lobe of the thyroid. The ultrasonogram demonstrated multiple nodules among which the most remarkable one was 15 x 24 mm in size, in the right lobe of the thyroid. After surgical excision, the lesion was found to be consistent withsignet ring cell adenomacharacterized by the presence of round to oval signet ring cells with large cytoplasmic vacuoles and hyperchromatic eccentric nuclei. Intracytoplasmic thyroglobulin, periodic acid-Schiff (PAS) with and without diastase and combined Alcian-blue-PAS were all positive. CONCLUSIONS Pathologists should keep this rare primary tumor of the thyroid in mind when examining thyroid lesions and should not confound it with metastatic signet ring cell carcinoma of the thyroid.
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Affiliation(s)
- Tulin Yalta
- Department of Pathology, Sivas State Hospital, Sivas, Turkey.
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Miwa M, Kasamatsu N, Shibata M, Ogasawara T, Kobayashi T, Haga T, Hashizume I. [A case of gastric cancer with bilateral chylothorax]. Nihon Kokyuki Gakkai Zasshi 2009; 47:1115-1119. [PMID: 20058689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The patient, a 77 year-old woman, visited our hospital with chief complaints of coughing and dyspnea. Chest radiography revealed bilateral pleural effusion especially on the right side, and she was admitted to our hospital to undergo a more thorough examination. The pleural effusion was identified as chyle. In cytodiagonosis, a number of adenocarcinoma cells in clumps were detected. After admission, her general condition worsened, and she died. Her condition was diagnosed as advanced gastric carcinoma on pathological dissection. Generally malignant lymphoma is most often reported as a cause of non-traumatic chylothorax. Because gastric carcinoma associated with bilateral chylothorax is very rare, we report the results of our study with some discussion based on a review of the literature.
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Affiliation(s)
- Masashi Miwa
- Department of Respiratory Medicine, Hamamatsu Medical Center
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Abstract
BACKGROUND Signet ring cell carcinoma is a very rare subtype of adenocarcinoma of the urinary bladder. Urine cytology is a useful method for screening and followup of urinary bladder carcinoma. CASE A 43-year-old woman was referred for evaluation of painless hematuria. Laboratory evaluation showed anemia, hematuria and elevated tumor marker levels. Pelvic computed tomography (CT) demonstrated diffuse wall thickening, and the chest CT suggested metastatic lesions in the lung and hepatic dome. Abdominal CT, esophagogastroduodenoscopy and colonoscopy revealed no evidence of malignancy in the gastrointestinal tract. Cystoscopy revealed very large masses in the anterior and posterior wall of the bladder. Bladder washings, urine cytology and biopsy demonstrated characteristic signet ring cells without foci of urothelial carcinoma or other lesions. Three months later, ascitic fluid was obtained; the results showed signet ring cells identical to those seen in the urine specimen. CONCLUSION Signet ring cell carcinoma of the urinary bladder can be diagnosed by urinary cytology and confirmed by cystoscopic biopsy.
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Affiliation(s)
- Sung Sun Kim
- Department of Pathology, Chonnam National University Medical School, and Genome Research Center for Hematopoietic Diseases, Chonnam National University Hwasun Hospital, Chonnam, Republic of Korea
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Okazaki Y, Yonezawa K, Shimomatsuya T, Komai Y, Yukioka N. [A case of pseudo-Meigs' syndrome caused by metastatic ovarian tumors from gastric cancer]. Nihon Shokakibyo Gakkai Zasshi 2009; 106:529-535. [PMID: 19346721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
A 54-year-old woman brought by ambulance had a lower abdominal mass and cough. Bilateral pleural effusion was revealed by X-ray and CT. An abdominal CT and MRI disclosed bilateral ovarian tumors which were considered to be metastatic tumors. GI endoscopy disclosed IIc-like advanced gastric cancer on the posterior wall of the stomach. Distal gastrectomy, total hysterectomy and bilateral adnexectomy were carried out. Gastric cancer was pathologically diagnosed as signet-ring cell carcinoma. Ovarian tumors had a similar histology, which suggested metastasis from gastric cancer. Since bilateral pleural effusion completely vanished after the ovarian resection, we concluded that this case coincided with pseudo-Meigs' syndrome. Pseudo-Meigs' syndrome of metastatic ovarian tumor from gastric cancer is very rare, only 3 cases having been reported in Japan.
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Affiliation(s)
- Yuji Okazaki
- Department of Surgery, Nagahama Red Cross Hospital, Japan.
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Sierra Ausin M, Linares Torres P, Alvarez Posadilla M, Díez Rodríguez R, Rascarachi G, Arias Rodríguez L, Olcoz Goñi JL. [Signet-ring cell adenocarcinoma of the duodenal bulb]. Gastroenterol Hepatol 2008; 31:107-8. [PMID: 18279652 DOI: 10.1157/13116082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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46
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Affiliation(s)
- Edward T Ryan
- Division of Infectious Disease, Massachusetts General Hospital, USA
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47
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Schott M, Sagert C, Willenberg HS, Schinner S, Ramp U, Varro A, Raffel A, Eisenberger C, Zacharowski K, Perren A, Scherbaum WA. Carcinogenic hypergastrinemia: signet-ring cell carcinoma in a patient with multiple endocrine neoplasia type 1 with Zollinger-Ellison's syndrome. J Clin Endocrinol Metab 2007; 92:3378-82. [PMID: 17609302 DOI: 10.1210/jc.2007-0283] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
CONTEXT Gastric neuroendocrine tumors are rare neoplasms that originate from gastric enterochromaffin-like (ECL) cells in the oxyntic mucosa. Gastrin and its derivates have been reported to regulate epithelial cell proliferation, migration, and differentiation. Mutations in the epithelial cadherin (E-cadherin) gene have been shown to be associated with the occurrence of diffuse gastric carcinomas in affected families. OBJECTIVE In this study we investigated the histopathological and molecular findings in the gastrointestinal wall of a patient with multiple endocrine neoplasia type 1 with malignant duodenal gastrinoma and multiple gastric ECL cell tumors, who additionally developed a signet-ring cell carcinoma of the stomach. DESIGN AND PATIENT Biopsies from the gastrointestinal tract of a patient with multiple endocrine neoplasia type 1 were immunostained for vesicular monoamine transporter-2 and E-cadherin. Nonamidated gastrin products were measured in the serum of the patient using antibodies that react with progastrin, Gly-extended, and amidated gastrins. Genetic analyses were performed to exclude germ-line mutations within the E-cadherin gene. RESULTS Immunohistochemical studies of gastric ECL cell tumors showed a largely diminished E-cadherin expression in comparison to gastric surface mucosa cells and a loss of E-cadherin expression in the cells of the signet-ring carcinoma. Detailed biochemical measurements revealed progastrin concentrations that were approximately 20%, and Gly-gastrin concentrations that were approximately 10% the amidated gastrin concentrations in plasma. Molecular analyses revealed no E-cadherin germ-line mutation. CONCLUSION Our immunohistochemical studies might suggest that the gastrinoma-associated excessive progastrin tissue concentrations led to diminished expression of E-cadherin within the gastric mucosa and promoted tumor development of a signet-ring cell carcinoma.
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Affiliation(s)
- Matthias Schott
- Department of Endocrinology, Diabetes and Rheumatology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany.
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Lanznaster G, Adami M, Crivellaro C, Kluge R, Egarter-Vigl E, Wiedermann CJ. Gastric signet-ring cell carcinoma: unilateral lower extremity lymphoedema as the presenting feature. ScientificWorldJournal 2007; 7:1189-92. [PMID: 17704851 PMCID: PMC5901145 DOI: 10.1100/tsw.2007.199] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Gudrun Lanznaster
- 1Division of Internal Medicine 2, Department of Medicine, Central Hospital of Bolzano, L. Böhler Street 5, I-39100 Bolzano, Italy
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Sakashita N, Yokose C, Fujii K, Matsumoto M, Ohnishi K, Takeya M. Pulmonary tumor thrombotic microangiopathy resulting from metastatic signet ring cell carcinoma of the stomach. Pathol Int 2007; 57:383-7. [PMID: 17539970 DOI: 10.1111/j.1440-1827.2007.02111.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Pulmonary tumor thrombotic microangiopathy is an unusual malignancy-related respiratory complication characterized by multiple microthrombi and intimal myofibroblast proliferation. Its clinical manifestation is subacute respiratory failure with pulmonary hypertension. Herein is reported a case of pulmonary tumor thrombotic microangiopathy associated with gastric signet ring cell carcinoma. A 51-year-old woman with gastric cancer died of subacute respiratory failure. Autopsy showed gastric signet ring cell carcinoma with diffuse metastasis of pulmonary lymphatics and pleurae; every organ examined lacked a space-occupying tumor mass. Histologically, proliferated intimal myofibroblasts obliterated most of the pulmonary vascular lumen, and a few stenosed vascular lumina contained cancer cells. In addition, pulmonary vasculature associated with intimal proliferation contained microthrombi. Most cancer cells in the stomach and pulmonary lymphatics were typical signet ring cells, whereas those in vascular lesions were cells of poorly differentiated adenocarcinoma without mucous production. Consistent with a previous report, the latter expressed vascular endothelial growth factor (VEGF) and tissue factor (TF). The proliferated intimal myofibroblasts also expressed type 2A serotonin receptor (5-HT(2A)). These findings suggest that local expression of VEGF, TF, and 5-HT(2A) may be linked to the pathogenesis of this unusual pulmonary complication.
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MESH Headings
- Carcinoma, Signet Ring Cell/complications
- Carcinoma, Signet Ring Cell/metabolism
- Carcinoma, Signet Ring Cell/secondary
- Endothelium, Vascular/metabolism
- Endothelium, Vascular/pathology
- Fatal Outcome
- Female
- Humans
- Hypertension, Pulmonary/etiology
- Hypertension, Pulmonary/pathology
- Lung/blood supply
- Lung/pathology
- Lung Neoplasms/complications
- Lung Neoplasms/metabolism
- Lung Neoplasms/secondary
- Microcirculation/metabolism
- Microcirculation/pathology
- Middle Aged
- Neoplastic Cells, Circulating/pathology
- Receptor, Serotonin, 5-HT2A/metabolism
- Respiratory Insufficiency/etiology
- Respiratory Insufficiency/pathology
- Stomach Neoplasms/complications
- Stomach Neoplasms/metabolism
- Stomach Neoplasms/pathology
- Thromboembolism/pathology
- Thromboplastin/metabolism
- Vascular Endothelial Growth Factor A/metabolism
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Affiliation(s)
- Naomi Sakashita
- Department of Cell Pathology, Graduate School of Medical Sciences, Kumamoto University, Honjo, Kumamoto, Japan.
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50
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Chung DC, Yoon SS, Lauwers GY, Patel D. Case records of the Massachusetts General Hospital. Case 22-2007. A woman with a family history of gastric and breast cancer. N Engl J Med 2007; 357:283-91. [PMID: 17634464 DOI: 10.1056/nejmcpc079016] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Daniel C Chung
- Gastroenterology Unit, Massachusetts General Hospital, USA
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