Characteristics of primary signet ring cell carcinoma of colon and rectum: a case control study

Abstract

Background Primary signet ring cell carcinoma of the colon and rectum (PSRCCR) is rare, usually diagnosed at advanced stage with poor outcomes. We aimed to find possible diagnostic clues in order to help diagnosis. Methods A retrospective study of PSRCCR patients from 1993 to 2018 was reviewed at a single tertiary center. Colorectal adenocarcinoma patients as control group with 1:4 ratio was also enrolled. Results 18 patients with PSRCCR were identified. The prevalence rate was 0.16% (18 of 11,515). The mean age was 50.2 years-old in PSRCCR group and 63 years-old in non-SRCC colorectal cancer patients (p < 0.001). Diagnosis tool depends on colonoscopy were much less in PSRCCR group than control group (44.4% vs 93%, p < 0.001). SRCC patients had higher level of CEA (68.3 vs 17.7 ng/mL, p = 0.004) and lower level of Albumin (3.4 vs 4.3 g/dL, p < 0.001). The majority of PSRCCR tumor configuration was ulcerative and infiltrative. More PSRCCR pathology presented as high-grade carcinoma (66.7 vs 1.4%, p < 0.001) and lymphovascular invasion (77.8 vs 44.4%, p = 0.011) than control group. More PSRCCR patients were diagnosed at advanced stage (88.8 vs 40.3%, p = 0.001). Higher mortality was also noticed in PSRCCR group than control group (72.2 vs 20.8%, p < 0.001). Conclusion For young patients with long segment colonic stenosis and ulcerative/ infiltrative mucosa but endoscopic biopsy failed to identify malignant cells, earlier operation or non-colon site biopsy is suggested for diagnosing the PSRCCR.

Stage III and Metastatic Lymph Node Ratio Are the only Independent Prognostic Factors in Colorectal Signet-ring Cell Carcinoma Patients

“…The incidence of SRCC in our CRC population (1.32%) was similar to the one reported in the world literature (0.3%-4.6%) (10-17) with only one series showing an unusual higher rate (18%) (28). The reported sex prevalence is heterogeneous in the literature (9,12,12,21,(29)(30)(31); in our work, the female to male ratio was 25 to 14 (1.8:1). In line with some previous studies, in our cohort, SRCC showed higher incidence among elderly patients (mean age: 69.9 years); on the contrary, other authors demonstrated younger patients (mean age: 39 to 42 years) to be the most affected target-population advocating for a major local aggressiveness and predisposition to peritoneal carcinomatosis (9,(30)(31)(32)(33)(34)(35)(36).…”

“…more than 50% of the extracellular space, signet-ring cell carcinoma (SRCC) characteristically shows intracellular mucin accumulation and peripheral arrangement of the nuclei in more than 50% of tumor cells (4)(5)(6)(7)(8). SRCCs have been frequently described in the gastrointestinal tract (especially stomach) but also in the breast, lung, gallbladder, pancreas, ovary, cervix, urinary system and salivary glands (5,9). The large bowel represents a further, rare site of occurrence.…”

A call for standardized reporting of early-onset colorectal peritoneal metastases

“…Signet ring cell cancer (SRCC) tends to be detected at a late stage, resulting in a poor prognosis (Tung et al , 1996). SRCC cells are shaped like a signet ring; the ‘signet’ portion of the ring is formed by the nucleus pushing into the cell wall due to internal pressure from excess intracytoplasmic mucin (Benesch and Mathieson, 2020).…”

Predictors of Long-Time Survivors in Nonmetastatic Colorectal Signet Ring Cell Carcinoma: A Large Population-Based Study

“…Colorectal SRCC is a distinct subtype of colorectal cancer. According to previous reports, colorectal SRCC presents as high-grade carcinoma and is more commonly associated with lymphatic invasion, vascular invasion, perineural invasion, and more advanced tumor stage [ 36 , 37 ]. Besides, SRCC is a significantly prognostic factor for CRC [ 37 ].…”