Metastasis of Gastric Signet-Ring Cell Carcinoma to the Urinary Bladder: A Case Report and Review of the Literature

Abstract

Although signet-ring cell (SRC) adenocarcinoma is commonly seen in the stomach, it is a very rarely seen histologic entity in the bladder. It is difficult to distinguish primary SRC adenocarcinoma of the bladder from bladder metastasis of SRC carcinoma of the stomach only based on histological findings. In such cases, clinical findings and immunohistochemical studies may be helpful. We present here a 48-year-old male patient presenting with hematuria and abdominal pain. Computerised tomography of the patient revealed a gastric mass, peritoneal involvement, and thickening of the bladder wall, and histopathological analysis revealed SRC adenocarcinoma in both of the endoscopic biopsies taken from the stomach and bladder. Immunohistochemical analyses confirmed the diagnosis of SRC adenocarcinoma of the bladder secondary to gastric cancer.

Bladder metastasis of gastric signet-ring cell carcinoma

“…Mucicarmine is positive at a high rate in mucin producing tumors and particularly in gastrointestinal malignancies. 3 In our case we obtained CK7(+), CK20 focally (+), Gata 3(−), Uroplakin(−) and histochemical analyses, mucicarmine(+), PAS/AB(+), intraextracelluler mucin(+).…”

“…There are less than 20 cases in the literature. 3 The presence of adenocarcinoma in a transurethral resection (TUR) specimen should raise suspicion of secondary involvement. 1 Cystoscopic evaluation might be helpful for the diagnosis: in fact, usually secondary tumors are almost always solitary and are mostly (54%) located in the bladder neck or trigone region unlike primary bladder tumors.…”

“…1 Cystoscopic evaluation might be helpful for the diagnosis: in fact, usually secondary tumors are almost always solitary and are mostly (54%) located in the bladder neck or trigone region unlike primary bladder tumors. 3 Immunohistochemical studies may be helpful. Torenbeek et al reported, at least focally, of CK7 in 82% positive of cases and CK20 in 73% positive, whereas a CK20-positive and CK7-negative profile was detected in only 29% of the cases of primary adenocarcinomas of the bladder.…”

“…The overall outcome for signet-ring cell cancers is very poor. 3 Bilici reported that; currently combination chemotherapy regimens as ECX (epirubicin, cisplatin and capecitabine), CX (cisplatin and capecitabine), EOX (epirubicin, oxaliplatin and capecitabine), IC (irinotecan and cisplatin) are preferred. These regimens have been found to be superior to the earlier gold standard of fluorouracil, doxorubicin and mitomycin.…”

“…Signet-ring cell carcinoma is a subtype of mucin producing adenocarcinomas, and is associated with aggressive clinical course and early metastatic disease. 3 We present a case with gastric signet-ring cell carcinoma metastasing to urinary bladder.…”