Signet-ring type adenocarcinoma arising from a tiny gastric polyp - 23/08/11
Doi : 10.1016/j.gie.2007.10.045
Chia-Hsien Wu, MD, Ming-Jen Chen, MD, MS, Wen-Hsiung Chang, MD
Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital and Mackay Medicine, Nursing and Management College
Horng-Yuan Wang, MD, Shou-Chuan Shih, MD
Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital and Mackay Medicine, Nursing and Management College, Taipei, Taiwan
| Commentary A signet ring originally was an intaglio engraving bearing a seal or coat of arms and signifying the authenticity of the wearer’s aristocracy. Sigillography or sphragistics is the study of seals and is as old as the first written word. Today, signet rings are no longer symbols of power, and in histopathology, the term refers to a type of cancer cell in which the nucleus is pushed over to one side of the cell because of the cell’s high mucin content, giving the cell a signet ring appearance. Signet ring histology has been described in many adenocarcinomas—particularly those of gastric, urinary bladder, urethral, colorectal, mediastinal, and pulmonary origin. Signet ring cell carcinoma of the stomach accounts for a percentage of stomach cancers ranging from 3.4% in Japan to 29% in Western countries, and is reported to be more frequent in female patients and patients of younger age than those with nonsignet ring cancers. Signet ring cancers typically diffusely infiltrate the gastric wall and cause a marked scirrhous reaction. They also tend to be larger and to spread superficially in the mucosa and submucosa, making them more amenable to early detection. The natural history of this disease is quite aggressive, although the majority of cases will not have transmural invasion. In this particular case, the gastric polyp was quite small and unimpressive, thus emphasizing that the size and endoscopic appearance of polyps cannot be used absolutely to predict their histology. While the vast majority of tiny gastric polyps are benign, adenocarcinoma can develop within one on occasion. Hence, biopsy or endoscopic polypectomy should be considered when polyps are encountered. Lawrence J. Brandt, MD Associate Editor for Focal Points |
© 2008
American Society for Gastrointestinal Endoscopy. Publié par Elsevier Masson SAS. Tous droits réservés.
Vol 67 - N° 4
P. 724-725 - avril 2008 Retour au numéro
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