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      Lower Limb Edema Caused by Metastatic Signet Ring Cell Stomach Cancer

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          Abstract

          Overall gastric cancer incidence is decreasing, but incidence of gastric signet ring cell carcinoma has been rising. The diagnosis can be challenging. It has a poorer prognosis because it tends to be diagnosed at advanced stages. Lymphedema is a rare presentation. We report a rare presentation of signet ring cell carcinoma in a 49-year old male, with no underlying medical condition. The patient presented with lymphedema of lower limbs, scrotum and abdominal wall.

          LEARNING POINTS

          • Signet ring cell carcinoma tends to have an infiltrative behavior. Endoscopic analysis may not lead to any macroscopic finding.

          • In highly suspicious cases, endoscopic exploration should be complemented with an endoscopic ultrasound or blind random biopsies.

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          Signet-ring cell carcinoma of the stomach: Impact on prognosis and specific therapeutic challenge.

          Simon Pernot, Thibault Voron, Geraldine Perkins … (2015)
          While the incidence of gastric cancer has decreased worldwide in recent decades, the incidence of signet-ring cell carcinoma (SRCC) is rising. SRCC has a specific epidemiology and oncogenesis and has two forms: early gastric cancer, which can be resected endoscopically in some cases and which has a better outcome than non-SRCC, and advanced gastric cancer, which is generally thought to have a worse prognosis and lower chemosensitivity than non-SRCC. However, the prognosis of SRCC and its chemosensitivity with specific regimens are still controversial as SRCC is not specifically identified in most studies and its poor prognosis may be due to its more advanced stage. It therefore remains unclear if a specific therapeutic strategy is justified, as the benefit of perioperative chemotherapy and the value of taxane-based chemotherapy are unclear. In this review we analyze recent data on the epidemiology, oncogenesis, prognosis and specific therapeutic strategies in both early and advanced SRCC of the stomach and in hereditary diffuse gastric cancer.
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            Prognostic significance of signet ring gastric cancer.

            S A Taghavi, Senthil Jayarajan, Adam Davey … (2012)
            Studies in Asia have questioned the dictum that signet ring cell carcinoma (SRC) has a worse prognosis than other forms of gastric cancer. Our study determined differences in presentation and outcomes between SRC and gastric adenocarcinoma (AC) in the United States. The National Cancer Institute Surveillance, Epidemiology, and End Results database was reviewed for SRC and AC from 2004 to 2007. We reviewed 10,246 cases of patients with gastric cancer, including 2,666 of SRC and 7,580 of AC. SRC presented in younger patients (61.9 v 68.7 years; P < .001) and less often in men (52.7% v 68.7%; P < .001). SRC patients were more frequently black (11.3% v 10.9%), Asian (16.4% v 13.2%), American Indian/Alaska Native (0.9% v 0.8%), or Hispanic (23.3% v 14.0%; P < .001). SRC was more likely to be stage T3-4 (45.8% v 33.3%), have lymph node spread (59.7% v 51.8%), and distant metastases (40.2% v 37.6%; P < .001). SRC was more likely to be found in the lower (30.7% v 24.2%) and middle stomach (30.6% v 20.7%; P < .001). Median survival was not different between the two (AC, 14.0 months v SRC, 13.0 months; P = .073). Multivariable analyses demonstrated SRC was not associated with mortality (hazard ratio [HR], 1.05; 95% CI, 0.96 to 1.11; P = .150). Mortality was associated with age (HR, 1.01; 95% CI, 1.01 to 1.02; P < .001), black race (HR, 1.10; 95% CI, 1.01 to 1.20; P = .026), and tumor grade. Variables associated with lower mortality risk included Asian race (HR, 0.83; 95% CI, 0.77 to 0.91; P < .001) and surgery (HR, 0.37; 95% CI, 0.34 to 0.39; P < .001). In the United States, SRC significantly differs from AC in extent of disease at presentation. However, when adjusted for stage, SRC does not portend a worse prognosis.
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              Signet ring cells in carcinomatous lymphangitis due to gastric adenocarcinoma ☆ ☆☆

              Beatriz Souza, Renan Rangel Bonamigo, Gabriela Lusa Viapiana … (2020)
              Cutaneous metastases are rare. They usually present as nodules or tumors. Diagnosis is based on histopathological examination and prognosis is unfavorable. This report describes the case of a female patient, 72 years old, with surgically treated gastric antrum adenocarcinoma. Pathology showed poorly differentiated adenocarcinoma with signet ring cells. It evolved with bone involvement, lymph node enlargement in the inguinal region, and skin infiltration in the lower limbs, abdomen, and root of the upper limbs. Skin biopsy demonstrated signet ring carcinoma embolizing the dermal and hypodermic vessels and invasion of adipose tissue, confirming carcinomatous lymphangitis. Carcinomatous lymphangitis is the cutaneous and subcutaneous lymphatic invasion by tumor cells. Cutaneous metastasis is relatively uncommon and presents mainly as cutaneous or subcutaneous nodules, and more rarely as inflammatory lesions. The present case reports carcinomatous lymphangitis associated with gastric cancer.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Eur J Case Rep Intern Med
                Title: European Journal of Case Reports in Internal Medicine
                Publisher: SMC Media Srl
                ISSN (Electronic): 2284-2594
                Publication date Collection: 2023
                Publication date (Electronic): 07 August 2023
                Volume: 10
                Issue: 9
                Electronic Location Identifier: 003848
                Affiliations
                Internal Medicine Department at Hospital Santa Maria Maior, Portugal
                Author notes
                Corresponding author: Dany Cruz, e-mail: danycamposcruz@ 123456gmail.com
                Article
                Publisher ID: 3848
                DOI: 10.12890/2023_003848
                PMC ID: 10482131
                PubMed ID: 37680782
                SO-VID: 0e038c2f-70e8-4af4-91a7-fa240050c084
                Copyright © © EFIM 2023
                License:

                This article is licensed under a Commons Attribution Non-Commercial 4.0 License

                History
                Date received : 04 March 2023
                Date accepted : 12 March 2023
                Categories
                Subject: Article

                Keywords: signet ring cell carcinoma,gastric cancer,paraneoplastic syndrome
                Data availability:
                Keywords: signet ring cell carcinoma, gastric cancer, paraneoplastic syndrome

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