Case 010096

Patient 54 yo with persistent epigastric pain. Endoscopy showed an irregular suspicious angular area. Biopsy: Signet ring  cell carcinoma. Gastrectomy performed.

Gastrectomy specimen opened along the greater curvature.

Close-up on the angular region, showing a ill defined flatened mucosae, with irregular depressed serpiginous areas.

Low power panoramic view of the antrum, showing mainly a preserved muscularis mucosae.

Closer views on the mucosae, demonstrate atrophy of the glands and an infiltrate of the lamina.

High power of previous fields: the infiltrate is formed by Signet Ring Cells (SRC)

Low power PAS stain.

Mucinous content of the SRC, microvacuolar type.

Immunohistochemistry Cytokeratins: Absence of invasion of the muscularis mucosa or the submucosa.

Diagnosis: Early gastric carcinoma, intramucosal signet ring cell type.

Macroscopic classification IIb-c (Jap Gast Endosc Soc)

Patterns of the surrounding mucosa (Does SRC Ca In Situ Exist?)

Lymphnode Status

References