Document Type : Case Report
Authors
1 Cancer Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran & Clinical Research Development Center, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran
2 Pathology department, Babol University of Medical Sciences, Babol, Iran
Abstract
Background: Pulmonary carcinoma is a burdensome malignancy that has the third rank in prevalence among other cancers and is the leading cause of death in patients with cancer diagnosis. Signet ring morphology is encountered commonly in many sites like stomach, bladder, gallbladder and etc. Primary signet ring adenocarcinoma of the lung is a rare phenomenon, including about 5% of all surgically removed pulmonary adenocarcinoma. It should be distinguished from metastatic tumors.
Case presentation: a 34-year-old nonsmoker man who referred to Babol Rohani Hospital with a one-month history of nonproductive cough. Biopsy with CT scan guidance from ground-glass opacities of the left lung revealed neoplastic cells with signet ring appearance infiltrating lung parenchyma. Immunohistochemistry (IHC) study revealed positivity of neoplastic cells for AE1/AE3, CK7, TTF-1 and negativity for CK20, CDX2, and CD68.
Conclusion: The signet ring feature of pulmonary adenocarcinoma has shorter survival, therefore, it is associated with poor prognosis. Immunohistochemistry (IHC) techniques provide the ability to originate tumor cells in these conditions.
Keywords
- Vallonthaiel AG, Jain D, Madan K, Arava S. Pulmonary adenocarcinoma with signet ring features: Detailed cytomorphologic analysis. Diagn 2016; 44(7):607-11. doi: 10.1002/dc. 23492.
- Mohammadi G, Vaziri Gohar A, Shakibaie M, Baghaie M. Detection of mutations in exons 5 and 8 of tumor suppressor tp53 gene in patients with squamous cell carcinoma of lung hospitalized in afzalipour hospital, Kerman, Iran. Journal of Kerman University of Medical Sciences, 2007; 14(2):90-99.
- Zeinalzadeh A, Kosha A, Abdolahi L, Naghizadeh M, Javaheri J. Pattern of age distribution of different cancers in East Azerbaijan province, IRAN. Journal of Kerman University of Medical Sciences, 2012; 19(3):308-316.
- 2. Tsuta K, Ishii G, Yoh K, Nitadori J, Hasebe T, Nishiwaki Y, Endoh Y, Kodama T, Nagai K, Ochiai A. Primary lung carcinoma with signet-ring cell carcinoma components: clinicopathological analysis of 39 cases. Am J Surg Pathol. 2004; 28(7):868-74. doi: 10.1097/00000478-200407000-00004.
- Moran CA. Pulmonary adenocarcinoma: the expanding spectrum of histologic variants. Arch Pathol Lab Med. 2006;130(7):958-62. doi: 10.5858/2006-130-958-PATESO..
- Colby TV, Noguchi M, Henschke C, Vazquez MF, Geiniger K, Yokosa T, et al. World Health Organization classification of tumours: Tumors of the lung, pleura, thymus and heart. Geneva, Switzerland: World Health Organization 2004.
- Travis WD, Brambilla E, Nicholson AG, Yatabe Y, Austin JHM, Beasley MB, et al. The 2015 world health organization classification of lung tumors: Impact of genetic, clinical and radiologic advances since the 2004 classification. J Thorac Oncol. 2015; 10(9): 1243-1260. doi: 10.1097/JTO.0000000000000630.
- Ou SH, Ziogas A, Zell JA. Primary signet-ring carcinoma (SRC) of the lung: a population-based epidemiologic study of 262 cases with comparison to adenocarcinoma of the lung. J Thorac Oncol. 2010; 5(4):420-7. doi: 10.1097/JTO.0b013e3181ce3b93.
- Cohen PR, Yoshizawa A, Motoi N, Riely GJ, Kris MG, Park BJ, et al. Signet ring cell features (SRCF) in lung adenocarcinoma: a cytologic feature or a histologic subtype? Mod Pathol. 2010; 23:400.
- Castro CY, Moran CA, Flieder DG, Suster S. Primary signet ring cell adenocarcinomas of the lung: a clinicopathological study of 15 cases. 2001; 39(4):397-401. doi: 10.1046/
j.1365-2559.2001.01224.x. - Maemondo M, Saijo Y, Ebina M, Abe T, Yaekashiwa M, Satoh K, et al. Rapidly progressive primary adenocarcinoma of the lung with signet-ring cells responding to 5-fluorouracil and leucovorin: A case report. Int J Clin Oncol. 1997; 2: 47-50. doi: 10.1007/BF02492597.
- McLeer-Florin A, Moro-Sibilot D, Melis A, Salameire D, Lefebvre C, Ceccaldi F, et al. Dual IHC and FISH testing for ALK gene rearrangement in lung adenocarcinomas in a routine practice: a French study. J Thorac Oncol. 2012; 7(2):348-54. doi: 10.1097/JTO.0b013e3182381535.
- Yoshida A, Tsuta K, Watanabe S, Sekine I, Fukayama M, Tsuda H, et al. Frequent ALK rearrangement and TTF-1/p63 co-expression in lung adenocarcinoma with signet-ring cell component. Lung Cancer. 2011; 72(3):309-15. doi: 10.1016/j.lungcan.2010.09.013.
- Rodig SJ, Mino-Kenudson M, Dacic S, Yeap BY, Shaw A, Barletta JA, et al. Unique clinicopathologic features characterize ALK-rearranged lung adenocarcinoma in the western population. Clin Cancer Res. 2009; 15(16):5216-23. doi: 10.1158/
1078-0432.CCR-09-0802. - Shaw AT, Yeap BY, Mino-Kenudson M, Digumarthy SR, Costa DB, Heist RS, et al. Clinical features and outcome of patients with non-small-cell lung cancer who harbor EML4-ALK. J Clin Oncol. 2009; 27(26):4247-53. doi: 10.1200/JCO. 2009.22.6993.
- Livieratos S, Smith JK, Fatakhov E, Koch CF Jr. Primary signet ring cell carcinoma of the lung: a rare subtype. BMJ Case Rep. 2013; 2013: bcr2013200111. doi: 10.1136/bcr-2013-200111.
- Hayashi H, Kitamura H, Nakatani Y, Inayama Y, Ito T, Kitamura H. Primary signet-ring cell carcinoma of the lung: histochemical and immunohistochemical characterization. Hum Pathol. 1999; 30(4):378-83. doi: 10.1016/s0046-8177(99)90111-9.
- Merchant SH, Amin MB, Tamboli P, Ro J, Ordóñez NG, Ayala AG, et al. Primary signet-ring cell carcinoma of lung: immunohistochemical study and comparison with non-pulmonary signet-ring cell carcinomas. Am J Surg Pathol. 2001; 25(12):1515-9. doi: 10.1097/00000478-200112000-00007.
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