Clinicopathologic Features of Signet-ring Cell Carcinoma of the Colon and Rectum

Tomoki Makino, Hideyuki Mishima, Masakazu Ikenaga, Toshimasa Tsujinaka, Masashi Takeda* and Masayuki Mano*

Department of Surgery and Department of Pathology*, Osaka National Hospital

Introduction: Signet-ring cell carcinoma of the colon and rectum, although rare, bodes a dismal diagnosis, yet precise characteristics remain to be clarified. Methods: Among 3,169 patients we treated for colorectal carcinoma excluding patients with m disease, signet-ring cell carcinoma was found in 7 (0.2%). We compared clinicopathological characteristics and prognoses of different histological types of cancer-differentiated, poorly differentiated, mucinous, and signet-ring cell types. Results: In the 2 men and 5 women with signet-ring cell carcinoma, mean age was 45.7 years old and 4 tumors were located in the rectum, and 1 each in the cecum, sigmoid colon, and transverse colon. Three were Type 3 and 2 Type 1 tumors, with the depth of invasion ss (a1) or more in all. Lymph node metastasis was found in 5 of the 6 cases and peritoneal dissemination in 3 of the 7 cases, but no liver metastasis. Recurrent patterns in the 4 undergoing curative surgery (Cur A and B) were 2 local, 1 nodal, and 1 bone marrow recurrence. Mean survival was 319.9 days, with no 3-year survival, giving signet-ring cell carcinoma the worst prognosis of all histological types. Microsatellite instability was examined in 6 cases, with 3 showing positive results. Conclusion: To improve the prognosis of signet-ring cell carcinoma, early diagnosis and multimodal therapy, including the most up-date chemotherapy are vital.

Key words
colorectal signet-ring cell carcinoma, prognosis, recurrent pattern, microsatellite instability, clinicopathologic features

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Tomoki Makino Department of Surgery, National Hospital Organization Osaka National Hospital
2-1-14 Hoenzaka, Chuo-ku, Osaka, 540-0006 JAPAN

Accepted
June 22, 2005

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