Breast – Malignant, Males, Children - Signet ring variant of lobular carcinoma

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Breast-malignant, males, children

Signet ring variant of lobular carcinoma

Author: Nat Pernick, M.D, PathologyOutlines.com, Inc.

Reviewer: Daniel Visscher, M.D., University of Michigan Hospitals, February 2009 (see Reviewers page)

Revised: 16 September 2009

Last major update: September 2009

Definition

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● “Significant” number of cells with signet rings (20% in one study)

● First described in 1976 (Cancer 1976;37:828)

● Signet ring: a ring that can create a wax impression or seal to close an envelope or sign a document, in a secure, not easily copied way (image)

Clinical

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● Rare

● Signet ring appearance may be due to blockage in secretion because of deletion of necessary enzyme, or to disruption of E-cadherin/beta-catenin complex (J Pathol 2007;212:278)

● Associated with poor prognosis, metastases to GI tract and female genital tract (metastases may not have signet ring features)

Case reports

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● 50 year old woman presenting with abnormal cervicovaginal pap smear (Acta Cytol 2000;44:824)

● 57 year old woman with tumor associated with papilloma (Cases J 2009;2:130)

Microscopic description

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● “Significant” number of cells with signet rings (20% in one study)

● Cells not as bizarre as pleomorphic lobular carcinoma

● Some lobular features

Micro images

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Mixed classic and Prominent signet ring cells

signet ring morphology

Vacuolated cytoplasm with (AFIP) Associated with papilloma

crescentic nuclei

Prominent signet-ring cells Metastasis from breast

MUC1+ in primary (Fig 2A) CK8 Alcian Blue-PAS

and metastasis (Fig 2B)

Other images: vacuolated cytoplasm with crescentic nuclei

Positive stains

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● Mucin+ intracytoplasmic vacuoles (MUC1, 100%), CK7 (95%)

● ER (91%), PR (91%), GCDFP-15

● E-cadherin (29%) (AJCP 2004;121:884)

Negative stains

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● CDX2, HEPPAR1

Electron microscopy

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● Large membrane bound vacuoles

Differential diagnosis

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● Signet ring cells can be a component of ductal, lobular or mucinous/colloid carcinomas (Am J Clin Pathol 1980;73:31)

● GI metastasis (World J Gastroenterol 2006;12:2958)

Additional references

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● Archives 1994;118:245, Mod Path 1993;6:516

End of Breast – Malignant, Males, Children > Signet ring variant of lobular carcinoma

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