Breast malignant, males, children - Signet ring variant of lobular carcinoma

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Breast malignant, males, children

Carcinoma subtypes

Signet ring variant of lobular carcinoma

Reviewer: Monika Roychowdhury, M.D., (see Reviewers page)
Revised: 15 November 2012, last major update August 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

General
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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 features
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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)

Micro 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 signet ring morphology

Prominent signet ring cells

Vacuolated cytoplasm with crescentic nuclei

(AFIP)

Associated with papilloma

CK8

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%) (Am J Clin Pathol 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 also be a component of ductal 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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● Arch Pathol Lab Med 1994;118:245, Mod Pathol 1993;6:516

End of Breast malignant, males, children > Carcinoma subtypes > Signet ring variant of lobular carcinoma

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