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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
Copyright: (c) 2002-2009, PathologyOutlines.com, Inc.
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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