Case Report
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Apr 7, 2008; 14(13): 2118-2120
Published online Apr 7, 2008. doi: 10.3748/wjg.14.2118
Primary rectal signet ring cell carcinoma with peritoneal dissemination and gastric secondaries
Hsien-Lin Sim, Kok-Yang Tan, Pak-Leng Poon, Anton Cheng
Hsien-Lin Sim, Kok-Yang Tan, Pak-Leng Poon, Anton Cheng, Department of Surgery, Alexandra Hospital, 378 Alexandra Road, 159964, Singapore
Author contributions: Sim HL and Tan KY wrote the paper, Poon PL and Cheng A were involved in the clinical discussion and management of the case.
Correspondence to: Hsien-Lin Sim, Department of Surgery, Alexandra Hospital, 378 Alexandra Road, 159964,
Telephone: +65-98636841
Fax: +65-64041478
Received: November 25, 2007
Revised: February 18, 2008
Published online: April 7, 2008
Abstract

Disseminated signet ring cell carcinomas frequently arise from the stomach. However, primaries in the colon and rectum have also been reported. We present a 68 year old lady who presented with a change in her bowel habit. Colonoscopy showed a stenosing rectal tumour at 7 cm to 8 cm from the anal verge. Multiple scattered ulcers were also noted along the entire length of the colon. Biopsy of the lesions revealed signet ring cell adenocarcinoma. Gastroscopy showed multiple nodules with ulceration over several areas of the stomach which were similar in appearance to the colonic lesions. However, no primary tumour of the stomach was seen. Biopsy of the gastric lesions also showed signet ring cell adenocarcinoma. Computed tomography scan of the abdomen and pelvis revealed circumferential tumour at the rectosigmoid junction with possible invasion into the left ischiorectal fossa. The overall picture was that of a primary rectal signet ring cell carcinoma with peritoneal dissemination. The patient was referred for palliative chemotherapy in view of the disseminated disease. In the present report, we discuss this interesting pathological entity and review the role of various histolological techniques in helping to identify the primary tumor.

Keywords: Signet ring cell carcinoma; Colorectal tumour; Peritoneal dissemination; Gastric secondaries