Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Apr;7(4):1160-1169.
doi: 10.1002/cam4.1417. Epub 2018 Mar 13.

Differences in Clinicopathological Characteristics and Computed Tomography Findings Between Signet Ring Cell Carcinoma and Nonsignet Ring Cell Carcinoma in Early and Advanced Gastric Cancer

Affiliations
Free PMC article

Differences in Clinicopathological Characteristics and Computed Tomography Findings Between Signet Ring Cell Carcinoma and Nonsignet Ring Cell Carcinoma in Early and Advanced Gastric Cancer

Jian Chen et al. Cancer Med. .
Free PMC article

Abstract

Signet ring cell carcinoma (SRC) of the stomach is a histological type based on microscopic characteristics. SRC's clinicopathological characteristics and prognosis are still controversial. Our study is to describe the clinicopathological features and multidetector computed tomography (MDCT) findings of patients with SRC of the stomach in comparison with nonsignet ring cell adenocarcinoma (NSRC). We retrospectively analyzed data from 241 patients who had undergone curative gastrectomy, including 62 SRC and 179 NSRC. Clinicopathological outcomes and MDCT findings were evaluated, and we investigated whether these variables were correlated with histopathological type. In early gastric carcinoma, patients with SRC were younger (50.2 vs. 60.2 years; P = 0.000) and more likely to be observed in the middle and lower third stomach (P = 0.010). Early SRC had a tendency to be confined to the mucosa (82.1%). There were significant differences in degree of enhancement between early SRC and NSRC on MDCT imaging (P < 0.001). In advanced gastric carcinoma, SRC was more likely to be stage T3-4 (100%). SRC patients had thicker tumors (P = 0.001) and a higher frequency of diffusely infiltrative gross appearance (P < 0.001). SRC was more likely to have high-degree contrast enhancement than were NSRC (P = 0.001). The maximal diameter of SRC tumor on MDCT imaging correlated with lymph node metastasis (sensitivity 93.9%, specificity 74.1%) and serosal invasion (sensitivity 89.5%, specificity 78.0%) of SRC. In conclusion, SRC differs significantly from NSRC in clinicopathological features at presentation. MDCT could help differentiate advanced gastric SRC from NSRC based on the thickened stomach wall, high-degree contrast enhancement, and a higher frequency of diffusely infiltrative gross appearance, particularly in combination.

Keywords: Comparative study; gastric cancer; multidetector computed tomography; signet ring cell carcinoma.

Figures

Figure 1
Figure 1
Contrast‐enhanced computed tomography images and corresponding endoscopic ultrasonography (EUS) images of early gastric carcinoma. (A, B) 72‐year‐old woman with early SRC. Contrast‐enhanced CT scan obtained during the parenchymal phase shows focal inner wall thickening (arrow). EUS image of the lesion shows an echo‐poor, inhomogeneous lesion. Surgical resection confirmed signet ring cell carcinoma infiltrated to the mucous layer. (C, D) Elevated early NSRC in a 38‐year‐old woman. The attenuation of the enhancing thickened gastric wall is higher than that of the SRC (arrow). EUS image of the lesion shows a hypoechoic lesion spreading from the mucosal to submucous layers.
Figure 2
Figure 2
Contrast‐enhanced computed tomography images of advanced gastric carcinoma. (A, B) Two contrast‐enhanced CT images in different patients with advanced SRC. Contrast‐enhanced CT scan shows diffuse gastric wall thickening with strongly enhancement. The layered and heterogeneous‐enhancement pattern is shown. (C) Endoscopic image (same patient in B) of the lesion shows a diffusely infiltrating lesion. (D–F) 55‐year‐old man with NSRC. Contrast‐enhanced CT scan and coronal reconstruction show focal gastric wall thickening mainly of the enhancing thickened inner layer (arrow). The homogeneous‐enhancement pattern is shown. Endoscopic image of the lesion shows an ulcer lesion located in the gastric antrum.
Figure 3
Figure 3
Performance of the MDCT characteristics for the diagnosis of the serosal invasion and lymph nodes metastatic of SRC tumors. (A) Receiver operating characteristic curves (ROCs) for the CT characteristics in determining the serosal invasion of SRC. The areas under the ROC curves (AUCs) for the maximal diameter, thickness and degree of enhancement were 0.89, 0.80 and 0.72. (B) ROCs for the CT characteristics in differentiating metastatic and non‐metastatic lymph nodes. AUCs for the maximal diameter, thickness and degree of enhancement were 0.90, 0.86 and 0.68.

Similar articles

See all similar articles

Cited by 5 articles

References

    1. Chen W., Zheng R., Baade P. D., Zhang S., Zeng H., Bray F., et al. 2016. Cancer statistics in China, 2015. CA Cancer J. Clin. 66:115–132. - PubMed
    1. Kim B. S., Oh S. T., Yook J. H., and Kim B. S.. 2014. Signet ring cell type and other histologic types: differing clinical course and prognosis in T1 gastric cancer. Surgery 155:1030–1035. - PubMed
    1. Taghavi S., Jayarajan S. N., Davey A., and Willis A. I.. 2012. Prognostic significance of signet ring gastric cancer. J. Clin. Oncol. 30:3493–3498. - PMC - PubMed
    1. Peng J., Xiao P., Liao B., Ye J., and He Y.. 2014. Analysis of clinicopathological features of 1879 cases of gastric cancer in Southern China: a single center experience. Zhonghua wai ke za zhi 52:168–170. - PubMed
    1. Bamboat Z. M., Tang L. H., Vinuela E., Kuk D., Gonen M., Shah M. A., et al. 2014. Stage‐stratified prognosis of signet ring cell histology in patients undergoing curative resection for gastric adenocarcinoma. Ann. Surg. Oncol. 21:1678–1685. - PubMed
Feedback