Clin Endosc.  2012 Nov;45(4):421-424.

Signet-Ring Cell Carcinoma Mimicking Gastric Gastrointestinal Stromal Tumor Confirmed by Endoscopic Ultrasound-Guided Trucut Biopsy

• Kim SH
• Lee ST
• Jeon BJ
• Kim IH
• Kim SW
• Lee SO
• Kim DG
• Park HS

Abstract

A submucosal gastric adenocarcinoma, especially the signet ring cell type, is rare. The histologic evaluation techniques for this lesion has not been established; however, histologic confirmation is very important for decision of treatment method. Here, we report a 57-year-old man with a 12-cm gastric submucosal signet ring cell type adenocarcinoma, diagnosed by an endoscopic ultrasound-guided Trucut biopsy and immunochemical studies. This case suggests that the endoscopic ultrasound-guided Trucut biopsy might be a useful diagnostic method in cases of gastric adenocarcinoma with features of gastrointestinal stromal tumor.

Keyword

Stomach neoplasms; Signet ring cell; Gastrointestinal stromal tumors; Endosonography; Biopsy

MeSH Terms

Adenocarcinoma
Biopsy
Endosonography
Gastrointestinal Stromal Tumors
Humans
Middle Aged
Stomach Neoplasms

Figure

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  Fig. 1 Initial endoscopic view showing the intraluminal protruding lesion covered by benign appearing mucosa along the anterior wall of the lower body, antrum, and the duodenal bulb.

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  Fig. 2 A computed tomography of the abdomen, showing about a 10×12 cm exophytic mass (arrow) at the antrum and lower body of stomach with invasion of the liver, pancreas, and transverse colon.

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  Fig. 3 (A) Endoscopic ultrasound (EUS) imaging showing heterogeneous echo texture with hyperechoic deposits and anechoic necrotic zones inside a large tumor mass suspected to have developed in the fourth hypoechoic layer (muscularis propria). The extraluminal border could not be assessed due to the very large size of the mass. (B) The QuickCore needle (19 gauge) is advanced under EUS guidance to mass.

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  Fig. 4 Endoscopic ultrasound-guided Trucut biopsy (A) and immunohistochemistry (B) of the gastric mass. (A) Numerous infiltrating signet ring cells are noted (H&E stain, ×200). (B) Tumor cells with signet ring cell features were immunoreactive for cytokeratin (CK, ×200).

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