Journal Article

126 A Case of Primary Signet Ring Cell Carcinoma of the Pancreas

Yingtao Zhang, Yousef Soofi and Jinrong Cheng

in American Journal of Clinical Pathology

Published on behalf of American Society for Clinical Pathology

Volume 149, issue suppl_1, pages S55-S55
Published in print January 2018 | ISSN: 0002-9173
Published online January 2018 | e-ISSN: 1943-7722 | DOI:
126 A Case of Primary Signet Ring Cell Carcinoma of the Pancreas

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Signet ring cell carcinoma of the pancreas is extremely rare variant carcinoma of the pancreas occurring in less than 1% of pancreatic carcinoma. Here we report such a case. The patient is a 67-year-old man with a past medical history significant for diabetes, hypertension, hyperlipidemia, and nephrolithiasis who presented with a one-week history of pruritus, jaundice, and dark-colored urine. Preliminary workup is indicative of obstructive jaundice with elevated AST, ALT, alkaline phosphatase, and bilirubin. Endoscopic retrograde cholangiopancreatography (ERCP) showed severe mid common bile duct stricture with proximal dilatation. Stricture brushing revealed atypical cells present. No definite pancreatic mass is seen on CT scan except the peripancreatic edema surrounding the pancreatic head and uncinate process. PET scan demonstrated a hypermetabolic mass centered within the body of the pancreas, extending to the neck and upper head, and the proximal tail of the pancreas, most likely a pancreatic carcinoma. There are no significant hypermetabolic lesions in other organs, including the GI system, liver, lungs, gallbladder, kidneys, brain, and lymph nodes. The patient then underwent endoscopic ultrasound, which showed lobulated, infiltrating mass in the proximal head, neck, and body regions of the pancreas abutting the bifurcation of the celiac artery to the common hepatic artery and splenic artery. Pancreatic ultrasound-guided fine needle aspiration (FNA) demonstrated malignant cells present as few groups and singly scattered cells. These malignant cells show large nuclei with irregular nuclear membrane and prominent nucleoli. Groups of loosely cohesive cells with signet-ring cell features are seen, especially in the cell block. Focal nerve involvement was also noted. Immunohistochemical stains show tumor cells to be positive for CK7 and negative for CK20, synaptophysin, CD68, and CDX2. Periodic acid-Schiff stain shows focal cytoplasmic staining. Clinical, radiological, and cytological findings with immunohistochemistry altogether supported a diagnosis of pancreatic signet ring cell carcinoma.

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Subjects: Medical Skills ; Pathology

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