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Case 010096

Patient 54 yo with persistent epigastric pain. Endoscopy showed an irregular suspicious angular area. Biopsy: Signet ring  cell carcinoma. Gastrectomy performed.



Gastrectomy specimen opened along the greater curvature.


Close-up on the angular region, showing a ill defined flatened mucosae, with irregular depressed serpiginous areas.



Low power panoramic view of the antrum, showing mainly a preserved muscularis mucosae.



Closer views on the mucosae, demonstrate atrophy of the glands and an infiltrate of the lamina.



High power of previous fields: the infiltrate is formed by Signet Ring Cells (SRC)



Low power PAS stain.



Mucinous content of the SRC, microvacuolar type.




Immunohistochemistry Cytokeratins: Absence of invasion of the muscularis mucosa or the submucosa.


Diagnosis: Early gastric carcinoma, intramucosal signet ring cell type.

Macroscopic classification IIb-c (Jap Gast Endosc Soc)


Patterns of the surrounding mucosa (Does SRC Ca In Situ Exist?)

Lymphnode Status