Poorer Prognosis of Primary Signet-Ring Cell Carcinoma of the Breast Compared with Mucinous Carcinoma

Pleomorphic Lobular Carcinoma In Situ Composed of Signet-Ring Cells Mimicking Ductal Carcinoma In Situ with A Papillary Pattern: A Case Report

While some forms of invasive or in situ carcinoma of the breast may be partly composed of signet-ring cells, signet-ring cells rarely become a prominent feature of pleomorphic lobular carcinoma in situ (LCIS). We report a rare example of pleomorphic LCIS composed predominantly of signet-ring cells with a papillary pattern mimicking ductal carcinoma in situ (DCIS). A 58-year-old woman presented with a mass in the left breast detected by ultrasonography. Fourteen years previously, the patient underwent right breast-conserving surgery for invasive breast carcinoma of no special type. Ultrasonography revealed an irregular parallel, angular hypoechoic mass measuring 1.5 cm in the left breast. An ultrasound-guided core needle core biopsy was conducted. Microscopically, the lesion was composed of epithelial cells supported by a fibrovascular stroma. The majority (> 70%) of the lesional cells between the fibrovascular stalks showed signet-ring cell features. Some of the nuclei of the signet-ring cells showed intermediate-grade atypia. A mucicarmine stain showed intracytoplasmic mucin in the signet-ring cells. Immunohistochemistry for E-cadherin was negative in the tumor cells. After surgical excision, the final diagnosis was a pleomorphic LCIS. To our knowledge, there have been no previous reports of pleomorphic LCIS consisting primarily of signet-ring cells with a papillary pattern.

Survival analysis and establishment of prognostic nomograms for primary breast signet ring cell carcinoma

Primary breast signet ring cell carcinoma (BSRCC) is an extremely rare malignancy with poor prognosis. Few consensus exists regarding the prognostic factors and treatment modalities. This study aimed to develop a nomogram model to predict survival probability and guide clinical treatment for BSRCC patients. Clinicopathological data of BSRCC patients were retrieved from SEER database. Univariate and multivariate Cox regression analyses were performed to screen and identify prognostic factors. Kaplan-Meier method was used to describe the survival curve for each prognostic factor. Additionally, these factors were incorporated to construct nomograms for predicting overall survival (OS) and disease-specific survival (DSS) of BSRCC patients. The nomograms were internally validated using receiver operating characteristic (ROC) curves, calibration curves and decision curve analysis (DCA). A total of 362 eligible BSRCC patients were included in this study. Multivariate Cox analysis demonstrated that age at diagnosis, T stage, N stage, and surgery were identified as independent prognostic factors for OS, while grade, T stage, N stage, ER status, and surgery were independent DSS-related factors. Our study elucidated that surgery is the effective treatment for BSRCC, while postoperative radiotherapy does not confer additional benefit to patients. Nomograms were established to predict OS and DSS probability by incorporating independent prognostic factors among BSRCC patients. The nomograms were subsequently validated using ROC curves, calibration curves, and DCA to display the robust prognostic capability. Robust nomograms for OS and DSS of BSRCC patients were established, facilitating precise personalized risk assessment and appropriate treatment regimens in clinical practice.

Pure signet ring cell carcinoma of the breast: a rare entity

Signet ring cell carcinoma (SRCC) is defined as carcinoma composed of epithelial cells with intracytoplasmic mucin that causes peripheral displacement of the nucleus, creating a crescent-shaped morphology. It can arise in many organs; however, pure primary SRCC of the breast is very rare. The WHO classification of tumours placed SRCC of the breast under mucin-producing carcinomas; however, nowadays, it is no longer regarded as a histological variant of invasive carcinoma. To date, only few cases have been reported in the literature. This report presents a woman in her 70s with primary pure SRCC of the breast. The patient underwent right lumpectomy with sentinel lymph node dissection and was proposed adjuvant chemotherapy followed by radiotherapy and hormonal treatment. She had no disease relapse until today. The histological features and treatment approach of this rare entity are debated in light of relevant literature.

Clinical characteristics, survival and prognostic nomogram for patients with esophageal mucinous adenocarcinoma: a SEER population-based analysis

Background

Esophageal mucinous adenocarcinoma (MAC) is a rare adenocarcinoma (AC) subtype. Limited research exists on its incidence, survival rates, and treatment responses. This study utilized the Surveillance, Epidemiology, and End Results (SEER) database to compare the clinical characteristics and prognoses of patients with esophageal MAC, AC, and signet-ring cell carcinoma (SRC), and developed nomograms to predict outcomes.

Methods

Patient information was retrieved from the SEER database from 2004 to 2015. The baseline characteristics were balanced using propensity score matching (PSM). Prognostic factors for esophageal MAC patients were identified by univariate and multivariate Cox analyses.

Results

A total of 497 esophageal MAC, 21,109 esophageal AC and 1,144 esophageal SRC patients were selected. MAC patients were more likely to have a higher pathological grade (P<0.001), and later T stage (P<0.001) and American Joint Committee on Cancer (AJCC) stage (P=0.003) than AC patients. The proportion of grade I-II MAC patients was higher than that of SRC patients. The overall survival (OS) and cancer-specific survival (CSS) of MAC patients were similar to those of AC patients. However, MAC patients had significantly better OS and CSS than SRC patients. After PSM analysis, the OS and CSS of MAC patients were similar to those of AC and SRC patients (all P>0.05). In MAC patients, N stage, M stage, and surgery were independent predictive factors for both OS and CSS. The area under the curve (AUC) and calibration curves demonstrated high precision and discrimination. Decision curve analysis (DCA) demonstrated that the CSS and OS nomograms have high potential clinical value.

Conclusions

Esophageal MAC patients had similar survival compared with esophageal AC and esophageal SRC patients. The nomograms provide OS and CSS predictions for MAC patients, to aid clinicians in predicting patients' prognoses.

Unmasking the silent killer: The hidden aggressiveness of signet-ring cell carcinoma in gallbladder cancer

The prognostic significance of the signet-ring cell component in gallbladder carcinoma (GBC) has not been systematically evaluated. The aim of this study was to assess the similarities and differences between gallbladder signet-ring cell carcinoma (GBSRCA) and gallbladder adenocarcinoma (GBAC) in terms of clinicopathological features and long-term survival. Using the Surveillance, Epidemiology, and End Results (SEER) database, we analyzed 6,612 patients diagnosed with gallbladder cancer between 2000 and 2021. The cohort included 147 patients with GBSRCA and 6,465 with GBAC. Patients with GBSRCA were significantly younger, with 33.3% being age 60 or younger compared to 23.9% of patients with GBAC (p = 0.009). There was a higher proportion of females in the GBSRCA group (77.6%) compared to the GBAC group (70.1%, p = 0.049). GBSRCA was associated with a more advanced tumor stage (T3-T4: 56.5% vs. 44.4%, P = 0.004), higher rates of lymph node metastasis (43.5% vs. 28.0%, P < 0.001), and poorer differentiation status (poorly to undifferentiated: 80.3% vs. 29.7%, P < 0.001). Survival analysis revealed that patients with GBSRCA had significantly worse overall survival (OS) and cancer-specific survival (CSS) compared to patients with GBAC (p < 0.001). GBSRCA was an independent prognostic factor for OS (P = 0.001) in the entire cohort, while the T stage and N stage were independent prognostic factors for OS and CSS in patients with GBSRCA. Even after propensity score matching, patients with GBSRCA still had a poorer prognosis.

Primary signet ring cell carcinoma of the breast: A case report and literature review

ABSTRACT

Primary signet ring cell carcinoma (SRCC) of the breast is a rare and aggressive type of breast cancer characterized by increased intracellular mucin production. It has a high risk of metastasis and poor prognosis compared to other breast cancer types. We report a 56-year-old woman with primary SRCC of the breast who first presented with retraction on her left breast. Radiological examination revealed a mass that causes the retraction. The patient underwent left modified radical mastectomy, and pathology results showed a 70% signet ring cell pattern. Chemotherapy consists of an adriamycin-cyclophosphamide regimen administered. in this case, we aim to review the literature on this topic and inform the physicians.

Spectrum of Mucin-containing Lesions of the Breast: Multimodality Imaging Review with Pathologic Correlation

Mucin-containing lesions of the breast encompass a wide range of benign and malignant processes. The spectrum of histologic findings includes incidental mucus-filled benign cysts or ducts, mucocele-like lesions (MLLs), mucin-producing ductal carcinoma in situ, and invasive mucinous carcinoma. MLL is characterized by the presence of mucin-containing cysts that are typically associated with extravasated stromal mucin. MLL is often benign but can be associated with epithelial atypia or malignancy. Mucinous carcinoma represents the malignant end of the spectrum of mucinous lesions of the breast. Evidence-based literature supports a conservative approach for benign MLLs without associated atypia or malignancy, reserving excision for those lesions exhibiting such pathologic features. The most common imaging finding for MLL is microcalcifications at mammography. No specific imaging feature is predictive of malignant outcome at surgical excision. Invasive mucinous carcinoma is a heterogeneous breast tumor subtype, as defined according to the World Health Organization criteria. Mucinous carcinomas are categorized into pure (>90% mucinous component) or mixed (10%-90% mucinous component) subtypes. Pure mucinous carcinomas are generally associated with excellent prognosis and survival, with a few exceptions. Mixed mucinous carcinomas do not have the same favorable prognosis and instead behave similarly to invasive breast carcinomas of no special type. Characteristic diagnostic imaging features can be identified for mucinous carcinoma based on its mucinous and nonmucinous contents. ©RSNA, 2023 Online supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.

Molecular profiling of signet-ring-cell carcinoma (SRCC) from the stomach and colon reveals potential new therapeutic targets

Signet ring cell carcinoma (SRCC) is rare: about 10% of gastric cancer (GC) and 1% of colorectal cancer (CRC). SRCC is associated with poor prognosis, however the underlying molecular characteristics are unknown. SRCCs were analyzed using NGS, immunohistochemistry, and in situ hybridization. Tumor mutational burden (TMB) was calculated based on somatic nonsynonymous missense mutations, and microsatellite instability (MSI) was evaluated by NGS of known MSI loci. A total of 8500 CRC and 1100 GC were screened. Seventy-six SRCC were identified from the CRC cohort (<1%) and 98 from the GC cohort (9%). The most frequently mutated genes in CRC-SRCC were TP53 (47%), ARID1A (26%), APC (25%); in GC-SRCC were TP53 (42%), ARID1A (27%), CDH1 (11%). When compared to non-SRCC histology (N = 3522), CRC-SRCC (N = 37) more frequently had mutations in BRCA1 (11% vs 1%, P < 0.001) and less frequently mutations in APC (19% vs 78%, P < 0.001), KRAS (22% vs 51%, P = 0.001) and TP53 (47% vs 73%, P = 0.001). Among the GC cohort, SRCC (N = 54) had a higher frequency of mutations in CDH1, BAP1, and ERBB2, compared to non-SRCC (N = 540). Our data suggest that SRCCs harbor a similar molecular profile, regardless of the tumor location. Tailored therapy may become available for these patients.

Prognostic Analysis of Primary Breast Signet Ring Cell Carcinoma and Mucinous Breast Adenocarcinoma: A SEER Population-Based Study

Background

Primary breast signet ring cell carcinoma (SRCC) is a rare type of breast cancer with typical morphological characteristics, high aggressiveness, and poor prognosis. SRCC is different from mucinous breast adenocarcinoma (MBC). However, only a few studies have explored the clinicopathological features and prognosis of SRCC and MBC.

Methods

Data retrieved from the Surveillance, Epidemiology, and End-Results (SEER) database (2004-2015) were used to explore the prognostic effect of clinicopathological features and treatment modalities on survival outcomes of SRCC and MBC patients. Kaplan-Meier plot analysis, multivariate Cox proportional risk model, propensity score matching (PSM), and subgroup analysis were performed.

Results

A total of 167 patients with SRCC and 11,648 patients with MBC were included in the study. SRCC patients exhibited higher histological grade (p < 0.001), larger tumor volume (p < 0.001), higher rate of lymph node metastasis (p < 0.001), and higher frequency of distal metastasis (p < 0.001) compared with MBC patients. Cox proportional hazards regression analysis showed that SRCC patients had lower overall survival (OS) and breast cancer-specific survival (BCSS) compared with MBC patients. Subgroup survival analysis showed that the SRCC patients had lower OS and BCSS in subgroups including younger than 60 years old, white race, married, without chemotherapy, and received radiotherapy compared with the MBC patients in these subgroups. In addition, the SRCC patients had lower BCSS in subgroups including other races (including Asian or Pacific Islander and American Indian/Alaska Native), without surgery, and lymph node metastasis.

Conclusion

The findings showed that primary breast SRCC patients have unique clinical characteristics and worse prognosis compared with MBC patients. Notably, different treatment methods resulted in different prognosis for SRCC and MBC types; therefore, SRCC patients should be distinguished from MBC patients to improve efficacy of treatment.

Prognostic Outcomes of Signet Ring Cell Carcinoma of the Breast

BACKGROUND

Signet ring cell breast carcinoma (SRCBC) is a rare variant of invasive lobular carcinoma and there are no large series characterizing its long-term prognosis.

MATERIALS AND METHODS

The NCDB was queried from 2004-2016 to identify SRCBC patients. Patients were excluded if they had non-invasive tumors, multiple malignancies, or incomplete surgical data. Univariate analysis was performed utilizing chi-squared and Fischer's Exact tests. Kaplan-Meier and Cox proportional hazard models were used for survival analysis.

RESULTS

324 patients met inclusion criteria. Patients were mostly White (75.3%), ≥50 years of age (88.2%), female (98.5%), and had a low Charlson-Deyo score (82.7%). 34.5% had Stage IV disease and 78.1% had ER+ tumors. In patients with non-Stage IV disease, 91.5% received surgery: 49.5% had lumpectomy and 50.5% underwent mastectomy. Radiation therapy was used in 40.7% (71.4% with lumpectomy and 35.8% with mastectomy) and 50% received chemotherapy. Significant differences in unadjusted overall survival were seen at 5 and 10 years based on stage (P < 0.001). On multivariate analysis, ER+ patients showed an improved survival (HR 0.5, P < 0.01) but there was no difference in survival if ER+ patients received endocrine therapy (ET) (HR 0.9, P = 0.57). Non-metastatic patients who underwent surgery had improved overall survival compared to those that did not (HR 0.5, P = 0.02), but there was no survival difference based upon type of breast operation (P = 0.8).

CONCLUSION

SRCBC frequently presents at an advanced stage. While ER+ patients appear to have improved survival, there was no clear survival benefit to receiving ET in ER+ patients.

Perforating duodenal ulcer with umbilical herniation as a metastatic complication of primary signet ring cell carcinoma of the breast

Primary signet ring cell carcinoma (SRCC) of the breast is extremely rare, and the associated patterns of metastatic dissemination poorly described. Here, we report the case of a 61-year-old woman presenting with acute abdominal pain. Esophagogastroduodenoscopy revealed a non-bleeding erosive gastropathy, which was biopsied and found significant for a poorly differentiated, GATA3-positive SRCC. The patient was lost to follow up until re-presenting 6 months later with a perforating duodenal ulcer and umbilical herniation. Biopsies of umbilical hernia sack contents were significant for an estrogen receptor (ER) positive SRCC, and breast examination identified a right breast mass significant for an ER positive lobular carcinoma with signet ring features, thereby affirming the diagnosis of metastatic SRCC of the breast. This case offers insight into an advanced form of a rare clinical entity, and suggests that staining for breast markers such as GATA3 should be considered for all biopsies significant for SRCC.

The treatment option of progressive disease in breast cancer during neoadjuvant chemotherapy: a single-center experience

Patients' responses to breast cancer neoadjuvant chemotherapy (NACT) differ because of heterogeneous tumor characteristics. Reports about NACT progression are sporadic. Here we enrolled 1187 patients who received NACT in our cancer center between January 1, 2007, and December 31, 2016. We analyzed the characteristics and treatments of patients with progressive disease (PD) or non-PD or pathological complete response (pCR). In total, 45 (3.8%) patients had PD. PD patients were associated with a significantly worse disease-free survival (DFS) (hazard ratio (HR) = 3.77; 95% CI, 1.77 to 8.00; P =.001) and overall survival (OS) (HR = 3.85; 95% CI, 1.77 to 8.35; P =.001). For the PD patients, 28 (62.2%) patients received mastectomy immediately after PD, and 17 (37.8%) changed to chemotherapy. DFS and OS exhibited no significant differences between these two salvage therapies. After a change to second chemotherapy, 58.8% (10/17) patients had PD or SD. With the exception of tumor size, pretreatment T stage, and histology type, no other significant differences were noted between PD and pCR patients. Our results demonstrated that PD patients were associated with a significantly worse prognosis. Based on these results, we suggest to give the addition of trastuzumab to HER-2 positive patients instead of changing the chemotherapy regimen and proceeding to surgery instead of further chemotherapy once patients have PD during NACT. Given that some similar characteristics exist between PD and pCR patients, more studies to identify novel molecular markers to predict disease response to NACT should be performed.

Survival in signet ring cell carcinoma varies based on primary tumor location: a Surveillance, Epidemiology, and End Results database analysis

BACKGROUND

The aim of this study was to investigate the survival of patients with signet ring cell carcinoma (SRCC) based on primary tumor location.

METHODS

Patient data were obtained from the Surveillance, Epidemiology, and End Results database (1988-2012) with ≥200 cases per tumor location. Cox regression analysis was used to investigate prognostic factors of cause-specific survival (CSS).

RESULTS

We identified 24,171 patients. Of the patients, 63.4% had gastric SRCC, followed by colon (18.2%), esophageal (5.0%), rectal (3.5%), lung (3.1%), pancreatic (1.8%), breast (1.5%), bladder (1.3%), small intestine (1.1%), and gallbladder SRCC (1.0%). The 5-year CSS was 22.1%, 69.0%, 33.2%, 28.1%, 24.8%, 16.1%, 13.6%, 12.6%, 11.0%, 6.4% in patients with gastric, breast, colon, rectum, bladder, small intestine, esophageal, gallbladder, lung, and pancreatic SRCC, respectively (P < 0.001). Multivariate analyses showed that the primary tumor location was an independent prognostic factor of survival. Patients with lung, small intestine, and bladder SRCC had a comparable CSS to gastric SRCC, while breast and colorectal SRCC had better survival than gastric SRCC. Esophageal, gallbladder, and pancreatic SRCC were significantly associated with poor CSS compared with gastric SRCC.

CONCLUSION

Our study suggests a major difference in survival of SRCC based on the primary tumor locations.

Krukenberg tumors: Seed, route and soil

The aim of this narrative review was to summarize the current evidence on Krukenberg tumors (KTs), addressing what is known on their natural history and their impact on the clinical prognosis and which are the most appropriate management strategies to treat this condition. A literature search was conducted on Pubmed up to December 2016, selecting the most relevant studies on the basis of the scope of the review. KTs are ovarian metastases from primary signet-ring cell carcinomas., characterized by the presence of a sarcoma-like stroma. They have three possible routes of diffusion (lymphatic, peritoneal and hematogenous), but the preferential one is still unclear. Prognosis is dismal. When KTs are encountered in the clinical practice, it is reasonable to offer surgical resection to young, fit patients with limited disease. Palliative surgery should be considered for all patients with symptomatic disease. Further studies should clarify the clinicopathologic characteristics of KTs, their main routes of diffusion, and the possible role of prophylactic oophorectomy, lymphadenectomy and intraperitoneal chemotherapy. Molecular and transitional research should parallel the clinical one to help understanding the natural history of signet-ring cell carcinomas.

Preoperative radiotherapy improves survival in rectal signet-ring cell carcinoma-a population-based study

Background

To investigate the clinical value of preoperative and postoperative radiotherapy (RT) in patients with rectal signet-ring cell carcinoma (SRCC).

Methods

Using the Surveillance, Epidemiology, and End Results program patients with stage II–III rectal SRCC were retrospectively included between 1988 and 2012. Univariate and multivariate Cox regression analyses were performed to analyze the effect of preoperative and postoperative RT on cause-specific survival (CSS).

Results

A total of 292 patients were included: 138 patients received preoperative RT, 101 patients received postoperative RT, and 53 patients underwent surgery alone. Overall, 5– and 10-year CSS was 43.8 and 37.6%, respectively. Preliminary survival analysis demonstrated that preoperative RT improved CSS versus surgery alone, especially in patients with stage III disease. Multivariate analysis demonstrated that preoperative RT was independent predictors for CSS in stage III rectal SRCC. CSS in preoperative and postoperative RT groups was comparable.

Conclusions

Preoperative RT significantly improved survival outcomes in patients with stage III rectal SRCC.