December 2019 Case


Corey Chang, MD, PhD (PGY-2), Kevin Waters, MD, PhD (Faculty)

Subject: Gastrointestinal pathology
Clinical History

A woman in her 30s with a history of bilateral invasive ductal carcinoma with focal lobular features status post bilateral mastectomy underwent genetic panel testing which revealed a germline CDH1 mutation. Screening endoscopy demonstrated a focus of signet-ring cell adenocarcinoma involving and confined to the lamina propria within oxyntic mucosa in one of six tissue fragments of randomly sampled transition zone. She subsequently underwent elective prophylactic total gastrectomy with lymphadenectomy and was found to have multiple foci of signet-ring cell adenocarcinoma confined within the superficial lamina propria (pT1aN0).

Pathology, Cedars-Sinai, Cancer,  Signet ring gastric adenocarcinoma, diffuse type

Figure 1. (H&E, 100x): Permanent section

Pathology, Cedars-Sinai, Signet ring gastric adenocarcinoma, diffuse type

Figure 2. (H&E, 200x): Permanent section


Signet ring gastric adenocarcinoma, diffuse type

  1. Figueiredo J et al. Clinical spectrum and pleiotropic nature of CDH1 germline mutations. J Med Genet (2019). 56:199-208.
  2. Luo W et al. CDH1 Gene and Hereditary Diffuse Gastric Cancer Syndrome: Molecular and Histological Alterations and Implications for Diagnosis and Treatment. Front In Pharm (2018). 9;1421.
  3. McLean MH and El-Omar EM. Genetics of gastric cancer. Nature Rev (2014). 11:664-74.
  4. NCCN Guidelines Version 3.2019. Gastric Cancer. Principles of Genetic Risk Assessment for Gastric Cancer.
  5. NCCN Guidelines Version 3.2019. Genetic/Familial High-Risk Assessment: Breast and Ovarian. Breast and Ovarian Management Based on Genetic Test Results.
Have Questions or Need Help?

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