Primary signet ring cell carcinoma of ampulla of vater: Report of a case and a review of the literature.

Öz

Abstract

Signet ring cell carcinoma of the ampulla of vater is a rare variant of adenocarcinoma. Morphology of the signet ring cell carcinoma is defined as intracytoplasmic mucin, with clear cytoplasm and hyperchromatic, eccentric nucleus.  It is divided into three subtypes as intestinal, pancreatobiliary and mixed type according to immunohistochemical findings. Gastric type is mentioned as the fourth type by other publications. In this study, signet ring cell carcinoma of ampulla vater in a 60-year-old male patient  is presented. Intracytoplasmic mucin accumulation was detected with PAS-Alcian Blue in cells that infiltrating the muscular wall of the duodenum. Immunohistochemically MUC1, MUC2, CK19, CK20, CDX2 positive; CK7 focal positive; MUC5AC locally weak positive detected in tumor cells. Because of coexistence MUC2, CK20, CDX2 antibodies associated with the intestinal type and CK7, CK19, MUC1 antibodies associated with pancreatobiliary type, the case was evaluated in favor of mixed type signet ring cell carcinoma of ampulla and discussed in terms of prognosis and treatment in the light of the literature.

Key words: Ampulla of vater, carcinoma, signet ring cell.

Anahtar Kelimeler

• ampulla of vater,carcinoma,signet ring cell

Ampulla vaterinin primer taşlı yüzük hücreli karsinomu: Olgu sunumu ve literatür özeti

Öz

Özet

Ampulla vaterinin taşlı yüzük hücreli karsinomu, adenokarsinomun nadir bir varyantıdır. Taşlı yüzük morfolojisindeki hücreler; intrasitoplazmik müsin içeren berrak sitoplazmalı, hiperkromatik, ekzantrik nükleuslu hücrelerdir. Bazı çalışmalarda immunohistokimyasal sonuçlara göre ampuller taşlı yüzük hücreli karsinom intestinal, pankreatobiliyer ve mikst tip olmak üzere üç subtipe ayrılmıştır. Bazı yayınlarda dördüncü tip olarak gastrik tipten de söz edilmektedir. Bu çalışmada 60 yaşında erkek hastada ampulla vateri yerleşimli taşlı yüzük hücreli karsinom olgusunu sunduk. Duodenum müsküler duvarını infiltre eden taşlı yüzük morfolojisindeki hücrelerde PAS-Alcian Blue ile intrasitoplazmik müsin birikimi tespit edildi. İmmunohistokimyasal incelemede taşlı yüzük hücrelerinde MUC1, MUC2, CK19, CK20, CDX2 pozitif; CK7 fokal pozitif; MUC5AC yer yer zayıf pozitif saptandı. İntestinal tip ile ilişkili MUC2, CK20, CDX2 antikorlarının ve pankreatobiliyer tip ile ilişkili CK7, CK19, MUC1 antikorlarının bir arada pozitifliği nedeniyle olgu mikst tip ampulla vateri taşlı yüzük hücreli karsinomu lehine değerlendirildi ve literatür ışığında prognoz ve tedavi açısından tartışıldı.

Anahtar sözcükler: Ampulla vateri, karsinom, taşlı yüzük hücresi.

Anahtar Kelimeler

• ampulla vateri,karsinom,taşlı yüzük hücresi

Kaynakça

1. 1) Yokota T, Kunii Y, Teshima S, et al. Signet ring cell carcinoma of the stomach: a clinicopathological comparison with the other histological types. Tohoku J Exp Med 1998;186:121-130.
2. 2) Daoudi K, El Haoudi K, Bouyahia N, Benlemlih A, Arifi S, Mellas N, et al. Signet ring cell carcinoma of the vater’s ampulla: A very rare malignancy. Case Rep Oncol Med 2012;2012:402798.
3. 3) Akatsu T, Aiura K, Takahashi S, Kameyama K, Kitajima M, Kitagawa Y. Signet-ring cell carcinoma of the ampulla of vater: report of a case. Surg Today 2007;37:1110-1114.
4. 4) Taş A, Ozer E, Köklü S, Kocak E. Signet ring cell carcinoma of the ampulla of vater: rare cause of acute pancreatitis. Scand J Gastroenterol 2011;46:126-127.
5. 5) Wen X, Wu W, Wang B, Yao H, Teng X. Signet ring cell carcinoma of the ampulla of vater: immunophenotype and differentiation. Oncol Lett 2014;8:1687-1692.
6. 6) Sekoguchi T, Mizumoto R. Clinicopathological study of papilla of vater. Geka Chiryo 1979;41:1-5.
7. 7) Acharya M.N, Panagiotopoulos N, Cohen P, Ahmad R, Jiao L.R. Poorly-differentiated signet-ring cell carcinoma of the ampulla of vater: report of a rare malignancy. JOP 2013;14:190-194.
8. 8) Ramia J.M, Mansilla A, Villar J, Muffak K., Garrote D., Ferron J.A. Signet-ring cell carcinoma of the vater’s ampulla. JOP 2004;5:495-497.

9. 9) Ishibashi Y, Ito Y, Omori K, Wakabayashi K. Signet ring cell carcinoma of the ampulla of vater: a case report. JOP 2009;10:690-693.
10. 10) de Paiva Haddad LB, Patzina RA, Penteado S, et al. Lymph node involvement and not the histopathologic subtype is correlated with outcome after resection of adenocarcinoma of the ampulla of vater. J Gastrointest Surg 2010;14:719-728.
11. 11) Kimura W, Futakawa N, Zhao B. Neoplastic diseases of the papilla of vater. J Hepatobiliary Pancreat Surg 2004;11:223-231. 12) Fischer HP, Zhou H. Pathogenesis of carcinoma of the papilla of vater. J Hepatobiliary Pancreat Surg 2004;11:301-309.
12. 12) Fischer HP, Zhou H. Pathogenesis of carcinoma of the papilla of vater. J Hepatobiliary Pancreat Surg 2004;11:301-309.
13. 13) Maekawa H, Sakurada M, Orita H, Sato K. Signet-ring cell carcinoma co-existing with adenocarcinoma of the ampulla of vater. A case report. JOP 2011;12:162-166.
14. 14) Ang D. C, Shia J, Tang L. H, Katabi N, Klimstra D. S. The utility of ımmunohistochemistry in subtyping adenocarcinoma of the ampulla of vater. Am J Surg Pathol 2014;38:1371-1379.
15. 15) Li L, Chen Q-H, Sullivan J. D, Breuer F.U. Case report: Signet-ring cell carcinoma of the ampulla of vater. Ann Clin Lab Sci 2004;34:471-475.
16. 16) Gao JM, Tang SS, Fu W, Fan R. Signet-ring cell carcinoma of ampulla of vater: contrast-enhanced ultrasound findings. World J Gastroenterol 2009;15:888-891.
17. 17) Kım W S, Choi D W, Choi S H, Heo J S, You DD, Lee HG. Clinical significance of pathologic subtype in curatively resected ampulla of vater cancer. J Surg Oncol 2012;105:266-272.
18. 18) Kimura W, Futakawa N, Zhao B. Neoplastic diseases of the papilla of vater. J Hepatobiliary Pancreat Surg 2004;11:223-231.
19. 19) Zhou H, Schaefer N, Wolff M, Fischer HP. Carcinoma of the ampulla of vater: comparative histologic/immunohistochemical classification and follow-up. Am J Surg Pathol 2004;28:875-882.
20. 20) Nabeshima S, Kishihara Y, Nabeshima A, Yamaga S, Kinjo M, Kashiwagi S, Hayashi J. Poorly differentiated adenocarcinoma with signet-ring cells of the vater’s ampulla, without jaundice but with disseminated carcinomatosis. Fukuoka Igaku Zasshi 2003;94:235-240.
21. 21) Paplomata E, Wilfong L. Signet ring cell carcinoma of the ampulla of vater with leptomeningeal metastases: a case report. J Clin Oncol 2011;29:627-629.
22. 22) Damania R, Weaver J, Cocieru A.Signet ring cell carcinoma of the ampulla of vater with early development of bone metastasis: Case report and review of the rare malignancy. J Gastrointest Cancer 2016;47(1);89-92.
23. 23) Purohit RC, Kant K, Bhargava N, Kothari N, Purohit V. Signet ring cell carcinoma of ampulla of vater in a young adult. Indian J Gastroenterol 2005;24:222-223.
24. 24) Lesquereux-Martínez L, Fernández-Pérez A, Bustamante-Montalvo M. Signet ring cell adenocarcinoma of the ampulla of Vater: A rare pathology. Rev Esp Enferm Dig 2012;104:501-502.
25. 25) Eriguchi N, Aoyagi S, Jimi A. Signet-ring cell carcinoma of the ampulla of vater: report of a case. Surg Today 2003;33:467-469.
26. 26) Wakasugi M, Tanemura M, Furukawa K, et al. Signet ring cell carcinoma of the ampulla of vater: Report of case and a review of the literature. İnt J Surg 2015;12:108-111.