title: Significance of signet-ring cells in patients with colorectal cancer.
abstract: OBJECTIVE
  We performed a retrospective study to determine the pattern of metastases and overall outcome of patients with tumors exhibiting a component of signet-ring cells comprising < 50 percent of the tumor mass.
  
  
  METHODS
  Medical records of 753 patients with primary colorectal cancer were retrospectively studied. Patients who had tumors with < 50 percent signet-ring cells were classified as having a component of signet-ring cells. The outcome of patients with a component of signet-ring cells was compared to all patients with mucinous adenocarcinoma (defined as adenocarcinomas with > or = 50 percent mucin) to all patients with adenocarcinomas with a component of mucin (defined as adenocarcinomas with < 50 percent mucin) and to 100 randomly selected patients with adenocarcinomas lacking mucin or signet-ring cells.
  
  
  RESULTS
  Five percent of patients had a component of signet-ring cells, 3 percent had mucinous adenocarcinoma, 9 percent had a component of mucinous adenocarcinoma, and 83 percent had adenocarcinoma lacking mucinous or signet components. Patients with a component of signet-ring cells and mucinous adenocarcinomas metastasized predominantly to the peritoneum/ovaries (75 and 56 percent of metastatic cases, respectively) and rarely to liver/lungs. The pattern of metastases of patients with adenocarcinoma without mucinous or signet components predominantly involved the liver/lungs and rarely the peritoneum/ovaries (12.5 percent). The pattern of metastases for patients with a component of mucinous adenocarcinoma was intermediate between mucinous adenocarcinoma and adenocarcinoma without mucin or signet-ring component. No differences in survival in Stage IV patients were seen among the four subgroups.
  
  
  CONCLUSIONS
  Patients with a component of signet-ring cells cancers, similar to mucinous adenocarcinoma, have a predisposition to metastasize to the peritoneum/ovaries.
authors.affiliation: University at Buffalo/Roswell Park Cancer Institute, Elm and Carlton, Buffalo, NY 14263, USA.
authors.forename: Rashmi
authors.initials: R
authors.lastname: Pande
authors.forename: Annette
authors.initials: A
authors.lastname: Sunga
authors.forename: Charles
authors.initials: C
authors.lastname: Levea
authors.forename: Gregory E
authors.initials: GE
authors.lastname: Wilding
authors.forename: Wiam
authors.initials: W
authors.lastname: Bshara
authors.forename: Mary
authors.initials: M
authors.lastname: Reid
authors.forename: Marwan G
authors.initials: MG
authors.lastname: Fakih
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000453:epidemiology / Q000473:pathology*; D018279:Carcinoma, Signet Ring Cell / Q000453:epidemiology / Q000473:pathology*; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis