title: Significance of signet ring cells in high-grade mucinous adenocarcinoma of the peritoneum from appendiceal origin.
abstract: Significance of signet ring cells in mucinous adenocarcinoma of the peritoneum from appendiceal origin has never been specifically studied. We retrospectively reviewed cases of mucinous adenocarcinoma of the peritoneum from appendiceal origin (n = 55) and collected clinical follow-up data. Signet ring cells were identified in 29 of 55 cases. No low-grade mucinous adenocarcinoma case (n = 11) had signet ring cells, whereas 29 of 44 high-grade mucinous adenocarcinoma cases did. Cases of high-grade mucinous adenocarcinoma were subdivided into 3 groups: (1) high-grade mucinous adenocarcinoma without signet ring cells (n = 15), (2) high-grade mucinous adenocarcinoma with signet ring cells only within mucin pools (n = 20), and (3) high-grade mucinous adenocarcinoma with signet ring cells invading tissue (n = 9). Overall survival (OS) and progression-free survival were subsequently evaluated. Five-year OS for cases of high-grade mucinous adenocarcinoma without signet ring cells and high-grade mucinous adenocarcinoma with signet ring cells within mucin pools were similar at 31.8% (SE, 14.4%) and 35.8% (SE, 13.9%), respectively. A significant survival difference was seen for cases of high-grade mucinous adenocarcinoma with signet ring cells invading tissue with a median OS of 0.5 years versus 2.9 and 2.4 years (P = .04 and P = .03), respectively, for cases of high-grade mucinous adenocarcinoma without signet ring cells and high-grade mucinous adenocarcinoma with signet ring cells within mucin pools. Finding signet ring cells floating in extracellular mucin pools made no prognostic difference when compared with cases of high-grade mucinous adenocarcinoma without signet ring cells. In contrast, high-grade mucinous adenocarcinoma with signet ring cells invading tissue was significant for worse survival, and thus, we propose reporting signet ring cell tissue invasion particularly when extensive.
authors.affiliation: Department of Pathology, Wake Forest Baptist Health, Winston-Salem, NC, 27157. Electronic address: sirintrs@mskcc.org.
authors.forename: S Joseph
authors.initials: SJ
authors.lastname: Sirintrapun
authors.affiliation: Department of Surgery, Wake Forest Baptist Health, Winston-Salem, NC, 27157.
authors.forename: Aaron U
authors.initials: AU
authors.lastname: Blackham
authors.affiliation: Department of Biostatistical Sciences, Wake Forest Baptist Health, Winston-Salem, NC, 27157.
authors.forename: Greg
authors.initials: G
authors.lastname: Russell
authors.affiliation: Department of Surgery, Wake Forest Baptist Health, Winston-Salem, NC, 27157.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Votanopoulos
authors.affiliation: Department of Surgery, Wake Forest Baptist Health, Winston-Salem, NC, 27157.
authors.forename: John H
authors.initials: JH
authors.lastname: Stewart
authors.affiliation: Department of Surgery, Wake Forest Baptist Health, Winston-Salem, NC, 27157.
authors.forename: Perry
authors.initials: P
authors.lastname: Shen
authors.affiliation: Department of Surgery, Wake Forest Baptist Health, Winston-Salem, NC, 27157.
authors.forename: Edward A
authors.initials: EA
authors.lastname: Levine
authors.affiliation: Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, 27157.
authors.forename: Kim R
authors.initials: KR
authors.lastname: Geisinger
authors.affiliation: Department of Pathology, Wake Forest Baptist Health, Winston-Salem, NC, 27157.
authors.forename: Simon
authors.initials: S
authors.lastname: Bergman
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000401:mortality / Q000473:pathology*; D000328:Adult; D000368:Aged; D001065:Appendix / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000473:pathology*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate
keywords: Appendix; Mucinous adenocarcinoma; Peritoneal mucinous carcinomatosis; Pseudomyxoma peritonei; Signet ring carcinoma; Signet ring cells