Oesophageal signet ring cell carcinoma as complication of gastro-oesophageal reflux disease.
BACKGROUND
Signet ring cell carcinoma occurs as a histological variant of oesophageal adenocarcinoma.


OBJECTIVE
In a cross-sectional study, to pursue the hypothesis that oesophageal signet ring cell cancers constitute a complication of gastro-oesophageal reflux disease.


METHODS
In a large national database of histopathology records, we accumulated 91 802 patients with Barrett's oesophagus (BE), 2817 with oesophageal nonsignet ring adenocarcinoma (EAC) and 278 with oesophageal signet ring cell carcinoma (SRC). The three groups were compared with respect to their clinical and demographic characteristics, as well as socio-economic risk factors (associated with patients' place of residence).


RESULTS
About 9% of all oesophageal adenocarcinomas harboured features of signet ring cell carcinoma. Patients with oesophageal adenocarcinoma and signet ring cell carcinoma were characterised by almost identical epidemiological patterns. Patients with either cancer type were slightly older than those with Barrett's oesophagus (EAC 68.0, SRC 66.7 vs. BE 63.7 years), and both showed a striking male predominance (EAC and SRC 85% vs. BE 67%). Both cancer types were associated with a similar set of alarm symptoms, such as dysphagia, pain and weight loss. The distribution by race (Whites vs. Blacks) and socio-economic parameters, such as levels of college education and family income, were similar among the three groups of patients.


CONCLUSIONS
Signet ring cell carcinoma is a rare variant of oesophageal adenocarcinoma with similar epidemiological characteristics. The reasons why a minority of reflux patients progress to develop signet ring cell carcinoma, rather than the usual type of oesophageal adenocarcinoma, remain unknown.
Miraca Life Sciences Research Institute, Irving, TX, USA.|University of Texas Southwestern Medical Center College of Medicine, Dallas, TX, USA.
K O
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Turner
Miraca Life Sciences Research Institute, Irving, TX, USA.|University of Texas Southwestern Medical Center College of Medicine, Dallas, TX, USA.|VA Medical Center, Dallas, TX, USA.
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RM
Genta
Oregon Health & Science University, Portland, OR, USA.|VA Medical Center, Portland, OR, USA.
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Sonnenberg
D000230:Adenocarcinoma / Q000453:epidemiology / Q000209:etiology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000150:complications; D018279:Carcinoma, Signet Ring Cell / Q000453:epidemiology / Q000209:etiology*; D003430:Cross-Sectional Studies; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors