title: Signet-ring cell lymphoma: clinicopathologic, immunohistochemical, and fluorescence in situ hybridization studies of 7 cases.
abstract: BACKGROUND
  Signet-ring cell lymphoma (SRCL) is a rare morphologic variant of non-Hodgkin lymphoma. Although it was initially reported as a rare morphologic variant of follicular lymphoma (FL), SRCL has to date been described in most types of non-Hodgkin lymphoma, mostly as single-case reports.
  
  
  OBJECTIVE
  To study SRCL systematically by immunohistochemical stains and fluorescent in situ hybridization analyses.
  
  
  METHODS
  Seven SRCL cases were stained for CD3, CD5, CD20, PAX-5, CD10, CD21, CD23, cyclin D1, BCL2, BCL6, Ki-67, and MUM-1, and were analyzed by fluorescent in situ hybridization for BCL2, BCL6, MYC, and MALT1 rearrangements. Clinical information and patient outcome were reviewed in all patients.
  
  
  RESULTS
  The patients were 3 women and 3 men, ranging in age from 31 to 75 years (average 60.3 years). The lesions involved lymph nodes, tonsil, parotid gland, soft tissue, and breast. There were 4 FLs, 1 diffuse large B-cell lymphoma (DLBCL), 1 DLBCL with FL, and 1 DLBCL with marginal zone lymphoma. All cases had typical signet-ring cell morphology. They were positive for CD20 and BCL-2, and had low-to-intermediate Ki-67 proliferation index (10%-40%) except in the parotid DLBCL with FL (70%). BCL-6 was detected in all but 1 FL (6/7). Fluorescent in situ hybridization detected IGH/BCL2 translocation in 1 FL, increased BCL6 copy number in another FL, BCL6 rearrangement, and increased copy number of MYC and MALT1 in the DLBCL with marginal zone lymphoma.
  
  
  CONCLUSIONS
  The FL with signet-ring cell morphology (1/5) tends to lack IGH/BCL2 translocation, and an extended immunohistochemical study is recommended for correct diagnosis and classification of SRCL.
authors.affiliation: Department of Pathology & Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN. Electronic address: sz5@iupui.edu.
authors.forename: Shanxiang
authors.initials: S
authors.lastname: Zhang
authors.affiliation: Department of Pathology & Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Jihong
authors.initials: J
authors.lastname: Sun
authors.affiliation: Department of Pathology, Montefiore Medical Center, Bronx, NY.
authors.forename: Yanan
authors.initials: Y
authors.lastname: Fang
authors.affiliation: Department of Pathology & Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Nassiri
authors.affiliation: AmeriPath, Indianapolis, IN.
authors.forename: Lanting
authors.initials: L
authors.lastname: Liu
authors.affiliation: Department of Pathology & Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Jiehao
authors.initials: J
authors.lastname: Zhou
authors.affiliation: Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Ryan
authors.initials: R
authors.lastname: Stohler
authors.affiliation: Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Haki
authors.initials: H
authors.lastname: Choi
authors.affiliation: Department of Pathology & Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN; Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Gail H
authors.initials: GH
authors.lastname: Vance
mesh_terms: D000328:Adult; D000368:Aged; D018279:Carcinoma, Signet Ring Cell / Q000378:metabolism / Q000473:pathology*; D004268:DNA-Binding Proteins / Q000235:genetics; D005260:Female; D006801:Humans; D017404:In Situ Hybridization, Fluorescence / Q000379:methods; D018442:Lymphoma, B-Cell, Marginal Zone / Q000175:diagnosis / Q000473:pathology; D008224:Lymphoma, Follicular / Q000175:diagnosis / Q000473:pathology; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010338:Pathology, Clinical / Q000379:methods; D014178:Translocation, Genetic / Q000235:genetics
chemical_list: D004268:DNA-Binding Proteins
keywords: B-cell lymphoma; Clinicopathologic features; Non-Hodgkin lymphoma; Signet ring cell lymphoma