A Case of Gastric Amphicrine Signet-Ring Cell Carcinoma

Abstract

“Amphicrine” (in Greek, amphi- means “both” or “double”) refers to cells that synchronously exhibit the endocrine and exocrine phenotypes. Gastric amphicrine carcinoma is very rare, and only a few case reports are found in the English literature; thus, its pathobiological features remain unclear. Here, we report a case of amphicrine gastric carcinoma. A woman in her sixth decade of life presented with anemia and underwent upper endoscopy, followed by histopathological examination of biopsy specimens. She appeared to have gastric cancer with a tumor measuring 5.0 cm × 4.0 cm in size. Subsequently, the patient underwent total gastrectomy with lymph node dissection. Histopathological examination revealed a poorly cohesive carcinoma that sparsely coexisted with signet-ring cell carcinoma cells with regional lymph node metastasis. Interestingly, synaptophysin immunoreactivity with the coexistence of Alcian blue was found in individual signet-ring cell carcinoma cells. Furthermore, the present amphicrine carcinoma cells immunohistochemically expressed CD44 variant 9, a functional cancer stem cell marker. We believe that the present case findings may support the idea of multipotent stem cells being an origin of amphicrine gastric cancers.

Gastric amphicrine carcinoma: A histopathological diagnostic conundrum

“…5 Studies have showed various architectural pattern like tubular, nest, solid sheet, scattered goblet cell or signet ring like cells. 5,[10][11][12][13] Huang et al 5 studied 10 amphicrine carcinomas in stomach and rectum. They classified tumour as low grade or high grade (both grades may mix with other components but less than 30% of tumour) or mixed amphicrineneuroendocrine carcinoma with each component accounting for more than 30% of tumour.…”

“…Hamamatsu et al 11 described the lesion as a poorly cohesive carcinoma sparsely co-existing with signet ring cell carcinoma. Alipov et al 12 reported a poorly differentiated adenocarcinoma with neuroendocrine differentiation along with signet-ring cells.…”

“…5,[10][11][12][13] All observed that dual positivity for neuroendocrine markers (synaptophysin and chromogranin A) and mucin stain (PAS and/ Alcian blue) in the same cells was required for the diagnosis of amphicrine carcinoma. [1][2][3][4][5][6][7][8][9][10][11][12][13] Immunopositivity for EMA, CEA, low molecular Cytokeratin, Neuron specific enolase and CD56 has also been seen. Huang et al, showed Ki67 ranging from 5-40% in low grade and 20-70% in high grade.…”

“…Sun et al, observed diffuse immunopositivity of p53 in two cases and immunonegative expression was also seen in one case like our case. 5,[10][11][12][13] Grossly, they may present as ulcerative lesion, fungating mass or diffusely infiltrating mass. Literature review shows involvement of any part of stomach, antrum being the most common site.…”

“…Literature review shows involvement of any part of stomach, antrum being the most common site. 5,[10][11][12][13] Size of tumour ranges from 2 to 5 cm. 5 Sun et al 10 also compared 8 cases of gastric amphicrine carcinoma to gastric MiNEN by high resolution copy number profiling and whole expose sequencing of paraffinembedded tissue.…”