Signet Ring Cell Carcinoma in Urine Cytology: Cytomorphologic Findings and Differential Diagnosis

Abstract

Background: Signet ring carcinoma is an exceedingly rare and aggressive variant of primary bladder carcinoma. The cytomorphologic features of this rare entity in urinary specimens have not been well characterized. Methods: Twenty-seven cases of signet ring cell carcinoma of the urinary bladder were identified from the pathology archives of The Johns Hopkins Hospital (1989–2011). Of these, 6 cases with prior urinary cytology specimens were studied. Results: There were 5 males and 1 female, with a mean age of 62 years. The presenting complaints included hematuria with or without symptoms of bladder irritation. Histopathologically, there were 5 cases of primary bladder carcinoma and 1 case of metastatic colonic signet ring cell carcinoma. The salient cytomorphologic features included scattered malignant epithelial cells, displaying distinct cell borders, abundant cytoplasm with a single large, discrete mucin vacuole, and eccentric irregular nuclei with prominent nucleoli. Primary adenocarcinoma additionally revealed a few intact malignant glandular epithelial fragments. Metastatic colonic signet ring cell carcinoma displayed predominantly singly dispersed malignant cells with eccentrically placed, oval nuclei with occasional small nucleoli and a moderate amount of vacuolated cytoplasm. Conclusion: Signet ring cell carcinomas are rarely encountered in urinary cytology. The differential diagnosis includes distended histiocytes or degenerated urothelial cells, primary signet ring cell carcinoma, and metastatic adenocarcinoma.

Intracytoplasmic Lumen in Urine Cytology Predicts Worse Prognosis in Non-Muscle-Invasive Bladder Cancers

“…Intracytoplasmic lumina (ICL), a well-known feature in invasive lobular carcinoma of the breast and signetring cell carcinoma of the stomach, among others, are sometimes observed in UC. The presence of ICL in UC was previously reported in studies utilizing cytology and/ or histology [3][4][5][6][7]. At the ultrastructural level, the ICL contain coarsely granular material and occasionally have microvilli in the lumen [3,4].…”

Primary signet-ring cell carcinoma of the urinary bladder

“…Lastly, the urinary bladder PSRCC can also arise from the isolated signet-ring cell from the urothelium. 7,11,12 The cytomorphological detail of signet ring cell carcinoma has been described by Guan et al 13 According to them, the cytospin smears were hypercellular with mixed inflammatory cells in the background. Scattered signet ring cells were described as large cells with eccentrically placed nuclei, prominent nucleoli, and discrete mucin vacuoles in the abundant cytoplasm.…”

“…In primary urothelial carcinoma with signet ring cell features, the signet ring cells were admixed with coexisting malignant glandular epithelial cells. 13 The histomorphological features of urinary bladder PSRCC is quite characteristic. Loosely cohesive signet-ring cells are scattered containing intracellular mucin abutting nuclei to the periphery.…”

A rare synchronous of dual primary genitourinary carcinoma manifested with a rapidly progressive renal failure

“…In addition, the patient’s whole-body multislice CT-scan with contrast (intravenous, oral and injection trans-anal and per nephrostomy) was normal. Also, the negative PSA staining in the urinary bladder specimen ruled out the adjacent invasion from prostatic adenocarcinoma [ 9 , 10 ]. The synchronous of dual cancer or more is well-known issue which was first described by Billroth in 1869.…”