Article ID: WMC00688 ISSN 2046-1690 Signet-Ring Cell Change in Benign Prostatic Hyperplasia - A Rare Case Report Author(s):Dr. Pallavi Bhuyan, Dr. Smita Mahapatra, Dr. Sujata Pujari, Dr. Jayasree Rath Corresponding Author: Dr. Pallavi Bhuyan, Assistant Professor, Pathology, S.C.B.Medical College - India Submitting Author: Dr. Pallavi Bhuyan, Assistant Professor, Pathology, S.C.B.Medical College - India Article ID: WMC00688 Article Type: Case Report Submitted on:22-sep-2010, 06:19:35 AM GMT Article URL: http://www.webmedcentral.com/article_view/688 Subject Categories:UROLOGY Keywords:Signet ring, Prostate Published on: 22-Sep-2010, 07:18:04 AM GMT How to cite the article:bhuyan P, Mahapatra S, Pujari S, Rath J. Signet-Ring Cell Change in Benign Prostatic Hyperplasia - A Rare Case Report. WebmedCentral:UROLOGY 2010;1(9):WMC00688 Webmedcentral > Case Report Page 1 of 8
Signet-Ring Cell Change In Benign Prostatic Hyperplasia - A Rare Case Report Abstract Signet-ring cell change (SCC) is a non-neoplastic condition that morphologically simulates signet ring cell carcinoma (SRCC) both of which are rare entities in the prostate. Herewith, we report a case of 66 year old man with benign prostatic hyperplasia showing SCC in the stroma and discuss the case from a review of published reports. Introduction SCC in the prostate is very rarely encountered. Identification of this lesion as a non-neoplastic condition is important to distinguish it from SRCC, a rare prostate malignancy. It is the lymphocytes and benign stromal cells in the prostate that exhibit the SCC. 1 SCC can also result from hormone therapy prior to surgical intervention. Signet ring cells can also be seen in the prostate as metastatic deposit or by direct extension from the urinary bladder. Our aim is to identify SCC and avoid misdiagnosis of SRCC. Case Report(s) A 66 year old man presented with symptoms of urinary obstruction. The serum PSA is 7.6 ng/ml. Transurethral resection of prostate was done. Histopathological examination of TURP bits showed features of fibromusculoglandular hyperplasia of prostate. A significant finding was the presence of vacuolated cells with nuclei pushed to the periphery, in the stroma. These cells mimicked signet ring cells. The possibility of cancer was ruled out as multiple sections did not reveal the histopathological features of malignancy. Special stains like Alcian blue, PAS and mucicarmine stains were also negative. Discussion Signet ring cells in the prostate is extremely rare and can be seen in both non-neoplastic and neoplastic conditions. A review of the literature also shows case reports of signet ring cells present as artifacts. Alguacil-Garcia have reported 20 cases of transurethral prostatectomy showing signet ring cells in the stroma associated with dense lymphocytic infiltrates.1 The absence of mucin and immunoreactivity for PSA and PSAP was also observed. Ultrastructurally, degenerated lymphocytes as well as vacuolated smooth muscle cells were noted in their study. They concluded in their study that areas of chronic prostatitis in TURP specimen usually showed degenerated lymphocytes and stromal cells with signet ring appearance, an artifact induced by TURP procedure[1,2]. Signet ring appearance can mimic carcinoma. A review of the literature reveals 43 cases of primary SRCC of prostate reported till date[3]. Almost all of the reported cases have been associated with high grade prostatic adenocarcinoma[3,4]. Serum PSA value was usually significantly elevated. These tumors exhibit more aggressive behaviour than conventional adenocarcinoma and are associated with poor prognosis[5]. The signet ring cells in these cases comprised of >25% of the tumor. Special stains for mucin was negative. Immunohistochemically the cells were positive for PSA and PSAP[6]. SRCC metastasizing to the prostate is an extremely rare phenomenon. However direct extension from the urinary bladder needs to be ruled out. SCC can be induced by prior hormone therapy in cases of prostatic adenocarcinoma. Conclusion Artifactual presence of signet ring cells in the prostate can occur and needs to be distinguished from carcinoma, primary or metastatic. References 1. Alguacil-Garcia A. Artifactual changes mimicking signet ring cell carcinoma in transurethral prostatectomy specimens. Am J Surg Pathol. 1985 10 : 759-800. Webmedcentral > Case Report Page 2 of 8
2. Wang HL, Humphrey PA. Exagerated Signet ring cell change in stromal nodule of prostate : a pseudoneoplastic proliferation. Am J. Surg. Pathol. 2002 Aug;26(8):1066-70. 3. Cukur Selma, Alper Murat, Cam H. Kamil. Primary Signet Ring Cell Carcinoma of the Prostate. Medical Journal of Trakya University. 2006;23(3) : 155-157. 4. Kuroda N, Yamasaki I, Nakayama H, et al. Prostatic signet-ring cell carcinoma : case report and literature review. Pathol Int. 1999 May;49(5):457-61. 5. Saito S, Iwaki H. Mucin producing carcinoma of the prostate : review of 88 cases. Urology 1999;54:141-4. 6. Ro JY, el-naggar A, Ayala AG, et al. Signet-ring-cell carcinoma of the prostate. Electron microscopic and immunohistochemical studies of eight cases. Am J Surg Pathol. 1988 Jun;12(6) : 453-60. Webmedcentral > Case Report Page 3 of 8
Illustrations Illustration 1 Fig: Photomicrograph showing signet ring cell change. (H&E X400) Webmedcentral > Case Report Page 4 of 8
Reviews Review 1 Review Title: Signet Ring Cell... Posted by Dr. Kumar Gaurav on 26 Mar 2011 01:47:06 AM GMT 1 Is the subject of the article within the scope of the subject category? Yes 2 Are the interpretations / conclusions sound and justified by the data? No 3 Is this a new and original contribution? No 4 Does this paper exemplify an awareness of other research on the topic? No 5 Are structure and length satisfactory? No 6 Can you suggest brief additions or amendments or an introductory statement that will increase the value of this paper for an international audience? 7 Can you suggest any reductions in the paper, or deletions of parts? No 8 Is the quality of the diction satisfactory? No 9 Are the illustrations and tables necessary and acceptable? No 10 Are the references adequate and are they all necessary? Yes 11 Are the keywords and abstract or summary informative? No Rating: 2 Comment: Very poorly written article. There are gross errors in sentence structure and english of the article. I can sort of see the point of the article but not very clearly. It would be nice to describe more details about how the conclusion was reached. The review of literature is not described well. I don't quite understand why the prostate biopsy was not done. I am not able to understand how SRCC was ruled out as both can have just signet ring cells. The discussion is poorly structured. It has free standing sentences without clear significance like " SCC can be induced by prior hormone therapy in cases of prostatic adenocarcinoma". Competing interests: None Invited by the author to make a review on this article? : No Experience and credentials in the specific area of science: Gaurav K, Fitch J, Panda M, Increased frequency and nocturia in a middle aged male may not always be due to benign prostatic hypertrophy: a case report. Cases J. 2009 Sep 15;2:9274. Publications in the same or a related area of science: Yes References: Gaurav K, Fitch J, Panda M, Increased frequency and nocturia in a middle aged male may not always be due to benign prostatic hypertrophy: a case report. Cases J. 2009 Sep 15;2:9274. How to cite: Gaurav K.Signet Ring Cell...[Review of the article 'Signet-Ring Cell Change in Benign Prostatic Hyperplasia - A Rare Case Report ' by ].WebmedCentral 1970;2(3):REVIEW_REF_NUM626 Yes Webmedcentral > Case Report Page 5 of 8
Review 2 Review Title: Signet-Ring Cell Change in Benign Prostatic Hyperplasia - A Rare Case Report Posted by Dr. luis busto martin on 08 Feb 2011 10:25:39 AM GMT 1 Is the subject of the article within the scope of the subject category? Yes 2 Are the interpretations / conclusions sound and justified by the data? Yes 3 Is this a new and original contribution? No 4 Does this paper exemplify an awareness of other research on the topic? Yes 5 Are structure and length satisfactory? No 6 Can you suggest brief additions or amendments or an introductory statement that will increase the value of this paper for an international audience? 7 Can you suggest any reductions in the paper, or deletions of parts? No 8 Is the quality of the diction satisfactory? Yes 9 Are the illustrations and tables necessary and acceptable? No 10 Are the references adequate and are they all necessary? Yes 11 Are the keywords and abstract or summary informative? Yes Rating: 7 Comment: When you are talking about the case i think it would be nice if you explained a if you did or did not perform a prostate biopsy because you had a high PSA value... Yes I also think that it would be nice if you explained a little what are the histological differences between the Carcinoma and the benign signet-ring cell change. The conclusion should be a little more extense (2 or 3 lines). The rest is ok. Competing interests: no Invited by the author to make a review on this article? : No Experience and credentials in the specific area of science: Im a Urologist so we had some cases similar to this in our department. I also made a review of our signed ring cells carcinoma of the bladder. Publications in the same or a related area of science: Yes References: Arch Esp Urol. 2010 Mar;63(2):150-3. Signet-ring cell adenocarcinoma of the bladder: case series between 1990-2009. Busto Mart?n LA, Janeiro Pais M, Gonz?lez Dacal J, Chantada Abal V, Busto Casta??n L. Urology Department, Complejo Hospitalario Universitario de Coru?a, La Coru?a, Spain. lbm@urologiabusto.com How to cite: busto martin l.signet-ring Cell Change in Benign Prostatic Hyperplasia - A Rare Case Report Webmedcentral > Case Report Page 6 of 8
[Review of the article 'Signet-Ring Cell Change in Benign Prostatic Hyperplasia - A Rare Case Report ' by ].WebmedCentral 1970;2(2):REVIEW_REF_NUM447 Webmedcentral > Case Report Page 7 of 8
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