SHM Converge Scientific Abstract ePoster Gallery-Signet Ring Cell Carcinoma: Potential Screening for Early Detection

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This case report describes a 45-year-old Vietnamese woman with a history of H. pylori infection who presented with six months of worsening epigastric pain, nausea, vomiting, and early satiety that acutely worsened over two weeks and progressed to inability to tolerate oral intake. Initial exam and labs were largely unremarkable, while CT imaging showed a distended stomach with gastric wall thickening and minimal ascites. Early attempts to sample the ascites were unsuccessful due to low volume.<br /><br />Upper endoscopy revealed a circumferential near-obstructing gastric mass just proximal to the pylorus. Biopsy demonstrated poorly differentiated gastric adenocarcinoma with signet ring cells. Initial CT staging suggested no metastases, and endoscopic ultrasound staged the tumor as T3N0M0 (Stage IIB), with apparent serosal invasion. However, staging laparoscopy performed later showed numerous peritoneal plaques, omental and mesenteric nodules, ascites, and diaphragmatic involvement. Biopsies and ascitic cytology confirmed metastatic Stage IV gastric adenocarcinoma with signet ring cell features.<br /><br />The report emphasizes the known poor prognosis of signet ring gastric cancers and the limitations of imaging-based staging. Endoscopic ultrasound can be helpful for local staging, but its accuracy is imperfect, especially in the proximal stomach, where anatomy can make interpretation difficult. The case highlights that normal labs and negative CT findings do not exclude advanced disease.<br /><br />The authors conclude that unexplained ascites should be tapped whenever possible and that preoperative staging laparoscopy should be routinely considered before surgical planning. They also note that this patient had several risk factors, including Asian ancestry and H. pylori infection, and suggest that earlier endoscopic screening in high-risk individuals may improve detection and outcomes.

Asset Subtitle

Terrence Sun

Meta Tag

Author List Eulanca Liu, Jovian Lam, Manasi Ghatge, Terrence Sun

Category Clinical Vignettes

Concept Signet Ring Cell Carcinoma

Concept Gastric Malignancy

Concept Upper Endoscopy

Concept Biopsy

Concept Staging Laparoscopy

Distinguished Non-Finalist

Presenter Organization Scripps Mercy

Presenting Author Terrence Sun

Track Adult

Keywords

gastric adenocarcinoma

signet ring cells

H. pylori infection

epigastric pain

endoscopic ultrasound

staging laparoscopy

peritoneal metastasis

ascites

gastric obstruction

Stage IV cancer

Signet Ring Cell Carcinoma

Gastric Malignancy

Upper Endoscopy

Biopsy

Staging Laparoscopy