Incidental Detection of Signet Ring Cell Carcinoma during Emergent Endoscopy for Suspected Foreign Body Impaction in a 23-year-old woman

A 23-year-old female patient underwent emergent esophagogastroduodenoscopy (EGD) due to suspected esophageal foreign body impaction. No foreign body was detected, and visualization of the mucosal lining was obscured by retained food in the stomach. Random biopsies were obtained from the gastric antrum and corpus to assess for Helicobacter pylori infection. Histopathological examination identified signet ring cell carcinoma in one of the three biopsy samples, confirmed by CK18 immunohistochemistry staining. Additionally, Helicobacter pylori (HP) infection was confirmed. Staging computed tomography (CT) of the abdomen and thorax showed no identifiable gastric lesions or signs of metastasis. Laboratory tests, including tumor markers, were within normal limits. Seventeen days following the initial endoscopy, a scheduled therapeutic endoscopy was conducted. Neither white light endoscopy nor narrow band imaging revealed any discernible focal lesions. Mucosal scars from the previous biopsies were identified and resected via endoscopic mucosal resection (20x10 mm). Histopathological analysis of the resected tissue confirmed residual intramucosal carcinoma with clear resection margins and no evidence of lymphatic, vascular, or perineural invasion. The cancer was 0.2 x 0.01 mm and consisted of 8 cells. The patient received eradication therapy for HP. Genetic counseling and testing were performed, with negative findings for CTNNA1 and CDH1 gene mutations. A follow-up endoscopy at 9 months showed no evidence of tumor recurrence, with histopathological analysis indicating only mild chronic inflammation, likely residual from the HP eradication therapy. After careful consideration of the next steps, the patient will undergo annual surveillance with EGD [1].

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

• 1 van der Post RS, Bisseling TM, van Dieren JM.. Endoscopic surveillance: time for a paradigm shift in hereditary diffuse-type gastric cancer management? Lancet Oncol. 2023; 24 (4) 311-312 doi:10.1016/S1470-2045(23)00094-3 PMID: 36990606.