Zhang Liang, Wu Lingyuan, Li Jiyu, Song Shasha, Lu Huanyu, Fang Chao, Zhu Kunbing
School of Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China.
Department of Breast and Thyroid Surgery, Shandong Provincial Maternal and Child Health Care Hospital, Jinan, China.
Gland Surg. 2022 May;11(5):943-952. doi: 10.21037/gs-22-242.
Signet ring cell carcinoma (SRCC) is characterized by strong invasiveness and rapid progression. It occurs mostly in young and middle-aged patients, and early patients may have no clinical symptoms. Gastric SRCC with breast cancer metastasis is relatively rare. It often presents challenges for clinicians and pathologists and may lead to an absolutely different therapeutic strategy.
In this paper, we report on a 37-year-old woman who was admitted to the hospital with a left breast mass discovered 5 days earlier, the mass was occasionally painful, and there was no skin swelling, skin depression, or other abnormalities. The initial diagnosis considered her to have a left breast tumor. The patient was previously healthy with no family history of tumor. Considering the possibility of malignant lesions, she underwent resection of the left breast tumor and surrounding tissue. Postoperative pathological findings suggested SRCC (left breast mass). Although the patient had no history of gastrointestinal tumors, considering that SRCC can also appear in the gastrointestinal tract and other organs. We performed gastroscopy on the patient, showed an ulcerative mass in the greater curvature of the gastric body, with irregular nodular uplift of the surrounding mucosa. The excised breast lesions were analyzed by immunohistochemistry, and the pathological result showed SRCC (left breast tumor). Combined with the results of immunohistochemistry, it was consistent with gastrointestinal metastasis. Through our multi-faceted differential diagnosis, the final diagnosis of the patient was clear, which not only bought time for the patient's subsequent treatment, but also avoided misdiagnosis and blind treatment due to the particularity and rarity of the case.
Gastric cancer should be considered when breast tumors show SRCC without lesion. Signet ring cell gastric cancer (occult) should be excluded even if the patient has no family history of gastric cancer. It is important to distinguish metastatic cancer from primary breast cancer to avoid misdiagnosis and blind treatment due to the particularity of the case, at which point an early recognition can be made and an optimal treatment plan can be chosen.
印戒细胞癌（SRCC）具有侵袭性强、进展迅速的特点。多见于中青年患者，早期患者可能无临床症状。胃SRCC伴乳腺癌转移相对少见。这常给临床医生和病理学家带来挑战，并可能导致截然不同的治疗策略。
本文报告一名37岁女性，因5天前发现左乳肿块入院，肿块偶尔疼痛，无皮肤肿胀、皮肤凹陷或其他异常。初步诊断考虑为左乳肿瘤。患者既往健康，无肿瘤家族史。考虑到恶性病变的可能性，她接受了左乳肿瘤及周围组织切除术。术后病理结果提示为SRCC（左乳肿块）。尽管患者无胃肠道肿瘤病史，但鉴于SRCC也可出现在胃肠道及其他器官。我们对患者进行了胃镜检查，显示胃体大弯侧有一溃疡性肿块，周围黏膜呈不规则结节状隆起。对切除的乳腺病变进行免疫组化分析，病理结果显示为SRCC（左乳肿瘤）。结合免疫组化结果，符合胃肠道转移。通过我们多方面的鉴别诊断，患者最终诊断明确，这不仅为患者后续治疗争取了时间，也避免了因病例的特殊性和罕见性导致的误诊及盲目治疗。
当乳腺肿瘤表现为SRCC且无其他病变时，应考虑胃癌。即使患者无胃癌家族史，也应排除隐匿性印戒细胞胃癌。区分转移性癌与原发性乳腺癌很重要，以避免因病例特殊性导致的误诊和盲目治疗，此时可尽早识别并选择最佳治疗方案。
