![]() 188 Distorted lymphocytes within areas of chronic inflammation and fibromuscular stroma can have strikingly vacuolated signet ring cell–like morphology, mimicking signet ring–like cell carcinoma. ![]() Vacuoles can be seen within even Gleason pattern 3 tumors, and therefore to avoid the diagnosis of signet ring–like cell carcinoma, the tumor should be evaluated as if vacuoles were not present, by evaluating only the underlying architectural pattern. Adenocarcinoma may contain vacuoles and can mimic true signet ring–like cell carcinoma. The differential diagnosis of signet ring–like cell carcinoma of the prostate includes tumors with a signet ring cell appearance and nonneoplastic processes. b The signet ring cells are positive for prostatic markers, including PAP and PSA, 309,311 but CEA is negative. Unlike disease in the other common sites, such as stomach, colon, breast, or urinary bladder, signet ring–like cell carcinoma of the prostate is usually not associated with mucinous adenocarcinoma. 311 Pure signet ring–like cell carcinoma has not been reported in the literature. All signet ring–like cell carcinoma of the prostate are associated with other forms of high-grade prostatic carcinoma, including solid, comedo, and cribriform types. 14A.54) in a pattern similar to that at other sites, such as the stomach, colon, and breast. 311,312,314 The tumor cells diffusely infiltrate the prostatic stroma ( Fig. Although intracytoplasmic mucin has been described in a few cases, it is not usually present in the majority of cases. The signet ring cells are characterized by nuclear displacement to the edge by clear cytoplasm with nuclear indentation ( Fig. ![]() Signet ring–like cell carcinoma grows as focal or diffuse sheets of undifferentiated cells with signet ring cell morphology, and thus this tumor is considered Gleason pattern 5. 272 Most patients died of disease between 32 and 60 months after the diagnosis, comparable with patients with high-grade prostatic adenocarcinoma. However, patients with prostate signet ring–like cell carcinoma often are diagnosed with advanced-stage disease (pT3/T4) and metastasis and have a poor prognosis. 52,304,311–317 The age of the patients reported has ranged from 50 to 80 years (mean 67.5 years), and the signs and symptoms are similar to those in conventional adenocarcinoma. Primary signet ring–like cell carcinoma of the prostate is extremely rare, with only about 60 cases reported in the literature. Fletcher MD, FRCPath, in Diagnostic Histopathology of Tumors, 2021 Signet Ring–Like Cell Carcinoma of the Prostate.
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