Signet ring adenocarcinoma metastatic to the bronchus and mimicking gobletcell hyperplasia - A case report

BACKGROUND: Goblet cells in the lower respiratory tract ave metaplastic bro nchial epithelial cells usually associated with asthma or chronic bronchiti s. Goblet cells acquire their name by a tendency to distend with mucus, wit h subsequent distortion in cell shape. Due to similarity of similarity of s hape, metaplastic goblet cells and signet ring cells can be easily confused in cytologic samples. CASE: A 55-year-old male with a history of gastrointestinal adenocarcinoma underwent brushing, washing and biopsy of a bronchial lesion. The bronchial wash and brush samples showed a very cellular specimen, with large aggrega tes of distended columnar cells. These were arranged in long strips, thick bundles and occasional three-dimensional aggregates. Some aggregates contai ned numerous rounded cells with markedly distended cytoplasm. The rounded c ells were slightly larger than the distended columnar cells, These cells ha d a relatively large but innocuous-appearing nucleus displaced to the perip hery of the cell. The correspending bronchial biopsy revealed signet ring a denocarcinoma, presumably metastatic from the gastrointestinal primary. CONCLUSION: Signer ring adenocarcinoma, either primary or metastatic, can b e difficult to diagnose in cytologic and histologic specimens. There are nu merous mimics of signet ring cells, both benign and neoplastic. In respirat ory cytologic specimens, one of the benign imposters is goblet cell metapla sia.