Primary signet ring cell adenocarcinomas of the lung: a clinicopathological study of 15 cases

Aims: We describe the clinicopathological characteristics of 15 cases of pr imary signet ring cell adenocarcinoma of the lung and highlight the importa nce of recognizing that not all adenocarcinomas with signet ring cell featu res represent metastatic adenocarcinomas. Methods and results: We evaluated the clinicopathological and immunohistoch emical features of 15 cases of signet ring cell adenocarcinoma of the lung. The patients were 12 men and three women, age 30-75 years (mean 52.5 years ). No evidence of a primary tumour elsewhere could be found on thorough cli nical examination. Nine patients underwent resection and the remainder were biopsied. The tumours ranged from 18 to 80 mm in greatest dimension. Micro scopically. two distinct patterns of growth were recognized: acinar and dif fuse. The tumours were characterized by the presence of >75% signet ring ce lls. Periodic acid-Schiff and mucicarmine showed strong intracellular posit ive staining. Immunohistochemical stains for TTF-1 (6/6) and CEA (9/9) show ed strong positive reaction in all cases evaluated. Three out of six cases were also positive for cytokeratin 7. All the tumours (6/6) were negative f or cytokeratin 20, ER, PR and GCDFP-15. Follow-up information was obtained in 11 patients; six patients died within 1 year and five patients were aliv e from 3 to 36 months after initial diagnosis. Conclusion: These cases highlight an unusual histological growth pattern of primary lung adenocarcinoma that may be mistaken for a metastasis from an occult primary. The recognition of this pattern of lung tumours is importan t for proper treatment.