Poorly cohesive gastric carcinoma

Poorly cohesive gastric carcioma (signet-ring cell type)

Poorly Cohesive Gastric Carcinoma (PCGC), also known as signet ring cell carcinoma when the majority of the tumor cells have a signet ring cell appearance, is a distinct type of gastric cancer characterized by poorly cohesive cells, including cells that may appear isolated or in small clusters without forming glandular structures. This form of cancer is aggressive and often diagnosed at an advanced stage. Understanding its pathology, epidemiology, and treatment options is crucial for managing this disease.

Epidemiology

PCGC is more common in younger patients and has a slightly higher prevalence in females compared to other types of gastric cancer. The incidence of PCGC has been increasing globally, contrasting with the declining rates of other forms of gastric cancer. This trend suggests distinct etiological factors or lifestyle changes affecting its prevalence.

Pathophysiology

The hallmark of PCGC is the presence of poorly cohesive cells, often with signet ring cell features. These cells are characterized by the presence of a large vacuole displacing the nucleus to the periphery, giving the cell a signet ring appearance. The lack of cohesion among tumor cells is thought to be due to reduced expression of E-cadherin, a cell adhesion molecule, leading to an aggressive behavior with a propensity for diffuse infiltration of the stomach wall and early metastasis.

Clinical Presentation

Patients with PCGC may present with non-specific symptoms such as weight loss, abdominal pain, or nausea. Due to its aggressive nature, PCGC often presents at an advanced stage with signs of gastric outlet obstruction, peritoneal dissemination, or metastasis to distant organs including the liver and lungs.

Diagnosis

Diagnosis of PCGC involves a combination of endoscopic examination and histopathological analysis of biopsy specimens. Endoscopy may reveal thickening of the stomach wall or a linitis plastica appearance without a well-defined mass. Histopathology confirms the diagnosis by demonstrating poorly cohesive cells, often with signet ring cell features.

Treatment

The treatment of PCGC typically involves a multimodal approach. Surgical resection remains the cornerstone of curative treatment, often requiring total gastrectomy due to the diffuse nature of the disease. Chemotherapy and, in some cases, radiation therapy may be used as neoadjuvant or adjuvant treatments to improve survival rates. However, the prognosis of PCGC remains poor, with a high rate of recurrence and metastasis.

Prognosis

The prognosis of PCGC is generally poor compared to other types of gastric cancer, mainly due to its aggressive behavior and tendency for early dissemination. The overall survival rate is significantly lower, highlighting the need for early detection and aggressive treatment strategies.

Conclusion

Poorly Cohesive Gastric Carcinoma represents a challenging form of gastric cancer with distinct clinical and pathological features. Its aggressive nature and poor prognosis necessitate ongoing research into more effective diagnostic and therapeutic strategies. Early detection and a multidisciplinary approach to treatment are crucial in managing this disease.