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Primary Signet Ring Cell Carcinoma of the Lung with Cerebellar Metastasis Showing Full Response to Cisplatin and Docetaxel Therapy

Primary Signet Ring Cell Carcinoma of the Lung with Cerebellar Metastasis Showing Full Response... Hindawi Publishing Corporation Case Reports in Oncological Medicine Volume 2014, Article ID 968723, 3 pages http://dx.doi.org/10.1155/2014/968723 Case Report Primary Signet Ring Cell Carcinoma of the Lung with Cerebellar Metastasis Showing Full Response to Cisplatin and Docetaxel Therapy 1 2 2 2 Onur Kocas, Fatih Selcukbiricik, Ahmet Bilici, Metin KanJtez, 1 1 3 Serdar Yildiz, Suna Avci, and Canan Tanik Division of Internal Medicine, Sisli Education and Research Hospital, 34200 Istanbul, Turkey Division of Medical Oncology, Department of Internal Medicine, Sisli Education and Research Hospital, 34200 Istanbul, Turkey Division of Pathology, Sisli Education and Research Hospital, 34200 Istanbul, Turkey Correspondence should be addressed to Onur Kocas; onurkocas@gmail.com Received 14 November 2013; Accepted 11 December 2013; Published 9 January 2014 Academic Editors: F. A. Mauri and M. Romkes Copyright © 2014 Onur Kocas et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. Primary signet ring cell carcinoma (SRCC) of the lung is a very rare disease. We describe a new case of primary SRCC of the lung with cerebellar metastasis, which responded well to the therapeutic approach with cisplatin and docetaxel. Case Report. A 41-year-old female patient (nonsmoker) was consulted to our oncology outpatient clinic aer ft cerebellar metastasectomy. eTh histopathological diagnosis was SRCC metastasis. eTh primary tumor was unknown. The PET-CT imaging showed a hypermetabolic mass in the right middle lobe of the lung and hypermetabolic mediastinal lymph node stations. Oesophagogastroduodenoscopy and colonoscopy showed no evidence of gastrointestinal system tumor. eTh clinical diagnosis of primary SRCC of the lung was made and the administration of six rounds of cisplatin and docetaxel treatment was planned. After the chemotherapy the PET-CT scan to evaluate the therapy response showed full metabolic regression of the primary tumor and the mediastinal lymph nodes. er Th e was no evidence of new metastasis. Conclusion. Primary SRCC of the lung is a very rare disease with poor prognosis. There are not many cases in literature and no standardized chemotherapy protocols. Cisplatin and docetaxel may be a good treatment option. 1. Introduction 2. Case PrimarySRCCofthe lung is averyraredisease.First A 41-years-old female patient (nonsmoker) was consulted to described by Kish et al. in 1989, it is reported that incidence our oncology outpatient clinic by the neurosurgery clinic of primary SRCC of the lung varies from 0.14% to 1.9% of all aer ft a cerebellar metastasectomy. The preop CT scan showed lung cancers [1]. The largest series was taken by Tsuta et al. in a right cerebellar hypodense lesion with the dimension of 5× which 39 of 2640 surgically resected primary lung carcinomas 5cm (Figure 1). showed SRCC components. Mean age of the patients was eTh histopathological examination of the metastasectomy 54.6 years, male to female ratio was 1.16 : 1.00, and 26 patients material showed SRCC metastasis with positive immunos- (66.7%) were smokers. eTh size of the SRCC component of taining for CEA, CK 7, and TTF-1. The immunostaining with the tumor positively correlated with the aggressiveness of CK 20, ER, COX2, CK 14, CDX2, and MUC2 was negative. thetumor andpooroutcome.The5-yearsurvivalwas 28% The histopathological morphology was shown Figures 2(a), [2]. 2(b),and 2(c). 2 Case Reports in Oncological Medicine (a) Figure 1: The preop CT scan showed a right cerebellar hypodens lesion. In order to find the primary tumor a PET-CT scan, oeso- phagogastroduodenoscopy and colonoscopy was planned. eTh endoscopic evaluation of the gastrointestinal system showed no evidence of tumor. The PET-CT scan showed a26× 23 mm sized hypermetabolic lesion (SUVmax: 12.1) in the right middle lobe of the lung, multiple 10 mm sized (b) hypermetabolic lymph nodes (SUVmax: 5.7) at station 10R, and a 21 × 19 mm sized hypermetabolic (SUVmax: 12.4) lymphnodeatstation 11R in themediastinum.Theclinical diagnosis was primary SRCC of the lung. eTh patient received cranial radiotherapy. Aeft r the radiotherapy we decided to administrate the patient six rounds of cisplatin and docetaxel regimen. The PET-CT scan to reevaluate the therapy aer ft the 3 rounds of the chemotherapy showed decreased FDG uptake (SUVmax: 5.1) and a decrease in the size of the primary lesion, which we interpreted as partial regression. eTh hilar metastatic lymph nodes showed nearly full regression and couldbarelybevisualizedinthe PET-CT images.Wedecided to complete the cisplatin and docetaxel protocol. eTh PET- (c) CT scan aer ft the completion of the chemotherapy showed adecreaseinsize(19 × 25 mm) and metabolic regression Figure 2: (a) Malign epithelial infiltration in the cerebellum with (SUVmax: 2.6) of the primary tumor in the right middle signet-ring cell morphology. HE x100. (b): Cell groups in the tumor show positive staining with cytoplasmic CK 7. CK7 x200. (c) Positive lobe of the lung, there was no hypermetabolic pathological nuclear staining with TTF-1 in the signet-ring tumor cells. TTF-1 lymphadenopathies in the mediastinum. In the left axilla, x200. a7 × 14 mm sized nodular lesion with slightly increased FDGuptake(SUVmax:1.3) wasdetected. eTh re wasno pathological FDG uptake in the rest of the body. SRCC’s from other sites of the body like stomach, colon, breast, urinary tract which are more common. 3. Discussion Immunohistochemical studies and molecular diagnostics Primary SRCC of the lung is a very rare disease. eTh largest should help in making the differential diagnosis. The studies series was taken by Tsuta et al. in which 39 of 2640 cases of Merchant et al. with 32 SRCC’s from various organs (17 surgically resected primary lung carcinomas showed SRCC lung, 5 breast, and 5 stomach and 5 colon) showed that components. Mean age of the patients was 54.6 years, male- 82.4% of pulmonary SRCC’s were TTF-1 positive and the to-female ratio was 1.16 : 1.00, and twenty six patients (66.7%) cytokeratine profile CK 7 +/CK20 - was identified in 94.1% were smokers. The size of the SRCC component positively of the pulmonary SRCC cases. Villin was in 29.4% of the correlated with the aggressivenes of the tumor and poor cases positive [3]. Positivity for both TTF-1 and Napsin-A is outcome. eTh 5-year survival was 28% [ 2]. a strong indicator for pulmonary origin [4, 5]. Becauseofthe rareness of thedisease,itisimportant to Hayashi et al. reported 5 cases of primary lung SRCC. distinguish the primary SRCC of the lung from metastatic 80% of the cases were immunoreactive for lactoferrin, 100% Case Reports in Oncological Medicine 3 showed K-Rasmutations,100%werepositivefor MUC1and the lung,” Applied Immunohistochemistry and Molecular Mor- phology,vol.19, no.4,pp. 313–317, 2011. 100% were negative for MUC 2. MUC 1, is most commonly seen in SRCC and the solid adenocarcinoma of the lung than [5] N. Fatima, C. Cohen, D. Lawson, and M. T. Siddiqui, “TTF-1 and Napsin A double stain: a useful marker for diagnosing lung in SRCC of other organ sites [6]. adenocarcinoma on fine-needle aspiration cell blocks,” Cancer Although uncommonly,TTF-1 canalsobeexpressed in Cytopathology,vol.119,no. 2, pp.127–133,2011. carcinomas originating from other primary sites (e.g., colon) [6] H. Hayashi, H. Kitamura, Y. Nakatani, Y. Inayama, T. Ito, [7]. On the other side negativity for TTF-1 does not exclude and H. Kitamura, “Primary signet-ring cell carcinoma of the pulmonary SRCC if the tumor is CK 7, positive. In this case lung: histochemical and immunohistochemical characteriza- metastatic tumor from other body sites need to be excluded tion,” Human Pathology,vol.30, no.4,pp. 378–383, 1999. clinically [8]. In our case the tumor was positive for CEA, [7] B.Xu, N. oTh ng,D.Tan,and T. Khoury,“Expression of CK 7 and TTF-1 and negative for CK 20, ER, COX2, CK thyroid transcription factor-1 in colorectal carcinoma,” Applied 14, CDX2, and MUC2. It should also be noted that in 70% Immunohistochemistry and Molecular Morphology,vol.18, no.3, of pulmonary adenocarcinomas ALK gene rearrangement pp. 244–249, 2010. can be identified, when the SRCC component is >10% [9]. [8] W. Dubinski, N. B. Leighl, M. -S. Tsao, and D. M. Hwang, “Ancil- Shaw et al. demonstrated that ALK thyroxine kinase inhibitor lary testing in lung cancer diagnosis,” Pulmonary Medicine,vol. (crizotinib) therapy has positive impact on improved survival 2012, Article ID 249082, 8 pages, 2012. [10]. [9] S. J. Rodig, M. Mino-Kenudson, and S. Dacic, “Unique clinico- A comprehensive, retrospective population-based analy- pathologic features characterize ALK-rearranged lung adeno- sis of the primary SRCC of the lung with the adenocarcinoma carcinomainthe westernpopulation,” Clinical Cancer Research, of the lung by Ou et al. showed that the patients with vol. 15, pp. 5216–5223, 2009. primary SRCC are significantly younger than patients with [10] A. T. Shaw, B. Y. Yeap, B. J. Salomon et al., “Effect of Crizotinib adenocarcinoma, with a signicfi antly higher proportion of on overall survival in patients with advanced non-small-cell poorly differentiated tumor and stage IV disease and no lung cancer (OPTIMAL, CTONG-0802): a multicentre, open- difference in the distribution of gender and ethnicity. Never label, randomized, phase 3 study,” The Lancet Oncology ,vol.12, smokers comprised a higher proportion of patients with pp. 735–742. SRCC (30.8%) compared to patients with adenocarcinoma [11] S.-H. I. Ou, A. Ziogas, and J. A. Zell, “Primary signet-ring (11.0%). Never smokers with SRCC were younger and had carcinoma (SRC) of the lung: a population-based epidemiologic an improved overall survival (median age: 55 years, median study of 262 cases with comparison to adenocarcinoma of the lung,” Journal of oTh racic Oncology ,vol.5,no. 4, pp.420–427, overall survival: 8 months) than smokers with SRCC (median age: 59 years, median overall survival: 4.5 months). Patients with SRCC had decreased overall survival compared to adenocarcinoma patients [11]. Our patient is a 41-year-old, female, never smoker. Seven months aer ft diagnosis and six rounds of cisplatin and docetaxel therapy, she is well and alive with asatisfactoryresponsetochemotherapy. Conflict of Interests eTh authors declare that there is no conflict of interests regarding the publication of this paper. References [1] J. K. Kish,J.Y.Ro, A. G. Ayala, andM.J.McMurtrey,“Primary mucinous adenocarcinoma of the lung with signet-ring cells: a histochemical comparison with signet-ring cell carcinomas of other sites,” Human Pathology,vol.20,no.11,pp.1097–1102,1989. [2] K.Tsuta,G.Ishii,K.Yoh et al., “Primary lung carcinomawith signet-ring cell carcinoma components: clinicopathological analysis of 39 cases,” American JournalofSurgicalPathology,vol. 28,no. 7, pp.868–874,2004. [3] S. H. Merchant, M. B. Amin, P. Tamboli et al., “Primary signet- ring cell carcinoma of lung: immunohistochemical study and comparison with non-pulmonary signet-ring cell carcinomas,” American Journal of Surgical Pathology,vol.25, no.12, pp.1515– 1519, 2001. [4] J. Ye, J. J. Findeis-Hosey, Q. Yang et al., “Combination of napsin A and TTF-1 immunohistochemistry helps in differentiating primary lung adenocarcinoma from metastatic carcinoma in MEDIATORS of INFLAMMATION The Scientific Gastroenterology Journal of World Journal Research and Practice Diabetes Research Disease Markers Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 International Journal of Journal of Immunology Research Endocrinology Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Submit your manuscripts at http://www.hindawi.com BioMed PPAR Research Research International Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Journal of Obesity Evidence-Based Journal of Journal of Stem Cells Complementary and Ophthalmology International Alternative Medicine Oncology Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Parkinson’s Disease Computational and Behavioural Mathematical Methods AIDS Oxidative Medicine and in Medicine Research and Treatment Cellular Longevity Neurology Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Case Reports in Oncological Medicine Hindawi Publishing Corporation

Primary Signet Ring Cell Carcinoma of the Lung with Cerebellar Metastasis Showing Full Response to Cisplatin and Docetaxel Therapy

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Publisher
Hindawi Publishing Corporation
Copyright
Copyright © 2014 Onur Kocas et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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2090-6706
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2090-6714
DOI
10.1155/2014/968723
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Abstract

Hindawi Publishing Corporation Case Reports in Oncological Medicine Volume 2014, Article ID 968723, 3 pages http://dx.doi.org/10.1155/2014/968723 Case Report Primary Signet Ring Cell Carcinoma of the Lung with Cerebellar Metastasis Showing Full Response to Cisplatin and Docetaxel Therapy 1 2 2 2 Onur Kocas, Fatih Selcukbiricik, Ahmet Bilici, Metin KanJtez, 1 1 3 Serdar Yildiz, Suna Avci, and Canan Tanik Division of Internal Medicine, Sisli Education and Research Hospital, 34200 Istanbul, Turkey Division of Medical Oncology, Department of Internal Medicine, Sisli Education and Research Hospital, 34200 Istanbul, Turkey Division of Pathology, Sisli Education and Research Hospital, 34200 Istanbul, Turkey Correspondence should be addressed to Onur Kocas; onurkocas@gmail.com Received 14 November 2013; Accepted 11 December 2013; Published 9 January 2014 Academic Editors: F. A. Mauri and M. Romkes Copyright © 2014 Onur Kocas et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. Primary signet ring cell carcinoma (SRCC) of the lung is a very rare disease. We describe a new case of primary SRCC of the lung with cerebellar metastasis, which responded well to the therapeutic approach with cisplatin and docetaxel. Case Report. A 41-year-old female patient (nonsmoker) was consulted to our oncology outpatient clinic aer ft cerebellar metastasectomy. eTh histopathological diagnosis was SRCC metastasis. eTh primary tumor was unknown. The PET-CT imaging showed a hypermetabolic mass in the right middle lobe of the lung and hypermetabolic mediastinal lymph node stations. Oesophagogastroduodenoscopy and colonoscopy showed no evidence of gastrointestinal system tumor. eTh clinical diagnosis of primary SRCC of the lung was made and the administration of six rounds of cisplatin and docetaxel treatment was planned. After the chemotherapy the PET-CT scan to evaluate the therapy response showed full metabolic regression of the primary tumor and the mediastinal lymph nodes. er Th e was no evidence of new metastasis. Conclusion. Primary SRCC of the lung is a very rare disease with poor prognosis. There are not many cases in literature and no standardized chemotherapy protocols. Cisplatin and docetaxel may be a good treatment option. 1. Introduction 2. Case PrimarySRCCofthe lung is averyraredisease.First A 41-years-old female patient (nonsmoker) was consulted to described by Kish et al. in 1989, it is reported that incidence our oncology outpatient clinic by the neurosurgery clinic of primary SRCC of the lung varies from 0.14% to 1.9% of all aer ft a cerebellar metastasectomy. The preop CT scan showed lung cancers [1]. The largest series was taken by Tsuta et al. in a right cerebellar hypodense lesion with the dimension of 5× which 39 of 2640 surgically resected primary lung carcinomas 5cm (Figure 1). showed SRCC components. Mean age of the patients was eTh histopathological examination of the metastasectomy 54.6 years, male to female ratio was 1.16 : 1.00, and 26 patients material showed SRCC metastasis with positive immunos- (66.7%) were smokers. eTh size of the SRCC component of taining for CEA, CK 7, and TTF-1. The immunostaining with the tumor positively correlated with the aggressiveness of CK 20, ER, COX2, CK 14, CDX2, and MUC2 was negative. thetumor andpooroutcome.The5-yearsurvivalwas 28% The histopathological morphology was shown Figures 2(a), [2]. 2(b),and 2(c). 2 Case Reports in Oncological Medicine (a) Figure 1: The preop CT scan showed a right cerebellar hypodens lesion. In order to find the primary tumor a PET-CT scan, oeso- phagogastroduodenoscopy and colonoscopy was planned. eTh endoscopic evaluation of the gastrointestinal system showed no evidence of tumor. The PET-CT scan showed a26× 23 mm sized hypermetabolic lesion (SUVmax: 12.1) in the right middle lobe of the lung, multiple 10 mm sized (b) hypermetabolic lymph nodes (SUVmax: 5.7) at station 10R, and a 21 × 19 mm sized hypermetabolic (SUVmax: 12.4) lymphnodeatstation 11R in themediastinum.Theclinical diagnosis was primary SRCC of the lung. eTh patient received cranial radiotherapy. Aeft r the radiotherapy we decided to administrate the patient six rounds of cisplatin and docetaxel regimen. The PET-CT scan to reevaluate the therapy aer ft the 3 rounds of the chemotherapy showed decreased FDG uptake (SUVmax: 5.1) and a decrease in the size of the primary lesion, which we interpreted as partial regression. eTh hilar metastatic lymph nodes showed nearly full regression and couldbarelybevisualizedinthe PET-CT images.Wedecided to complete the cisplatin and docetaxel protocol. eTh PET- (c) CT scan aer ft the completion of the chemotherapy showed adecreaseinsize(19 × 25 mm) and metabolic regression Figure 2: (a) Malign epithelial infiltration in the cerebellum with (SUVmax: 2.6) of the primary tumor in the right middle signet-ring cell morphology. HE x100. (b): Cell groups in the tumor show positive staining with cytoplasmic CK 7. CK7 x200. (c) Positive lobe of the lung, there was no hypermetabolic pathological nuclear staining with TTF-1 in the signet-ring tumor cells. TTF-1 lymphadenopathies in the mediastinum. In the left axilla, x200. a7 × 14 mm sized nodular lesion with slightly increased FDGuptake(SUVmax:1.3) wasdetected. eTh re wasno pathological FDG uptake in the rest of the body. SRCC’s from other sites of the body like stomach, colon, breast, urinary tract which are more common. 3. Discussion Immunohistochemical studies and molecular diagnostics Primary SRCC of the lung is a very rare disease. eTh largest should help in making the differential diagnosis. The studies series was taken by Tsuta et al. in which 39 of 2640 cases of Merchant et al. with 32 SRCC’s from various organs (17 surgically resected primary lung carcinomas showed SRCC lung, 5 breast, and 5 stomach and 5 colon) showed that components. Mean age of the patients was 54.6 years, male- 82.4% of pulmonary SRCC’s were TTF-1 positive and the to-female ratio was 1.16 : 1.00, and twenty six patients (66.7%) cytokeratine profile CK 7 +/CK20 - was identified in 94.1% were smokers. The size of the SRCC component positively of the pulmonary SRCC cases. Villin was in 29.4% of the correlated with the aggressivenes of the tumor and poor cases positive [3]. Positivity for both TTF-1 and Napsin-A is outcome. eTh 5-year survival was 28% [ 2]. a strong indicator for pulmonary origin [4, 5]. Becauseofthe rareness of thedisease,itisimportant to Hayashi et al. reported 5 cases of primary lung SRCC. distinguish the primary SRCC of the lung from metastatic 80% of the cases were immunoreactive for lactoferrin, 100% Case Reports in Oncological Medicine 3 showed K-Rasmutations,100%werepositivefor MUC1and the lung,” Applied Immunohistochemistry and Molecular Mor- phology,vol.19, no.4,pp. 313–317, 2011. 100% were negative for MUC 2. MUC 1, is most commonly seen in SRCC and the solid adenocarcinoma of the lung than [5] N. Fatima, C. Cohen, D. Lawson, and M. T. Siddiqui, “TTF-1 and Napsin A double stain: a useful marker for diagnosing lung in SRCC of other organ sites [6]. adenocarcinoma on fine-needle aspiration cell blocks,” Cancer Although uncommonly,TTF-1 canalsobeexpressed in Cytopathology,vol.119,no. 2, pp.127–133,2011. carcinomas originating from other primary sites (e.g., colon) [6] H. Hayashi, H. Kitamura, Y. Nakatani, Y. Inayama, T. Ito, [7]. On the other side negativity for TTF-1 does not exclude and H. Kitamura, “Primary signet-ring cell carcinoma of the pulmonary SRCC if the tumor is CK 7, positive. In this case lung: histochemical and immunohistochemical characteriza- metastatic tumor from other body sites need to be excluded tion,” Human Pathology,vol.30, no.4,pp. 378–383, 1999. clinically [8]. In our case the tumor was positive for CEA, [7] B.Xu, N. oTh ng,D.Tan,and T. Khoury,“Expression of CK 7 and TTF-1 and negative for CK 20, ER, COX2, CK thyroid transcription factor-1 in colorectal carcinoma,” Applied 14, CDX2, and MUC2. It should also be noted that in 70% Immunohistochemistry and Molecular Morphology,vol.18, no.3, of pulmonary adenocarcinomas ALK gene rearrangement pp. 244–249, 2010. can be identified, when the SRCC component is >10% [9]. [8] W. Dubinski, N. B. Leighl, M. -S. Tsao, and D. M. Hwang, “Ancil- Shaw et al. demonstrated that ALK thyroxine kinase inhibitor lary testing in lung cancer diagnosis,” Pulmonary Medicine,vol. (crizotinib) therapy has positive impact on improved survival 2012, Article ID 249082, 8 pages, 2012. [10]. [9] S. J. Rodig, M. Mino-Kenudson, and S. Dacic, “Unique clinico- A comprehensive, retrospective population-based analy- pathologic features characterize ALK-rearranged lung adeno- sis of the primary SRCC of the lung with the adenocarcinoma carcinomainthe westernpopulation,” Clinical Cancer Research, of the lung by Ou et al. showed that the patients with vol. 15, pp. 5216–5223, 2009. primary SRCC are significantly younger than patients with [10] A. T. Shaw, B. Y. Yeap, B. J. Salomon et al., “Effect of Crizotinib adenocarcinoma, with a signicfi antly higher proportion of on overall survival in patients with advanced non-small-cell poorly differentiated tumor and stage IV disease and no lung cancer (OPTIMAL, CTONG-0802): a multicentre, open- difference in the distribution of gender and ethnicity. Never label, randomized, phase 3 study,” The Lancet Oncology ,vol.12, smokers comprised a higher proportion of patients with pp. 735–742. SRCC (30.8%) compared to patients with adenocarcinoma [11] S.-H. I. Ou, A. Ziogas, and J. A. Zell, “Primary signet-ring (11.0%). Never smokers with SRCC were younger and had carcinoma (SRC) of the lung: a population-based epidemiologic an improved overall survival (median age: 55 years, median study of 262 cases with comparison to adenocarcinoma of the lung,” Journal of oTh racic Oncology ,vol.5,no. 4, pp.420–427, overall survival: 8 months) than smokers with SRCC (median age: 59 years, median overall survival: 4.5 months). Patients with SRCC had decreased overall survival compared to adenocarcinoma patients [11]. Our patient is a 41-year-old, female, never smoker. Seven months aer ft diagnosis and six rounds of cisplatin and docetaxel therapy, she is well and alive with asatisfactoryresponsetochemotherapy. Conflict of Interests eTh authors declare that there is no conflict of interests regarding the publication of this paper. References [1] J. K. Kish,J.Y.Ro, A. G. Ayala, andM.J.McMurtrey,“Primary mucinous adenocarcinoma of the lung with signet-ring cells: a histochemical comparison with signet-ring cell carcinomas of other sites,” Human Pathology,vol.20,no.11,pp.1097–1102,1989. [2] K.Tsuta,G.Ishii,K.Yoh et al., “Primary lung carcinomawith signet-ring cell carcinoma components: clinicopathological analysis of 39 cases,” American JournalofSurgicalPathology,vol. 28,no. 7, pp.868–874,2004. [3] S. H. Merchant, M. B. Amin, P. Tamboli et al., “Primary signet- ring cell carcinoma of lung: immunohistochemical study and comparison with non-pulmonary signet-ring cell carcinomas,” American Journal of Surgical Pathology,vol.25, no.12, pp.1515– 1519, 2001. [4] J. Ye, J. J. Findeis-Hosey, Q. Yang et al., “Combination of napsin A and TTF-1 immunohistochemistry helps in differentiating primary lung adenocarcinoma from metastatic carcinoma in MEDIATORS of INFLAMMATION The Scientific Gastroenterology Journal of World Journal Research and Practice Diabetes Research Disease Markers Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 International Journal of Journal of Immunology Research Endocrinology Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Submit your manuscripts at http://www.hindawi.com BioMed PPAR Research Research International Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Journal of Obesity Evidence-Based Journal of Journal of Stem Cells Complementary and Ophthalmology International Alternative Medicine Oncology Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Parkinson’s Disease Computational and Behavioural Mathematical Methods AIDS Oxidative Medicine and in Medicine Research and Treatment Cellular Longevity Neurology Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014

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Case Reports in Oncological MedicineHindawi Publishing Corporation

Published: Jan 9, 2014

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