P160

An atypical presentation of Signet-Ring Cell Adenocarcinoma of the lung with pleural effusion – a case report

G. Lekatsas*a (Mr), G. Chrysofakisa (Mr)

a General Hospital of Rethymno, Rethymno, Crete, GREECE

* ger.lekatsas@gmail.com

Background

Signet-Ring Cell Adenocarcinoma (SRCA) is a subtype of adenocarcinoma occurring mostly in the gastrointestinal tract. Primary SRCA of other organs are rare, such as breast and lung.

Case report

We present a case of a 77-year-old patient who was referred to our hospital due to fever, non-productive cough in the last 2 days. He mentioned progressively worsening dyspnoea during the past month. The CT scan revealed large unilateral pleural effusion on the left hemithorax with secondary compressive atelectasis and consolidation pattern of the left lung. Empiric antibiotic therapy for pneumonia was initiated. The diagnostic thoracentesis revealed an exudate with neutrophilic predominance. The cytologic examination of the fluid was positive for malignant undifferentiated cells, so further investigation was decided. The patient underwent flexible bronchoscopy which revealed diffuse inflammatory and oedematous bronchial mucosa of the left bronchial tree. The specimens taken by biopsies and brushing were positive for SRCA and the IHC was suggestive for the lung as the primary site.

Conclusion

Primary lung SRCA can be a challenge to diagnose due to its rarity (0.14% to 1.9% of all lung cancers) and the heterogeneity of clinical manifestations. It is important to In our case, we performed and extensive diagnostic workup and we reached the diagnosis of a rare malignancy with atypical presentation (20% of pleural effusions with neutrophilic predominance are malignant).

Bibliography

  1. O. Kocas et al., Primary signet ring cell carcinoma of the lung with cerebellar metastasis showing full response to cisplatin and docetaxel therapy, CROM, 2014
  2. J.Kovacevic et al., Pulmonary Adenocarcinoma With Signet Ring Features: An Unusual Case of a Rare Disease, ACCP, 2017
  3. M. Benesch and A.Mathieson, Epidemiology of Signet Ring Cell Adenocarcinomas, Cancers, 2020
  4. Y.Mingguang et al., A case report of primary signet ring cell carcinoma of the lung: imaging study and literature review, TLCR, 2021

Disclosure of funding source(s): none