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Carcinoma-like Signet-ring Cells in Gastric Mucosa-associated Lymphoid Tissue (MALT) Lymphoma

Zamboni, Giuseppe; Franzin, Giuseppe; Scarpa, Aldo; Bonetti, Franco; Pea, Maurizio; Mariuzzi, Gian; Menestrina, Fabio

The American Journal of Surgical Pathology: May 1996 - Volume 20 - Issue 5 - p 588-598
Gastrointestinal Pathology Section

We noticed the presence of epithelial signet-ring cells (SRCs) in a proportion of primary gastric B-cell lymphomas, and in some endoscopic biopsies we found it difficult to decide whether they represented an associated carcinoma. To evaluate the frequency and nature of this phenomenon, we reviewed 108 stomachs resected for primary lymphoma, including 70 mucosa-associated lymphoid tissue (MALT) and 38 non-MALT lymphomas. We found SRCs, either isolated or grouped in clusters, in 26 of 70 MALT lymphomas. The SRCs were always localized in the superficial portion of the lamina propria and associated exclusively with lymphomatous areas. Isolated and scarce SRCs were also found in four of 22 cases of polyclonal atypical lymphoid hyperplasia. Our data suggest that SRCs occurring in gastric MALT lymphomas represent a particular type of LEL in which the foveolar cells disaggregated by the lymphomatous infiltration acquire a globoid, signet-ring appearance. These “foveolar” LELs are found in 37% of MALT lymphomas and are usually associated with the more classic and constant “neck” LELs, which are localized between the foveolae and mucopeptic glands. An awareness of the existence of the foveolar LEL may help avoid overdiagnosis of SRC carcinoma on gastric endoscopic biopsies.

From the Istituto di Anatomia Patologica, Università di Verona (G.Z., A.S., F.B., M.P., G.M.M., F.M.), and Servizio Autonomo Endoscopia Digestiva, Ospedale Borgo Trento (G.F.), Verona Italy.

Address correspondence and reprint requests to Dr. Giuseppe Zamboni, Istituto di Anatomia Patologica, Università di Verona, Policlinico Borgo Roma, I-37134 Verona, Italy.

This work was presented in part at the 80th Annual Meeting United States and Canadian Academy of Pathology 1991, Chicago.

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