Simultaneous Presentation of Hairy Cell Leukemia and Metastatic Signet Ring Carcinoma of the Stomach Diagnosed by Bone Marrow BiopsyPerunicic-Jovanovic, Maja MD*; Djunic, Irena MD*; Tomin, Dragica PhD*; Terzic, Tatjana MD*; Jakovic, Ljubomir MD*; Sokic, Aleksandra PhD†; Gotic, Mirjana PhD*Applied Immunohistochemistry & Molecular Morphology: May 2011 - Volume 19 - Issue 3 - p 279–282 doi: 10.1097/PAI.0b013e3181f7b30f Case Reports Buy Abstract Author InformationAuthors Article MetricsMetrics Hairy cell leukemia (HCL) is a rare chronic B-cell disorder with an increased risk of second tumors. The relative risk of second cancers reported in various series of HCL patients ranged from 0.95 to 4.33, but simultaneous presentation of HCL and other epithelial malignancies is very rare. To our knowledge, we present the first case of the coexistence of signet ring carcinoma of the stomach and HCL. We report a case of the simultaneous presentation of HCL and metastasis of the primary signet ring cell carcinoma of the stomach to the bone marrow and skin. A bone marrow biopsy was performed on a patient with pancytopenia. A histologic examination with immunostaining of the bone marrow specimen showed the presence of signet ring carcinoma cells in addition to HCL. As a consequence, our patient underwent further diagnostic procedures including endogastroduodenoscopy with biopsy of gastric tumor mass, which established the diagnosis of gastric signet ring cell carcinoma. *Clinic for Hematology †Clinic for Digestive Disease, Clinical Center of Serbia, Belgrade, Serbia The authors' disclosure of funding received for this work from any of the following organizations: National Institutes of Health (NIH), Wellcome Trust, Howard Hughes Medical Institute (HHMI), and other(s). Reprints: Irena Djunic, MD, Koste Todorovica 2, Clinical Center of Serbia, 11000 Belgrade, Serbia (e-mail: firstname.lastname@example.org). Received July 7, 2010 Accepted August 16, 2010 © 2011 Lippincott Williams & Wilkins, Inc.