We reviewed the medical records of all patients in our service who underwent transurethral resection between the years 1990-2009 ruling out those tumors that did not meet the histological criteria, excluding local bladder adenocarcinomas or bladder metastases resected.
We found nine cases with signet ring cell carcinoma diagnosed and treated in our service between January 1992 and January 2009; eight patients were male and there was only one woman, with an average age of 82 years old bladder cancer.
The clinical presentation was hematuria in six cases and clinical irritation with pollakiuria and significant dysuria in one of them.
One of these patients had an important general syndrome with cachexia at the time of diagnosis.
The cytological study of urine showed malignant cells in three patients, atypia in two and was normal in the remaining two.
CT showed thickening of the bladder wall in all cases, with non-obstructive bladder pericystium and retroperitoneal adenopathy in four patients and uni- or bilateral uropathy in four cases.
Two of the cases presented alterations in the gastroduodenal radiological study being completed with upper and lower endoscopy with the finding of chronic antral gastritis with foci of intestinal metaplasia in one of the subjects and adenomatous pemphigus.
Histological studies of the resected masses were performed in all cases, including paraffin, hematoxylin/eosin staining and PAS staining.
In some cases immunohistochemical studies were performed (PSA, E-cadherin, cytokeratin 20, S100) to rule out extravesical origin (1).
After the pathological study we found four cases of bladder adenocarcinoma of primary seal ring cells pure and five mixed with areas of signet ring cells within transitional cell carcinomas.
The pathology of these tumors showed large eosinophilic cytoplasm cells with positive central vacuum PAS and displacement of the nucleus to the periphery (typical signet ring morphology).
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Definitive treatment consisted of radical cystectomy with Bricker-type derivation in three patients, cystectomy with Mainz II derivation in another and palliative in the remaining four with TURP in three cases and NPCs.
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Three patients consistent with VMAC received adjuvant chemotherapy.
Survival was 570, 480, 250 and 8 days for pure tumors and 512, 410, 280, 270 days and more than 4 years in one case for mixed tumors.
All patients except two had died at the time of this study.
In the reviewed literature, overall survival did not exceed 11% at 5 years (2.3).
