Cancer Research and Treatment

Original Articles

Gynecologic cancer

Image-Guided Versus Conventional Brachytherapy for Locally Advanced Cervical Cancer: Experience of Single Institution with the Same Practitioner and Time Period: Tae Hoon Lee, Kyung Su Kim, Hak Jae Kim, Chang Heon Choi, Seonghee Kang, Keun-Yong Eom, Chan Woo Wee, Yong Sang Song, Noh Hyun Park, Jae-Weon Kim, Hyun Hoon Chung, Hee Seung Kim, Maria Lee, Hyun-Cheol Kang; Cancer Res Treat. 2023;55(1):258-269. Published online August 10, 2022; DOI: https://doi.org/10.4143/crt.2022.418

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Purpose
This study aimed to compare treatment outcomes and toxicity profile between imaged-guided brachytherapy (IGBT) versus conventional brachytherapy (CBT) performed by the same practitioner during the same time period.
Materials and Methods
Medical records of 104 eligible patients who underwent brachytherapy for locally advanced cervical cancer were retrospectively reviewed. Fifty patients (48.1%) underwent IGBT, and 54 (51.9%) patients underwent CBT. All patients underwent concurrent chemoradiation with cisplatin. High-dose-rate intracavitary brachytherapy with dose prescription of 25-30 Gy in 4-6 fractions was performed for all patients. Late lower gastrointestinal (GI) and urinary toxicities occurred more than 3 months after the end of brachytherapy were included for comparative and dosimetric analyses.
Results
The median follow-up period was 18.33 months (range, 3.25 to 38.43 months). There were no differences in oncologic outcomes between the two groups. The IGBT group had lower rate of actuarial grade ≥ 3 toxicity than the CBT group (2-year, 4.5% vs. 25.7%; p=0.030). Cumulative equieffective D2cc of sigmoid colon was significantly correlated with grade ≥ 2 lower GI toxicity (p=0.033), while equieffective D2cc of rectum (p=0.055) and bladder (p=0.069) showed marginal significance with corresponding grade ≥ 2 toxicities in the IGBT group. Half of grade ≥ 3 lower GI toxicities impacted GI tract above the rectum. Optimal thresholds of cumulative D2cc of sigmoid colon and rectum were 69.7 Gy and 70.8 Gy, respectively, for grade ≥ 2 lower GI toxicity.
Conclusion
IGBT showed superior toxicity profile to CBT. Evaluating the dose to the GI tract above rectum by IGBT might prevent some toxicities.

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Cisplatin

Reactions Weekly.2023; 1947(1): 125. CrossRef
A Mixed Methods Study to Implement the Synergy Tool and Evaluate Its Impact on Long-Term Care Residents
Farinaz Havaei, Francis Kobekyaa, Andy Ma, Maura MacPhee, Wei Zhang, Megan Kaulius, Bahar Ahmadi, Sheila Boamah, Adam Easterbrook, Amy Salmon
Healthcare.2023; 11(15): 2187. CrossRef

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Venous Invasion in Colorectal Cancer: Impact of Morphologic Findings on Detection Rate: Chungsu Hwang, Sojeong Lee, Ahrong Kim, Young-Geum Kim, Sang-Jeong Ahn, Do Youn Park; Cancer Res Treat. 2016;48(4):1222-1228. Published online February 12, 2016; DOI: https://doi.org/10.4143/crt.2015.429

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Purpose
Venous invasion (VI) is widely accepted as a poor prognostic factor in colorectal cancer (CRC), and is indicated as a high-risk factor determining the use of adjuvant chemotherapy in CRC. However, there is marked interobserver and intraobserver variability in VI identification and marked variability in the real prevalence of VI in CRC.
Materials and Methods
We investigated the detection rate of VI in 93 consecutive cases of T3 or T4 CRC based on the following: original pathology report, review of hematoxylin and eosin (H&E) slides with attention to the “protruding tongue” and “orphan arteriole” signs, and elastic stain as the gold standard.
Results
Overall, the detection rate of VI was significantly increased as follows: 14/93 (15.1%) in the original pathology report, 38/93 (40.9%) in review of H&E slides with attention to the “protruding tongue” and “orphan arteriole” signs, and 45/93 (48.4%) using elastic stain. VI detection based on morphologic features showed 77.8% sensitivity and 91.1% specificity and showed a linear correlation (Spearman correlation coefficient, 0.727; p < 0.001) with VI detected by elastic stain. In addition, improved agreement between detection methods (detection on the basis of morphologic features, κ=0.719 vs. original pathology report, κ=0.318) was observed using kappa statistics.
Conclusion
Slide review with special attention to the “protruding tongue” and “orphan arteriole” signs could be used for better identification of VI in CRC in routine surgical practice.

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Colorectal adenosquamous carcinoma: clinicopathologic analysis of two large cohorts and literature review confirm poor prognosis and reveal prognostic aspects
Raul S Gonzalez, Rachel K Horton, Xuchen Zhang, Rondell P Graham, Teri A Longacre, Anupamjit Mehrotra, Daniela S Allende, Kelsey E McHugh, Jinru Shia, Maria Westerhoff, Amitabh Srivastava, Wei Chen, Jennifer Vazzano, Paul E Swanson, Deyali Chatterjee, Has
Histopathology.2025; 86(7): 1064. CrossRef
Usefulness of Elastica van Gieson staining and the number of samples prepared for venous invasion of colorectal cancer (pT2–pT4)
Kota Nakashima, Jun Akiba, Shinji Mizuochi, Masamichi Nakayama, Naohiro Yoshida, Kenichi Koushi, Takefumi Yoshida, Fumihiko Fujita, Hitoshi Obara, Tatsuyuki Kakuma, Yoshito Akagi, Hirohisa Yano
Human Pathology Reports.2023; 31: 300690. CrossRef
Routine elastin staining improves venous invasion detection in colorectal carcinoma
Hisham F. Bahmad, Ferial Alloush, Ali Salami, Rachel Sawah, Ciara Lusnia, Ekim Kilinc, Tyson Sutherland, Sarah Alghamdi, Robert J. Poppiti
Annals of Diagnostic Pathology.2023; 66: 152170. CrossRef
The Usefulness of Elastin Staining to Detect Vascular Invasion in Cancer
Jeffrey Gonzalez, Hisham F. Bahmad, Stephanie Ocejo, Alvaro Abreu, Meagan Popp, Samantha Gogola, Vielka Fernandez, Monica Recine, Robert Poppiti
International Journal of Molecular Sciences.2023; 24(20): 15264. CrossRef
Reevaluation of Venous Invasion with Elastic Tissue Stain in Colorectal Cancers
Ebru AKAY, Serdal Sadet ÖZCAN, Merve DOĞAN, Fatoş TEKELİOĞLU, Saliha KARAGÖZ EREN, Hatice KARAMAN
Sakarya Medical Journal.2022;[Epub] CrossRef
Addition of V-Stage to Conventional TNM Staging to Create the TNVM Staging System for Accurate Prediction of Prognosis in Colon Cancer: A Multi-Institutional Retrospective Cohort Study
Jung Hoon Bae, Ji Hoon Kim, Jaeim Lee, Bong-Hyeon Kye, Sang Chul Lee, In Kyu Lee, Won Kyung Kang, Hyeon-Min Cho, Yoon Suk Lee
Biomedicines.2021; 9(8): 888. CrossRef
Feasibility and Performance of Elastin Trichrome as a Primary Stain in Colorectal Cancer Resection Specimens
Sameer Shivji, Ipshita Kak, Stephanie L. Reid, Jennifer Muir, Sara Hafezi-Bakhtiari, Hector Li-Chang, Ardit Deliallisi, Ken J. Newell, Andrea Grin, James Conner, Richard Kirsch
American Journal of Surgical Pathology.2021; 45(10): 1419. CrossRef
Comparison of Vascular Invasion With Lymph Node Metastasis as a Prognostic Factor in Stage I-III Colon Cancer: An Observational Cohort Study
Jung Hoon Bae, Ji Hoon Kim, Bong-Hyeon Kye, Abdullah Al-Sawat, Chul Seung Lee, Seung-Rim Han, In Kyu Lee, Sung Hak Lee, Yoon Suk Lee
Frontiers in Surgery.2021;[Epub] CrossRef
Three-dimensional visualization of cleared human pancreas cancer reveals that sustained epithelial-to-mesenchymal transition is not required for venous invasion
Seung-Mo Hong, DongJun Jung, Ashley Kiemen, Matthias M. Gaida, Tadashi Yoshizawa, Alicia M. Braxton, Michaël Noë, Gemma Lionheart, Kiyoko Oshima, Elizabeth D. Thompson, Richard Burkhart, Pei-Hsun Wu, Denis Wirtz, Ralph H. Hruban, Laura D. Wood
Modern Pathology.2020; 33(4): 639. CrossRef
Prognostic significance of venous invasion in node‐negative head and neck squamous cell carcinoma
Arun Gopinath, Aysha Mubeen, Brett Baskovich, Ibraheem Mohammed, Raafat Makary, Erica S. Hoy, Roi Dagan, Carmen Smotherman, Shiva Gautam, Rui P. Fernandes, Anthony M. Bunnell, Phillip Pirgousis, Ahmad Alkhasawneh
Journal of Oral Pathology & Medicine.2020; 49(2): 150. CrossRef
Comparison of the efficiency of transgelin, smooth muscle myosin, and CD31 antibodies for the assessment of vascular tumor invasion and free tumor deposits in gastric, pancreatic, and colorectal adenocarcinomas
Betul Ogut, Ozgur Ekinci, Bulent Celik, EmelRodoplu Unal, Ayse Dursun
Indian Journal of Pathology and Microbiology.2020; 63(1): 25. CrossRef
Elastin and collagen IV double staining: A refined method to detect blood vessel invasion in breast cancer
Masayoshi Fujisawa, Masako Omori, Hiroyoshi Doihara, Ye‐Min Than, Hnin Wint Wint Swe, Teizo Yoshimura, Akihiro Matsukawa
Pathology International.2020; 70(9): 612. CrossRef
Incidence of extramural venous invasion in colorectal carcinoma as determined at the invasive tumor front and its prognostic impact
Klaus Dirschmid, William Sterlacci, Ewald Wöll, Peter Tschann, Michaela Rhomberg, Felix Offner
Human Pathology.2019; 86: 102. CrossRef
Why is pancreatic cancer so deadly? The pathologist's view
Ralph H Hruban, Matthias M Gaida, Elizabeth Thompson, Seung‐Mo Hong, Michaël Noë, Lodewijk AA Brosens, Martine Jongepier, G Johan A Offerhaus, Laura D Wood
The Journal of Pathology.2019; 248(2): 131. CrossRef
Rectal cancer and the pathologist
Mariana Berho, Pablo A. Bejarano
Minerva Chirurgica.2018;[Epub] CrossRef
Identifying molecular contributors to autofluorescence of neoplastic and normal colon sections using excitation-scanning hyperspectral imaging
Joshua Deal, Sam Mayes, Craig Browning, Shante Hill, Paul Rider, Carole Boudreaux, Thomas C. Rich, Silas J. Leavesley
Journal of Biomedical Optics.2018; 24(02): 1. CrossRef

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Preliminary Suggestion about Staging of Anorectal Malignant Melanoma May Be Used to Predict Prognosis: Won Young Chae, Jong Lyul Lee, Dong-Hyung Cho, Chang Sik Yu, Jin Roh, Jin Cheon Kim; Cancer Res Treat. 2016;48(1):240-249. Published online March 6, 2015; DOI: https://doi.org/10.4143/crt.2014.305

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Purpose
Anorectal malignant melanomas (AMM) are rare and have poor survival. The study aims to evaluate the clinicopathologic characteristics and outcomes of patients with AMM, and to devise a staging system predictive of survival outcome.
Materials and Methods
This was a retrospective study of 28 patients diagnosed with, and treated for AMM. Patients classified by clinical staging of mucosal melanoma (MM) were reclassified via rectal and anal TNM staging. Survival outcomes were compared among patients grouped by the three different staging systems.
Results
The three staging systems were equated with similar figures for 5-year overall survival (OS) and 5-year disease-free survival (DFS) of patients diagnosed with stage I disease. Patients (n=19) diagnosed with MM stage II disease were reclassified by rectal TNM staging into three subgroups: IIIA, IIIB, and IIIC. For these patients, both 5-year OS and 5-year DFS differed significantly between the subgroups IIIA and IIIC (OS: IIIA vs. IIIC, 66.7% vs. 0%, p=0.002; DFS: IIIA vs. IIIC, 51.4% vs. 0%, p < 0.001).
Conclusion
The accuracy of prognosis in patients diagnosed with AMM and lymph node metastasis has improved by using rectal TNM staging, which includes information regarding the number of lymph node metastases.

Citations

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Survival and Prognosis for Patients with Rectal Melanomas in the United States: A SEER-Based Study
Fan Zhang, Boqi Xu, Yao Peng, Runda Wu, Shan Tong, Zhongqi Mao
Journal of Investigative Surgery.2024;[Epub] CrossRef
Incidence and survival of patients with primary gastrointestinal melanoma: a population-based study
Yu Du, Xiaona Chang, Xiangxiang Li, Shugang Xing
International Journal of Colorectal Disease.2023;[Epub] CrossRef
Melanoma anorrectal primario: reporte de un caso y revisión de una neoplasia infrecuente
Hernando Marulanda Fernández, Felipe Vera-Polanía, Juan Antonio Trejos Naranjo, Julian Ernesto Parga Bermudez, William Otero Regino
Revista colombiana de Gastroenterología.2023; 38(4): 504. CrossRef
A New Anorectal Melanoma Cell Line Derived from a Primary Human Rectal Tumor
Seiichi Shinji, Yuuki Shichi, Takeshi Yamada, Goro Takahashi, Ryo Ohta, Hiromichi Sonoda, Akihisa Matsuda, Kazuhide Yonaga, Takuma Iwai, Kohki Takeda, Koji Ueda, Sho Kuriyama, Toshimitsu Miyasaka, Yoshibumi Ueda, Norihiko Sasaki, Kimimasa Takahashi, Ryuji
Journal of Nippon Medical School.2022; 89(4): 368. CrossRef
Difficulties in diagnosing anorectal melanoma: A case report and review of the literature
Raluca Cristina Apostu, Elena Stefanescu, Radu Razvan Scurtu, Gabriel Kacso, Radu Drasovean
World Journal of Clinical Cases.2021; 9(36): 11369. CrossRef
Outcomes of Surgical Treatment for Patients with Anorectal Malignant Melanoma; Results of Nine Cases in a Single Institution
Tomoyuki Nagaoka, Toshiya Nagasaki, Takashi Akiyoshi, Toshiki Mukai, Tomohiro Yamaguchi, Eiji Shinozaki, Yosuke Fukunaga
Journal of the Anus, Rectum and Colon.2021; 5(2): 192. CrossRef
Management and outcomes of primary anorectal melanoma in the United States
Hari Menon, Roshal R Patel, Taylor R Cushman, Arya Amini, Steven N Seyedin, Anngela C Adams, Chi Lin, Vivek Verma
Future Oncology.2020; 16(8): 329. CrossRef
Melanoma anal, una patología radicalmente distinta al melanoma cutáneo, con un pronóstico infausto
Mireia Merichal Resina, Carlos Cerdan Santacruz, Enrique Sierra Grañón, Jordi Antoni Tarragona Foradada, Jorge Juan Olsina Kissler
Cirugía Española.2020; 98(8): 491. CrossRef
Anal Melanoma, a Radically Different Pathology to the Cutaneous Melanoma, With an Infaustic Forecast
Mireia Merichal Resina, Carlos Cerdan Santacruz, Enrique Sierra Grañón, Jordi Antoni Tarragona Foradada, Jorge Juan Olsina Kissler
Cirugía Española (English Edition).2020; 98(8): 491. CrossRef
Beyond adenocarcinoma: MRI of uncommon rectal neoplasms and mimickers
David D. B. Bates, Maria Clara Fernandes de Paula, Natally Horvat, Shannon Sheedy, Chandana Lall, Zahra Kassam, Perry Pickhardt, Neeraj Lalwani, Dhakshinamoorthy Ganeshan, Iva Petkovska
Abdominal Radiology.2019; 44(11): 3581. CrossRef
Prognostic factors in primary anorectal melanoma: a clinicopathological study of 60 cases in China
Min Ren, Yawen Lu, Jiaojie Lv, Xuxia Shen, Jincheng Kong, Bo Dai, Yunyi Kong
Human Pathology.2018; 79: 77. CrossRef

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Body Mass Index and Doses at Organs at Risk in a Mediterranean Population Treated with Postoperative Vaginal Cuff Brachytherapy: Sebastia Sabater, Meritxell Arenas, Roberto Berenguer, Ignacio Andres, Esther Jimenez-Jimenez, Ana Martos, Jesus Fernandez-Lopez, Mar Sevillano, Angeles Rovirosa; Cancer Res Treat. 2015;47(3):473-479. Published online November 24, 2014; DOI: https://doi.org/10.4143/crt.2014.115

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Purpose
Association between body mass index (BMI) and doses in organs at risk during postoperative vaginal cuff brachytherapy (VCB) treatment has not been evaluated. The aim of this study was to analyse the impact of BMI on the dose delivered to bladder and rectum during high-dose-rate VCB using computed tomography (CT) scans at every fraction.
Materials and Methods
A retrospective analysis of 220 planning CT sets derived from 59 patients was conducted. Every planning CT was re-segmented and re-planned under the same parameters. Rectum and bladder dose-volume histogram values (D0.1cc, D1cc, and D2cc) were extracted and evaluated. The mean values for all applications per patient were calculated and correlated with BMI, as well as other factors influencing rectal and bladder doses. Multiple regression analysis performed to model organ at risk dose-volume parameters.
Results
According to World Health Organization (WHO), 6.8% of patients were normal, 35.6% were overweight, and 57.6% were class I obese. Median rectal doses were 133.5%, 110.9%, and 99.3% for D0.1cc, D1cc, and D2cc, respectively. The corresponding median bladder doses were 96.2%, 80.6%, and 73.3%, respectively. BMI did not show significant association with rectal doses. However, BMI did show a significant association with evaluated bladder dose metrics (D0.1cc, r=–0.366, p=0.004; D1cc, r=–0.454, p < 0.001; D2cc, r=–0.451, p < 0.001). BMI was retained in the multivariate regression models (D0.1cc, p=0.004; D1cc, p < 0.001; D2cc, p=0.001).
Conclusion
In this group of Mediterranean, overweight, and moderately obese patients, BMI showed association with lower bladder dose values, but not with rectal doses.

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Investigating the Influence of Body Mass Index on Organs at Risk Doses for Adjuvant High-Dose-Rate Vaginal Cuff Brachytherapy in Patients with Early-Stage Endometrial Carcinoma: A Single-Center Experience
Alexandra Timea Kirsch-Mangu, Diana Cristina Pop, Alexandru Țipcu, Andrei-Rareș Avasi, Claudia Ordeanu, Ovidiu Florin Coza, Alexandru Irimie
Diagnostics.2025; 15(7): 795. CrossRef
Vaginal dilator use more than 9 months is a main prognostic factor for reducing G2‑late vaginal complications in 3D‑vaginal‑cuff brachytherapy (interventional radiotherapy)?
Yaowen Zhang, Faegheh Noorian, Rosa Abellana, José Rochera, Antonio Herreros, Gabriela Antelo, Valentina Lancellotta, Luca Tagliaferri, Qian Han, Aureli Torne, Angeles Rovirosa
Clinical and Translational Oncology.2023; 25(6): 1748. CrossRef
Dose and secondary cancer-risk estimation of patients undergoing high dose rate intracavitary gynaecological brachytherapy
Chris Osam Doudoo, Prince Kwabena Gyekye, Geoffrey Emi-Reynolds, Simon Adu, David Okoh Kpeglo, Samuel Nii Adu Tagoe, Kofi Agyiri
Journal of Medical Imaging and Radiation Sciences.2023; 54(2): 335. CrossRef
Influence of body habitus on dose parameters of nodal levels III to IV irradiation for breast cancer: comparison of 3 techniques
Sebastia Sabater, Marina Gascon, Manuel Gutierrez-Perez, Roberto Berenguer, Ellen M. Donovan, Emma J. Harris, Meritxell Arenas
Medical Dosimetry.2018; 43(4): 328. CrossRef
Does postoperative irradiation improve survival in early-stage endometrial cancer?
Sebastia Sabater, Ignacio Andres, Veronica Lopez-Honrubia, Maria Magdalena Marti-Laosa, Susana Castro-Larefors, Roberto Berenguer, Esther Jimenez-Jimenez, Marimar Sevillano, Angeles Rovirosa, Meritxell Arenas
Brachytherapy.2018; 17(6): 912. CrossRef
Body mass index and outcomes of endometrial and ovarian cancer patients
Anke Smits, Alberto Lopes, Ruud Bekkers, Leon Massuger, Khadra Galaal
Expert Review of Quality of Life in Cancer Care.2016; 1(3): 221. CrossRef

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Laparoscopic Assisted Distal Rectal Cancer Resection with Preoperative Concurrent Chemoradiotherapy: Bong Hwa Lee, Mi Young Chang, Sung Kook Park, Taeik Eum, Hyun Joo Shin, Nam Kyu Ro, Chang Nam An, Hae Wan Lee, Lee Su Kim, Hyoung-Chul Park, Hoon Sik Bae, Dae Young Zang, Richard L Whelan; Cancer Res Treat. 2007;39(1):10-15. Published online March 31, 2007; DOI: https://doi.org/10.4143/crt.2007.39.1.10

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Purpose

Anatomy of deep pelvis, narrow distal margin and tumor invasion into neighbor organ are obstacles for curative radical resection for advanced cancer of distal rectum. Technically, laparoscopic application after downstaging the tumor with preoperative concurrent chemotherapy (CCRT) may give a solution to overcome the anatomical difficulties. We compared the results of laparoscopic surgery in the patients who received CCRT with those of patients who had conventional surgery.

Materials and Methods

A continuous infusion of 5FU plus leucovorin and radiotherapy (50.4 Gy) in 28 fractions was given each patient as CCRT. They underwent D2 radical resection with TME and ANP for the rectal cancer in 4 weeks.

Results

Thirty three patients had laparoscopic resection such as LAR, colo-anal anastomosis and APR. The results were compared with 12 cases of the conventional resections. As a result of preoperative CCRT, the cancer was down-staged in 71%. Two year disease free survival was 75% and 74% in the group of conventional and laparoscopic resection, respectively (p=0.427). Ileus, voiding difficulty and leakage after surgery were not different between two groups. Weakness of ejaculation was noted in 9~11% of both groups. The DFS of the preoperative CCRT followed by radical resection in the groups with a response was more favorable than that in the group with progressive or stable disease.

Conclusion

Radical resection of advanced distal rectal cancer could be done with performing a laparoscopic assisted operation after CCRT induced down-staging. We may suggest that laparoscopic assisted resection is a good treatment option as it doesn't increase the complications and it has a compatible survival rate to conventional surgery.

Citations

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DPYD,TYMS,TYMP,TK1, andTK2Genetic Expressions as Response Markers in Locally Advanced Rectal Cancer Patients Treated with Fluoropyrimidine-Based Chemoradiotherapy
Ming-Yii Huang, Chan-Han Wu, Chun-Ming Huang, Fu-Yen Chung, Ching-Wen Huang, Hsiang-Lin Tsai, Chin-Fan Chen, Shiu-Ru Lin, Jaw-Yuan Wang
BioMed Research International.2013; 2013: 1. CrossRef

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Primary Signet Ring Cell Carcinoma of the Colon and Rectum: Hee Chul Kim, Chang Nam Kim, Choon Sik Jeong, Chang Sik Yu, Byung Sik Kim, Hun Kyung Lee, Jin Cheon Kim; J Korean Cancer Assoc. 1998;30(3):521-526.

Abstract PDF: PURPOSE
Signet ring cell carcinoma is a rare type of adenocarcinoma in the colon and rectum. We evaluated the differences of clinical features between colorectal signet ring cell carcinoma and ordinary adenocarcinoma.
MATERIALS AND METHODS
The clincopathologic data of 13 cases with primary colorectal signet ring cell carcinoma were reviewed. The primary colorectal signet ring cell carcinoma was diagnosed when following criteria were met: 1) the tumor was primary; 2) histologic material was adequate; 3) signet ring cells represented more than 50% of the cancer.
RESULTS
Patients ranged in age from 20 to 68 (median, 45) years; 7 were male, and 6 were female. Three tumors were located in the proximal colon, 3 in the distal colon, and 7 in the rectum. There was no case that had family history. Most cases (77%) were stage III, one was stage II, and two were stage IV with peritoneal seeding. There were 9 cases that showed local recurrence or distant metastases during follow-up periods 6 cases with peritoneal seeding, 3 with bone metastases, 2 with brain metastases and 1 with pelvic recurrence (two cases had either bone and brain metastasis, and one case had bone and peritoneal seeding). Prognosis was extremely poor, and overall two years survival rate was 25%. CONCLUSION: Early onset, mode of metastasis and poor prognosis may imply the different biologic behavior of signet ring cell carcinoma, compared with ordinary adenocarcinoma. To improve outcome, early diagnosis and radical operation should be stressed.

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