Bazan et al. Journal of Medical Case Reports 2011, 5:458 http://www.jmedicalcasereports.com/content/5/1/458 Page 3 of 4 Figure 2 CT images. A) Hepatic metastasis (red arrow). B) Peritoneal metastases (red arrow). C) Liver infiltration, hilum adenopathies, and subcutaneous nodule at the entrance of the right laparoscopy trocar (red arrow). D) Nodular metastases in left pleura (red arrow) and right pleural effusion. Obtaining a complete medical history and performing radiological studies are the first steps in the diagnosis of possible metastatic SRCC, even before conducting immunohistochemical studies. In the case of our patient, clinical data, histology, radiology and an extensive autopsy ruled out the possibility of metastasis and non- neoplastic signet-ring cell changes. As long as GC is known as an aggressive neoplasm, early detection and radical surgery are the best treat- ments. According to several series, such as those pub- lished by Kondo [12] in Japan and Dixon [13] in the US, radical surgery was proven to increase the survival rate of GC patients, becoming the most appropriate surgical option whenever possible. Survival and prognosis of GC patients are improved by an early diagnosis; unfortunately its clinical characteris- tics appear at an advanced stage, so the more character- istics that are observed the poorer the prognosis. About one percent of all laparoscopic cholecystectomies pre- sent a focus of GC as an incidental finding [6]. It has been reported that the most important factor in determining the increase of survival in these patients is a negative surgical margin [13]; on the other hand, an intra-operative perforation of the gallbladder decreases survival [14]. Surgical dissemination appears to be a risk factor for peritoneal metastases. Therefore when a gall- bladder carcinoma is suspected, a vinyl bag is used to wrap the specimen and prevent its spread. Dissemina- tion by trocars used in the laparoscopy has been sus- pected, because they can spread cells through the abdominal wall entrance when they are removed, but this hypothesis is still questionable [15]. Although the procedure mentioned above were fol- lowed during the surgery of this patient, it is necessary to highlight the infiltrative behavior of this subtype of neoplasm (SRCC) with frequent local and distant metastases. Tetsyri reported a case of SRCC which over-expressed c-myc oncogene and reported that a specific monoclonal antibody with reactivity against gallbladder is being stu- died [16]. Karabulut has also reported that signet-ring cells resemble the histology seen in the stomach SRCC and that chemotherapies such as cisplatin could be use- ful [8]. This is also reported by Shikata, who achieved significant positive results [17]. Conclusion The determination of the neoplastic or non-neoplastic origin of signet-ring cells is required to determine whether to start treatment. It is also important to