Bazan et al. Journal of Medical Case Reports 2011, 5:458 http://www.jmedicalcasereports.com/content/5/1/458 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Metastatic gallbladder adenocarcinoma with signet-ring cells: A case report Fernando Bazan1*, Juan Sanchez1, Guadalupe Aguilar1, Aleksandar Radosevic1, Marcos Busto1, Flavio Zuccarino1, Lara Pijuan2 and Noelia Risueño1 Abstract Introduction: Signet-ring cell carcinoma is a rare and aggressive variant of mucinous adenocarcinoma. Only a few cases of gallbladder adenocarcinoma with signet-ring cells have been reported and because of this there is a lack of knowledge about the behavior and biology of this pathology. Case presentation: We present the case of a 63-year-old Arab man with gallbladder signet-ring cell adenocarcinoma. He had an elective cholecystectomy and refused chemotherapy. Two months later, a small hepatic metastatic nodule was found, and nine months later he presented with multiple metastases in the liver, lymphatic nodes, both pleuras, peritoneum and subcutaneous tissue. Conclusion: The proliferation of signet-ring cells in a gallbladder adenocarcinoma worsens the prognosis of an already adverse neoplasm. New lines of treatment in chemotherapy, such as cisplatin, or new biological therapy, such as monoclonal antibody c-myc oncogene, should be encouraged to improve the survival and life quality of these oncologic patients. Introduction Gallbladder carcinoma (GC) is the fifth most common malignant tumor of the gastrointestinal tract and the most frequent malignant neoplasm of the biliary tract [1]. Approximately 99% of gallbladder cancers are carcino- mas including 90% of adenocarcinomas, mostly well or moderately differentiated (74%). Five percent of gallblad- der carcinomas comprise other subtypes such as papil- lary adenocarcinomas, squamous cell carcinomas and mucinous adenocarcinomas [1]. Signet-ring cell carcinoma (SRCC) is a rare and aggressive variant of mucinous adenocarcinoma. It is histologically characterized by the presence of rounded cells with a clear and mucinous cytoplasm and a periph- eral nucleus. Its aggressive behavior is shown by the infiltration of the surrounding stroma, broad dissemina- tion and a high tendency to produce peritoneal metas- tases in the gastrointestinal tract, as in our patient [2]. The presence of non-neoplastic signet-ring cells on normal tissues is a source of pitfalls in biopsy specimens * Correspondence: LBazan@parcdesalutmar.cat 1Department of Radiology, Parc de Salut Mar Hospital, Barcelona, Cataluña, Spain Full list of author information is available at the end of the article that leads to over-diagnosis of SRCC. Although the meaning of this histological finding is still unclear [3], the features that define this entity are: the confinement of non-neoplastic cells to the mucosal surface, their lack of cellular atypia [4] and necrotic changes with sur- rounding inflammation [5]. GC-related symptoms are nonspecific. The risk factors have not been determined yet, although a close relation- ship with gallstones has been described [6]. As a result, almost one percent of all cholecystectomies have been reported to contain a malignant neoplasm focus [7]. Case report A 63-year-old Arab man with symptoms of three-month duration including a dull epigastric pain radiating to the right hypochondrium was transferred from a local hos- pital to our University Hospital. An upper endoscopy was performed and a mild gastritis (Helicobacter pylori negative) was diagnosed. The patient received proper treatment, but the pain persisted. Ultrasonography revealed many gallstones with thickened wall of the gall bladder. Images were not available to us because these examinations were performed before the referral of the patient. © 2011 Bazan et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.