- Question from Judi: My diagnosis was metastatic lobular carcinoma with signet ring cell features. Can you explain the significance of the signet ring cell?
Signet ring cells occur in many types of tumors. This name was given to them because the cells under the microscope look like a signet ring, with the nucleus pushed over to one side (the stone in the ring) and the remainder of the "ring" forming the cell membrane or boundary of the cell. It is a pattern of growth in tumors in gland-forming tumors.
In the breast, when one sees signet ring cells, one thinks of lobular carcinoma rather than ductal carcinoma. Cancers growing as signet ring cells can sometimes be missed or difficult to diagnose since these cells are small and often inconspicuous in the tissue. One has to look especially carefully at the lymph nodes in the patient with lobular carcinoma because this type of cancer can be difficult to see.
Marisa Weiss, M.D.
Two things I'd like to add. The presence or absence of signet cells has no real effect on the treatment plan. These cells act enough like other breast cancer cells, so standard treatment decisions are roughly the same.
Second, the word metastatic can be used in different ways to mean different things. But it always sounds very scary. The term may be used to describe the spread of cancer cells from one place to another, nearby (like lymph nodes) or further away (like the lungs). There is a whole system of staging that we use to describe the size of the cancer, whether or not there are lymph nodes involved (and if so, how many), and if there is spread beyond the breast and the nearby lymph nodes.
In your situation, if the cancer has spread to the lymph nodes under the armpits only, that could be stage II or III disease. If there is spread beyond that region to other parts of the body, it's referred to as stage IV, also called "metastatic," and sometimes the term "advanced" is used.
The Ask-the-Expert Online Conference called Your Operative and Pathology Reports featured Beth Baughman Dupree, M.D., F.A.C.S. and Ann Ainsworth, M.D. answering your questions about details of pathology and operative reports and the importance of discussing them with your doctors.
Editor's Note: This conference took place in November 2004.
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