Signet Ring Cell Carcinoma

It is defined by the presence of more than 50% of tumour cells with prominent intracytoplasmic mucin [30]. The typical signet-ring cell has a large mucin vacuole that fills the cytoplasm and displaces the nucleus. Some MSI+ tumours belong to this histo-


Table 1. Rectal resection: checklist

Clinical information Relevant history Previous colon adenoma(s)/carcinoma(s)

Relevant findings Clinical diagnosis Procedure Operative findings Anatomic site(s) of specimen(s)

Familial adenomatous polyposis syndrome Hereditary non-polyposis colon cancer syndrome Familial hamartomatous polyposis syndrome Inflammatory bowel disease

Colonoscopic endoscopic ultrasound and/or imaging studies

Low anterior resection, abdominoperineal resection Rectosigmoid, rectum and anal canal

Macroscopic examination

Microscopic evaluation

Specimen Organ(s)/tissue(s) included

Unfixed/fixed Number of pieces Dimensions

Appearance of mesorectal envelope Results of intraoperative consultation Tumour Location

Configuration Dimensions

Descriptive characteristics (e.g., colour, consistency) Ulceration/perforation

Distance from margins (proximal, distal, circumferential) Appearance of serosa overlying tumour Estimated depth of invasion

Lesions in no cancerous rectum (e.g., proctitis, other polyps)

Regional lymph nodes

Metastasis to other organ(s) or structure(s)

Rectum uninvolved by tumour

Other tissue(s)/organ(s)

Tissues submitted for Carcinoma microscopic evaluation

Points of deepest penetration Interface with adjacent sigmoid colon/anal canal Visceral serosa overlying tumour Margin (proximal, distal, circumferential) All lymph nodes Other lesions (proctitis, polyps) Frozen section tissue fragment(s)

Histologic type Histologic grade Extent of invasion Blood/lymphatic vessel invasion Perineural invasion Extramural venous invasion Peritumoral lymphocytic response

Pattern of growth at tumour periphery (infiltrating border, pushing border) Associated perirectal abscess formation, if present Associated pneumatosis intestinalis, if present Proximal Distal

Circumferential (specify distance of carcinoma from closest circumferential margin)

Regional lymph nodes Number

Number involved by tumour Inflammatory bowel disease

Dysplasia Adenomas

Other types of polyps



Additional pathologic findings, if present

Distant metastasis (specify site)

Results/status of special studies (specify)


Other tissue(s)/organ(s)

Correlation with intraoperative consultation Correlation with other specimens Correlation with clinical information

Table 2. pTNM: pathologic staging pT: primary tumour, not treated pTX: cannot be asessed pT0: no evidence of primary tumour pTis: carcinoma in situ, intraepithelial or intramucous pT1: tumour invades submucosa pT2: tumour invades muscularis propria pT3: tumour invades through the muscularis propria into the subserosa or the non-peritonealised perirectal soft tissue; the infiltration is evaluated in mm beyond the border of the muscularis propria pT3a: minimal invasion: less than 1 mm pT3b: slight invasion: 1-5 mm pT3c: moderate invasion: >5-15 mm pT3d: moderate invasion: >15 mm pT4: tumour directly invades other organs or structures (T4a) and penetrates visceral peritoneum (T4b) Tumours that invade the external sphincter are classified as T3 while tumours that invade the musculus levator ani are classified as T4

pN: regional lymph nodes pNX: cannot be assessed pN0: no regional lymph node metastasis pN1: metastasis in 1 to 3 regional lymph node pN2: metastasis in 4 or more regional lymph nodes pM: distant metastasis pMx: cannot be assessed pM0: no distant metastasis pM1: distant metastasis After pre-operative therapy pTNM categories should have the prefix "Y"

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