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Tumor Discovery

CASE REPORT
Signet ring cell carcinoma of the urinary bladder

presenting with carcinocythemia and skeletal
metastasis: A case report

Emma Rullo * , Piergianni Biondi 2 , Chiara Nicolazzo 3 , Walter Gianni ,
2
1
Luciano Colangelo 2 , Mirella Cilli 2 , Paola Gazzaniga 3 , Mara Riminucci 1 ,
Alessandro Corsi 1 , and Salvatore Minisola 2
1 Department of Molecular Medicine, Sapienza University, and Section of Pathology, Policlinico
Umberto I, Rome, Italy
2 Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University,
and Mineral Metabolism Section, Policlinico Umberto I, Rome, Italy
3 Department of Molecular Medicine, Sapienza University, and Cancer Liquid Biopsy Unit, Policlinico
Umberto I, Rome, Italy

Abstract

Cancer of unknown primary accounts for approximately 3 – 5% of all malignancies
and is typically associated with a dismal prognosis. We describe a 65-year-old man
who presented with skeletal metastasis and circulating tumor cells exhibiting signet
ring (SR) morphology. The patient was diagnosed with SR cell carcinoma (SRCC)
through a bone marrow biopsy. This case report aimed to emphasize the importance
of clinicians’ awareness of SRCC of the urinary bladder. The primary site of tumor
*Corresponding author: origin was not identified as antemortem. The patient died 2 months after being
Emma Rullo admitted for pulmonary embolism. At autopsy, the urinary bladder was determined
(emma.rullo@uniroma1.it)
to be the primary site of the tumor. Primary SRCC of the urinary bladder is extremely
Citation: Rullo E, Biondi P, rare. There are currently no established consensus guidelines for its management.
Nicolazzo C, et al. Signet ring cell Surgery continues to be the primary treatment option when the condition is localized.
carcinoma of the urinary bladder
presenting with carcinocythemia
and skeletal metastasis:
A case report. Tumor Discov. Keywords: Cancer of unknown primary; Signet ring cell carcinoma; Urinary bladder
2024;3(4):3736. carcinoma; Carcinocythemia
doi: 10.36922/td.3736
Received: May 22, 2024
Accepted: August 7, 2024 1. Introduction
Published Online: October 8, 2024
Cancer of unknown primary (CUP) is defined by the European Society of Medical
Copyright: © 2024 Author(s). Oncology as a “carcinoma or undifferentiated neoplasm for which a standardized
This is an Open-Access article diagnostic workup fails to identify the primary tumor responsible for metastatic
distributed under the terms of the
1
Creative Commons Attribution seeding.” It constitutes <5% of all cancers and its incidence is higher in men and increases
License, permitting distribution, with age. Histologically, approximately 80% of the tumors are adenocarcinomas or
1-4
and reproduction in any medium, undifferentiated carcinomas. Typically, patients exhibit metastases in various organs,
1-6
provided the original work is
properly cited. with the liver being the most frequently affected site. 1-4
Publisher’s Note: AccScience In the urinary bladder, primary adenocarcinomas account for <2% of all primary
Publishing remains neutral with malignant tumors. Pure signet ring cell carcinoma (SRCC) is one of the rarest histological
7
regard to jurisdictional claims in
published maps and institutional subtypes and is associated with the worst prognosis because of its presentation at an
affiliations. advanced stage and possible intrinsic aggressive biological features. 7-10
Volume 3 Issue 4 (2024) 1 doi: 10.36922/td.3736