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Vol. 86, No. 4, 2011
Issue release date: June 2011
Urol Int 2011;86:453–460

Clinical Characteristics and Outcomes of Patients with Primary Signet-Ring Cell Carcinoma of the Urinary Bladder

Wang J. · Wang F.W.
aDivision of Oncology/Hematology, Department of Internal Medicine, University of Nebraska Medical Center, and bDepartment of Internal Medicine, Creighton University Medical School, Omaha, Nebr., USA

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Objective: The aim of this study was to examine the epidemiology, natural history, treatment pattern and predictors of long-term survival of patients with signet-ring cell carcinoma (SRCC) of the urinary bladder based on the analysis of the national Surveillance, Epidemiology, and End Results (SEER) database. Methods and Results: In total, 230 patients with pathologically confirmed SRCC of the urinary bladder were identified between 1973 and 2004. The mean age was 65 ± 13 years. Overall, 75.7% of the patients had a poorly differentiated or undifferentiated histology grade, 26.5% presented with metastatic disease, 59 (25.7%) underwent transurethral resection for bladder tumor only and 107 (46.5%) had partial or radical cystectomy. The 1-, 3- and 10-year cancer-specific survival rates were 66.8, 40.6 and 25.8%, respectively. Using multivariable Cox proportional hazard model, age (HR 1.024; p = 0.004), stage (distant vs. local, HR 6.2; p < 0.001) and cystectomy (HR 0.53; p = 0.002) were identified as independent predictors for cancer-specific survival. Conclusions: Receipt of cystectomy was strongly associated with improved survival in the patients with SRCC of urinary bladder. However, many patients with localized tumors did not receive potentially curative cystectomy. Further studies to address the barriers to the delivery of appropriate care to these patients are warranted.

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  1. Saphir O: Signet-ring cell carcinoma of the urinary bladder. Am J Pathol 1955;31:223–231.
  2. Holmang S, Borghede G, Johansson SL: Primary signet-ring cell carcinoma of the bladder: a report on 10 cases. Scand J Urol Nephrol 1997;31:145–148.
  3. Jakse G, Schneider H, Jacobi G: Urachal signet-ring cell carcinoma, a rare variant of vesical adenocarcinoma: incidence and pathological criteria. J Urol 1978;120:764–766.
  4. Kume H, Kanai Y, Tobisu K, Fujimoto H, Tomita K, Kakizoe T: Signet-ring cell carcinoma of the urinary bladder associated with transitional cell carcinoma of the right ureter. Scand J Urol Nephrol 2000;34:278–279.
  5. Shinagawa T, Tadokoro M, Abe M, Koshitaka Y, Kouno S, Hoshino T: Papillary urothelial carcinoma of the urinary bladder demonstrating prominent signet-ring cells in a smear. Acta Cytol 1998;42:407–412.
  6. Fernandez-Arjona M, Herrero L, Romero JC, Nieto S, Martin R, Pereira I: Synchronous signet-ring cell carcinoma and squamous cell carcinoma arising in an augmented ileocystoplasty. Eur Urol 1996;29:125–128.
  7. DeMay RM, Grathwohl MA: Signet-ring-cell (colloid) carcinoma of the urinary bladder: cytologic, histologic and ultrastructural findings in one case. Acta Cytol 1985;29:132–136.
  8. Kondo A, Ogisu B, Mitsuya H: Signet-ring cell carcinoma involving the urinary bladder: report of a case and review of 21 cases. Urol Int 1981;36:373–379.
  9. Kim SS, Choi YD, Nam JH, Kwon DD, Juhng SW, Choi C: Cytologic features of primary signet-ring cell carcinoma of the bladder: a case report. Acta Cytol 2009;53:309–312.
  10. Del Sordo R, Bellezza G, Colella R, Mameli MG, Sidoni A, Cavaliere A: Primary signet-ring cell carcinoma of the urinary bladder: a clinicopathologic and immunohistochemical study of 5 cases. Appl Immunohistochem Mol Morphol 2009;17:18–22.
  11. Ohtsuki Y, Fukumoto T, Okada Y, Teratani Y, Hayashi Y, Lee GH, Furihata M: Immunohistochemical and ultrastructural characterization of the signet-ring cell carcinoma component in a case of urothelial carcinoma of the urinary bladder. Med Mol Morphol 2010;43:96–101.
  12. Lane Z, Hansel DE, Epstein JI: Immunohistochemical expression of prostatic antigens in adenocarcinoma and villous adenoma of the urinary bladder. Am J Surg Pathol 2008;32:1322–1326.
  13. Ponz M, Luzuriaga J, Robles JE, Guillén F, Urmeneta JM, Salvá A, Zudaire JJ, Berián JM: Primary signet-ring cell carcinoma of the urinary bladder (linitis plastica). Eur Urol 1985;11:212–214.
  14. Choi H, Lamb S, Pintar K, Jacobs SC: Primary signet-ring cell carcinoma of the urinary bladder. Cancer 1984;53:1985–1990.
  15. Kunze E, Francksen B: Histogenesis of nonurothelial carcinomas of the urinary bladder from pre-existent transitional cell carcinomas: a histopathological and immunohistochemical study. Urol Res 2002;30:66–78.
  16. Kunze E, Francksen B, Schulz H: Expression of MUC5AC apomucin in transitional cell carcinomas of the urinary bladder and its possible role in the development of mucus-secreting adenocarcinomas. Virchows Arch 2001;439:609–615.
  17. Kunze E: Histogenesis of nonurothelial carcinomas in the human and rat urinary bladder. Exp Toxicol Pathol 1998;50:341–355.
  18. Grignon DJ, Ro JY, Ayala AG, Johnson DE: Primary signet-ring cell carcinoma of the urinary bladder. Am J Clin Pathol 1991;95:13–20.
  19. Surveillance, Epidemiology, and End Results (SEER) Program: Public-Use Data (1973–2004), National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch. Available at:
  20. Kaplan EL, Meier P: Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958;53:457–481.

    External Resources

  21. Cox DR: Regression models and life-tables. J Royal Stat Soc [B] 1972;34:187–220.
  22. Poore TE, Egbert B, Jahnke R, Kraft JK: Signet-ring cell adenocarcinoma of the bladder: linitis plastica variant. Arch Pathol Lab Med 1981;105:203–204.
  23. Akamatsu S, Takahashi A, Ito M, Ogura K: Primary signet-ring cell carcinoma of the urinary bladder. Urology 2010;75:615–618.
  24. Thomas AA, Stephenson AJ, Campbell SC, Jones JS, Hansel DE: Clinicopathologic features and utility of immunohistochemical markers in signet-ring cell adenocarcinoma of the bladder. Hum Pathol 2009;40:108–116.
  25. Romics I, Székely E, Szendroi A: Signet-ring cell carcinoma arising from the urinary bladder. Can J Urol 2008;15:4266–4268.
  26. Burnett AL, Epstein JI, Marshall FF: Adenocarcinoma of urinary bladder: classification and management. Urology 1991;37:315–321.
  27. Lotan Y, Cadeddu JA, Roehrborn CG, Stage KH: The value of your time: evaluation of effects of changes in medicare reimbursement rates on the practice of urology. J Urol 2004;172:1958–1962.
  28. Gore JL, Yu HY, Setodji C, Hanley JM, Litwin MS, Saigal CS: Urinary diversion and morbidity after radical cystectomy for bladder cancer. Cancer 2010;116:331–339.
  29. Gore JL, Litwin MS, Lai J, Yano EM, Madison R, Setodji C, Adams JL, Saigal CS: Use of radical cystectomy for patients with invasive bladder cancer. J Natl Cancer Inst 2010;102:802–811.
  30. Hirano Y, Suzuki K, Fujita K, Furuse H, Fukuta K, Kitagawa M, Aso Y: Primary signet-ring cell carcinoma of the urinary bladder successfully treated with intra-arterial chemotherapy alone. Urology 2002;59:601xiii–xvi.
  31. Yamamoto S, Ito T, Akiyama A, Miki M, Tachibana M, Takase M, Matsumoto T, Mochizuki M: Primary signet-ring cell carcinoma of the urinary bladder inducing renal failure. Int J Urol 2001;8:190–193.
  32. von der Maase H, Hansen SW, Roberts JT, Dogliotti L Oliver T, Moore MJ, Bodrogi I, Albers P, Knuth A, Lippert CM, Kerbrat P, Rovira S, Wersall P, Cleall SP, Roychowdhury DF, Tomlin I, Visseren-Grul CM, Conte PF: Gemcitabine and cisplatin versus methotrexate, vinblastine, doxorubicin, and cisplatin in advanced or metastatic bladder cancer: results of a large, randomized, multinational, multicenter, phase III study. J Clin Oncol 2000;18:3068–3077.
  33. Heidemann J, Gockel HR, Winde G, Herbst H, Domschke W, Lugering N: Signet-ring cell carcinoma of unknown primary location. Metastatic to lower back musculature – remission following FU/FA chemotherapy. Z Gastroenterol 2002;40:33–36.
  34. Mizoshita T, Kataoka H, Kubota E, Okamoto Y, Shimura T, Mori Y, Wada T, Ogasawara N, Sasaki M, Kamiya T, Joh T: Gastric phenotype signet-ring cell carcinoma of the stomach with multiple bone metastases effectively treated with sequential methotrexate and 5-fluorouracil. Int J Clin Oncol 2008;13:373–376.
  35. Logothetis CJ, Samuels ML, Ogden S: Chemotherapy for adenocarcinomas of bladder and urachal origin: 5-fluorouracil, doxorubicin, and mitomycin-C. Urology 1985;26:252–255.
  36. Ohnita T, Sakai H, Matsuo M, Hisamatsu H, Shimokawa I, Saito Y: Primary signet-ring cell adenocarcinoma of the bladder with elevated serum carbohydrate antigens 19-9 and 50. J Urol 1998;159:1641.
  37. Braun EV, Ali M, Fayemi AO, Beaugard E: Primary signet-ring cell carcinoma of the urinary bladder: review of the literature and report of a case. Cancer 1981;47:1430–1435.
  38. Gore JL, Kwan L, Saigal CS, Litwin MS: Marriage and mortality in bladder carcinoma. Cancer 2005;104:1188–1194.

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