Gastric pseudo-signet ring cells: a potential diagnostic pitfall

Signet ring cells are characterised by a cytoplasmic inclusion or vacuole that pushes and displaces the crescent-shaped nucleus to the periphery of the cell. When the nuclei of the cells are hyperchromatic, pleomorphic and manifest mitoses, and when the cells infiltrate the lamina propria, this represents the histologic hallmark of signet ring cell carcinoma. The review of the medical literature reveals that the occurrence of mucus-negative pseudo-signet ring cells was first described in gastrectomy specimens of Japanese patients 25 years ago [1]. The authors of this paper Rubio et al. continued to publish extensively on this topic and postulated that these “pseudo-signet cells” or “glassy cells” may be due to environmental exposures [2]. Benign epithelial signet ring cells in the stomach have also been reported previously in association with ischaemia and ulceration [3–5]. We report two cases of benign signet ring cell change in gastric biopsy specimens which we believe to be a degenerative non-neoplastic change.