Polish Journal of Pathology

Abstract

4/2025 vol. 76
Case report

Diagnostic challenge of primary colonic poorly cohesive adenocarcinoma exhibiting gastric‑type immunohistochemistry profile and focal signet‑ring differentiation

  1. Department of Pathology, Faculty of Medicine, Canakkale Onsekiz Mart University, Faculty Çanakkale, Turkey
  2. Department of General Surgery, Faculty of Medicine, Canakkale Onsekiz Mart University, Çanakkale, Turkey
  3. Department of Pathology, Gumushane State Hospital, Gumushane, Turkey
Pol J Pathol 2025; 76 (4): 348-354
Online publish date: 2026/02/16
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Colorectal adenocarcinoma infrequently exhibits a diffuse, poorly cohesive architecture and a gastric-type immunophenotype, closely resembling diffuse-type gastric carcinoma and posing a formidable diagnostic challenge. This report describes a 65-year-old woman who presented with non-specific abdominal discomfort and was found by colonoscopy to have a 6.5 cm ulceroinfiltrative lesion in the hepatic flexure. Histologically, the tumor comprised discohesive cells with focal signet-ring morphology, accompanied by extensive lymphovascular and perineural invasion, necrosis, and a marked peritumoral lymphoid response. Immunohistochemical analysis demonstrated a gastric-type profile (CK7+, CK20–, SATB2–, CDX2 weak/focal, MUC5AC+, MUC2–), whereas panels excluding breast, urothelial, Müllerian, neuroendocrine, and hematolymphoid differentiation were uniformly negative. Comprehensive imaging and endoscopic evaluation excluded an extra-colonic primary malignancy/carcinoma. Mismatch repair testing revealed loss of MLH1/PMS2 expression with preserved MSH2/MSH6. This case underscores that, in such uncommon colorectal variants, reliance on immunophenotype alone may mislead, and that definitive diagnosis necessitates integrated clinicopathologic correlation, exhaustive sampling, and exclusion of alternative primaries/primary malignancies/carcinomas to confirm a primary colonic poorly cohesive adenocarcinoma with focal signet-ring differentiation.
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