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The cytologic features of dysplasia and carcinoma of the stomach are still poorly defined. In a series of 90 cases, a precise correlation could be made between smears and histologic data. Cytology was sensitive enough to allow characterization of: (1) active repair/regeneration, associated, in a number of cases, with intestinal metaplasia (slight dysplasia); the cellular atypia is minimal; (2) true dysplasia (formerly moderate and severe); this preneoplastic state is characterized by cellular atypia within clusters; and (3) true carcinomas (intestinal or diffuse type); classic criteria for malignancy are present, with a prominent lack of cell cohesiveness, though distinction from dysplasia may be very difficult. The advantages of cytology are the survey of large mucosal areas, investigation of the cardial region, not always accessible to endoscopic biopsy, and exploration of large ulcers. With the adjunct of cytology, the specificity and sensitivity of endoscopy plus histology clearly increase.

An occasional finding of a signet-ring cell type adenoma, occurring in a 81-year-old man, suffering from inoperable pharyngo-laryngeal carcinoma, is described. Multinodular thyroid parenchyma was excided in performing tracheostomy and histologically examined. On the basis of extensive morphological, histochemical and immunohistochemical observations and of reviewed literature, an unifying morphogenetic interpretation of the signet-ring cell transformation is proposed, with special reference to the pathogenesis of this cytotype and the significance of the cytostructural and cytometabolic characteristics. Problems related to the differential diagnosis and clinicopathological correlation are also discussed.

A 39-year-old Japanese male presented with multiple erythematous nodules on the head, face and trunk. Further investigations revealed a Borrmann type II gastric carcinoma and identified disseminated bone metastases. No other metastases of internal organs, including the liver and lungs, were clinically detected in this stage. This metastatic pattern is quite unusual.

The paper reports a case of intestinal occlusion due to adenocarcinoma of the large intestine as a sequel to ureterosigmoidostomy for exstrophy of the bladder which was subsequently converted to ureteroileocutaneostomy. Inadequate follow-up did not allow an early diagnosis to be made. The authors underline the need for annual colonoscopy in all patients suffering from or with previous ureterosigmoidostomy given the high incidence of malignant transformation of the colon.

We report a case of breast metastasis of signet ring cell gastric cancer clinically presented as a primary inflammatory carcinoma. Metastases to the breast are uncommon; review of the literature demonstrated only 300 cases. The clinical and radiographic features of the metastatic lesion were unlike those reported in the literature. Although a primary signet ring cell breast carcinoma were described, the pathologic patterns of the breast lesion, here reported, lead us to conclude this was a metastasis and not another primary tumor.

We report the case of an unsuspected G.I. cancer in a patient with no clinical signs other than ascites and positive PAP-smear on admission. Histologically, neither endometrium nor cervix were involved. To date, only 2 cases of primary gastrointestinal (gastric) cancers with no metastases to the cervix, suspected by PAP-smear, have been reported in medical literature. A few more have been reported with cervical metastases. The suspicion of intraabdominal adenocarcinoma was based on the evidence of signet ring cells found in the smear with negative cervical biopsies and negative fractional curettage. A postmortem examination confirmed the absence of genital involvement. Our aim is to remind the clinician that an abnormal PAP-smear, due to non gynecological malignancies, can, on rare occasions, be observed. In order to obtain a positive cervico-vaginal PAP-smear by a non gynecologic intraabdominal exfoliating cancer, both previous literature and our case suggest peritoneal effusion to be of major importance.