Advances in Endoscopic Detection and Therapeutic Strategies for Early Gastric Signet Ring Cell Carcinoma

Abstract

Signet ring cell carcinoma (SRCC), a highly aggressive adenocarcinoma, characteristically presents with mucin-filled cytoplasm that displaces the nucleus, creating its namesake signet ring appearance. While predominantly found in the stomach, SRCC also affects various organs, manifesting with a unique histopathological profile. Atypical clinical presentations often result in delayed diagnosis, leading to the historically poor prognosis. However, narrow-band imaging (NBI) combined with magnetic endoscopy (ME) and endoscopic ultrasonography (EUS) have revolutionized early detection, leading to a paradigm shift in SRCC management. Narrow-band imaging-magnifying endoscopy (NBI-ME), in particular, has been instrumental in enhancing the visualization of early SRCC, marked by an unclear demarcation line and disrupted microvascular and surface microstructure patterns. Similarly, EUS delineates the invasion depth of SRCC and is instrumental for preoperative staging. However, challenges persist, such as determining precise lesion boundaries and the depth of infiltration—critical factors influencing the decision for endoscopic resection. This article reviews the current knowledge and updates pertaining to the endoscopic diagnosis and treatment of early-stage SRCC. The therapeutic advancements achieved by endoscopic submucosal dissection and endoscopic mucosal resection in the treatment and management of early-stage SRCC were also discussed. Overall, this compendium advocates for continued clinical refinement and research to further enhance early diagnostic precision and expand the therapeutic prospects for SRCC, ultimately improving patient survival and quality of life.