PRIMARY SIGNET RING CELL ADENOCARCINOMA OF THE BLADDER WITH ELEVATED SERUM CARBOHYDRATE ANTIGENS 19-9 AND 50

An 85-year-old woman was admitted to the hospital with azotemia and bilateral hydronephrosis. Cystoscopy revealed a nonpapillary mass on the right wall of the bladder and a papillary tumor beside the left ureteral orifice. Histopathological analysis of a biopsy specimen revealed signet ring cell adenocarcinoma (see figure). Serum levels of carcinoembryonic antigen, and carbohydrate antigens 50 and 19-9 were 10.7 ng./ml. (normal less than 4.0), 223 units per ml. (normal less than 35) and 193.2 units per ml. (normal less than 37), respectively. The general poor health of the patient excluded all surgical treatment except nephrostomy. She died of cachexia 3 months after hospitalization. Autopsy revealed that signet ring cell adenocarcinoma had diffusely spread in the vesical mucosa and invaded the muscle layer. Although small metastatic tumors were seen in the left ureter, para-aortic lymph nodes and lung, no adenocarcinoma was observed in the digestive organs.