Metastatic tumors to paranasal sinuses are exclusively rare. In this paper, we report a case of breast carcinoma metastasizing to the right maxilla. The metastasis occurred 5 years after radical mastectomy and presented as a primary sinonasal mass. The diagnosis was confirmed with histopathologic and immunohistochemical examination however the patient died before starting any specific treatment because of tumor bleeding.

Neuroendocrine carcinomas of the thymus are uncommon, less than 200 cases have been described in the literature. Some previous studies indicate that these tumors may have a more aggressive behavior than their pulmonary counterparts with a poor response to chemotherapy for metastatic cases. In this paper, we report an atypical neuroendocrine carcinoma of the thymus associated with lymph node metastases and we analyze different data about diagnosis and treatment of this rare entity.

Introduction Gastric linitis plastica is a very particular malignant gastric tumor different from the usual gastric carcinoma. It refers to the diffuse proliferation of connective tissue, resulting in tissue thickening so that the stomach is constricted and rigid. Methods In this retrospective study, we reviewed the records of 34 patients diagnosed with gastric linitis between January 2008 and January 2012. The aim of this study is to identify the clinical, diagnostic and therapeutic features of this type of gastric cancer in Moroccan patients. Results The mean age at the diagnosis was 42.6 years ranged from 25 to 69 years, 22 patients were female. The clinical symptoms were mainly vomiting (73 %), epigastric pain (79 %) and deterioration of Performance Status (94 %). In all of the cases, endoscopy has revealed rigid and thickening stomach. 68 % (n=23) of the patients were metastatic at the diagnosis, sites of metastasis were: peritoneum (71 %), lymphatic nodes (53 %), lung (32 %), liver (24 %) and the ovary (6 %). Among the 34 patients, 32 % (n=11) were treated with curative strategy by total gastrectomy followed by adjuvant concomitant chemo radiotherapy (n=5), adjuvant chemotherapy (n=4) or perioperative chemotherapy (n=2). For the metastatic patients chemotherapy regimens were distributed as following: ECC (Epirubicin 50 mg/m2, Cisplatin 60 mg/m2, Capecitabine 625 mg/m2/12h) was administered to 56 % of the cases, combination of cisplatin and 5 fluorouracil (cisplatin at the dose of 75 mg/m2 and 5 fluorouracil at 300 mg/m2 for 3 days) to 22 % of the cases, capecitabine as monotherapy for 14 %, and FUFOL Mayo Clinic regimen for 4 % of metastatic patients. While 4 % of the cases received supportive care because of deterioration of the performance status and liver blood tests. Download : Download full-size image Figure 1 . Expression of AEG-1 in gastric cancer tissues by immunohistochemical staining AEG-1 expression is not detected in normal gastric mucosa (left). AEG-1 positive expression in intestinal metaplasia (middle). AEG-1 strong positive expression in gastric cancer (right). Download : Download full-size image Figure 2 . Expression of AEG-1-mRNA in gastric cancer cells by RT-PCR. Conclusion The gastric linitis plastica represent an entity with specific characteristics, which tends more toward tumor invasion depth, with nodal and peritoneal metastases. A multidisciplinary approach including cancer surgery and chemotherapy is recommended to improve the prognosis of patients with this disease.

ABSTRACT Introduction Bone metastases (BM) are a common event in advanced cancers of the breast, lung, prostate, kidney and thyroid. In gastric cancer, metastases are considered to be mainly to the peritoneum, liver, or lymph nodes; while BM occur only rarely and they are known to have a very poor prognosis. The clinicopathological manifestations and treatment outcomes of BM of gastric cancer are largely unknown. This retrospective study aimed to evaluate clinical, radiological and therapeutic features in BM of gastric cancer, and to examine their correlation with histology and lymph node extension of the gastric tumor. Then, we review the possible mechanisms and risk factors underlying this rare condition. Methods Between April 2007 and October 2011, 12 patients were collected in the department of medical oncology at Hassan II university hospital and were retrospectively analyzed in terms of Clinicopathological features of the gastric Cancer and bone metastasis. Results From April 2007 to October 2011, we retrospectively reviewed 12 patients with bone metastases from gastric cancer, 8 men and 4 women (sex-ratio: 2).The mean age at the time of diagnosis of gastric cancer was 50 years (range: 30-77 years). BM were synchronous to gastric cancer in 9 patients; in 3 patients, bone involvement occurs over a period ranging from 2 to 15 months after primary tumor diagnosis. Concerning the histological types of gastric tumor, undifferentiated histology was predominant, it was observed in 6 cases (50%); there were 4 cases (33.3%) of moderately differentiated carcinoma and 2 cases (16.6%) of poorly differentiated carcinoma. Positive nodal status was found in 9 cases (75%). BM were associated to: lung metastases in 5 cases (41.6%), to liver metastases in 2 cases (16.6%) and pancreatic metastases in one case (8.3%); Peritoneal dissemination was noted in 2 cases (16.6%). Only one patient had BM without other distant dissemination. Diagnosis of BM was made in 8 patients (66.6%) by computed tomography (CT) only, in 2 patients (16.6%) by CT and magnetic resonance imaging (MRI); and two patients were diagnosed by bone scintigraphy. All patients had diffuse and osteolytic bone lesions; the area of BM was in the order of the vertebrae (9 cases, 75%), costa (7 cases, 58.3%) and extremities (5 cases, 41.6%). 10 patients had symptoms related to bone involvement: bone pain in 10 patients (83.3%), spinal cord compression in 2 patients (16.6%) and hypercalcemia in 2 patients (16.6%). Management of BM included analgesic agent in 10 cases, palliative chemotherapy in 11 cases, radiotherapy in 1 case and bisphosphonates in 2 cases. As it has been reported in other series of BM caused by gastric cancer, all our patients died within period ranging from 1 to 4 months from the diagnosis of BM. Conclusion These data confirmed that the prognosis of BM from gastric cancer is uniformly poor. Hence, tests to assess for bone metastasis are required for gastric cancer patients at the time of the initial diagnosis and the postsurgical follow-up observation mainly in the setting of undifferentiated tumor and nodal involvement.

ABSTRACT Introduction Biliary tract cancers (BTC) are relatively rare (3% of digestive cancers), they mainly affect older women and are located in the gallbladder in about 70% of the cases. Methods In this retrospective study, we reviewed 70 cases of BTC admitted in the medical oncology unit of HASSAN II university hospital between January 2008 and January 2012. The aim of this study is to define epidemiologic, diagnostic and therapeutic aspects of this disease in a Moroccan population. Results In our study, BTC account for 4.8 % of digestive cancers. The mean age of our patients was 62.4 years ranged from 32 to 81 years, female gender represent 71 %. The tumors were located in the gallbladder (GB) in 72 % of the cases divided into adenocarcinoma (77 %) and squamous cell carcinoma (23 %). The other locations were hilar cholangiocarcinoma (21 %) and intrahepatic cholangiocarcinoma (7 %). Concerning the radiological finding, abdominal ultrasonography was performed in all of the patients but it allowed to suspect cancer in only 47% of the cases. Magnetic resonance cholangiographic was performed (n=16) and allowed to suspect cancer in all of these patients. Incidental finding of gallbladder cancer at surgery was recorded in 24 patients: intraoperatively in 10 cases or after pathological study in 14 cases. For all the cases of BTC, Staging of the disease was based on the thoraco-abdomino-pelvic scan and divided into localized stage (7 %), locally advanced stage (14 %) and metastatic stage (79 %). The site of metastases was as following: liver (85 %), lymph nodes (43 %), lung (35 %), peritoneum (25 %), bone (7.5 %), and soft subcutaneous metastasis (5 %). An initial complete surgery in gallbladder cancer (extended cholecystectomy including en bloc hepatic resection and lymphadenectomy with or without bile duct excision) was performed in 7 patients. A second curative surgery was performed in 8 patients. A complete surgery in cholangiocarcinoma cases (n=20) was performed in 6 patients. A palliative surgery was done in 24 patients of all BTC: cholecystectomy (n=9) and biliary drainage (n=15). In all the BTC metastatic patients (n=55), a palliative chemotherapy was administered as following: combination of cisplatin and gemcitabine (n=22), gemcitabine alone (n=10), combination of oxaliplatin and gemcitabine (GEMOX) (n=5), combination of cisplatin and 5 fluorouracil (n=4), capecitabine alone (n=4), combination of capecitabine and oxaliplatin (XELOX) (n=2), and FUFOL Mayo clinic (n=2). While 9% of the patients received supportive care because of their comorbidities and the deterioration of the performans status and liver blood tests. Conclusion Because of the silent evolution of BTC, the diagnosis is therefore delayed, the prognosis is poor and treatment is usually palliative. Our results are consistent with those of the literature concerning the epidemiological finding and diagnosis aspects. A multidisciplinary approach including methods for early diagnosis, oncologic surgery and chemotherapy is recommended to improve the prognosis of patients with biliary tract cancers.

ABSTRACT Introduction Melanomas are malignant tumors developed from the pigment system. The anorectal location is characterized by its rarity (1-3% of all melanomas) and its bad prognosis. The aim of this work is to show the rarity of this localization, treatment options and prognostic factors. Methods We report 6 cases of anorectal melanomas treated in department of medical oncology at Hassan II University hospital, between January 2007 and January 2012. Results Six cases of anorectal melanomas were collected. The mean age was 64 years (50-81ans), 4 men and 2 women. The symptomatology was mainly proctalgia, rectal syndrome, rectal bleeding and transit disorders. Colonoscopy was performed in all cases and revealed a circumferential non-pigmented burgeoning tumor in all cases and stenotic tumor in 5 cases. The radiological assessment included a thoraco-abdomino-pelvic scan in all cases and 2 patients underwent a pelvic MRI. Five patients had a metastatic disease, all in the liver, lymph node and lung. Only one patient was not metastatic and proceeded to surgery, he underwent an abdomino-perineal resection with lymphadenectomy; but his evolution was marked by occurrence of pulmonary and hepatic metastases 6 months later. First-line chemotherapy was received in all patients; it included paclitaxel-carboplatin in 2 cases, dacarbazine in 2 cases. Two patients; with over expression of C-Kit; received Imatinib with good clinical and radiological response. Three patients died with a median survival of 11 months from diagnosis to the date of death. Conclusion The prognosis of anorectal melanomas remains very bad because of late diagnosis and high metastatic potential. Treatment must be early and multidisciplinary. The new targeted therapies are hopeful.

e11502 Background: Few studies demonstrated that surgical resection of the primary tumor in patients with metastatic breast cancer at diagnosis is associated with significant improvement of survival. The aim of this study is to evaluate the correlation impact of local surgery in metastatic breast cancer at diagnosis with molecular subtypes. Methods: A retrospective study was conducted from 2007 to 2011 in our institution, of all stage IV breast cancer patients; who undergo breast surgery. Clinical , tumor characteristics, molecular subtypes, prognostic factors, therapeutic results data were analyzed. Results: We selected 59 cases. The mean age was 36 years (range: 22-44). 55 % women presented with locally advanced breast cancer with 13% T4 d . All patients underwent mastectomy except 4 who underwent conservative surgery .41 patients had axillary lymph node dissection. 63% were luminal A, 17% were luminal B, 7% were Her2-positive and 13% were basal-like . All patients received anthracycline based regimen and only 33% received taxanes. Loco regional radiotherapy (RT) was given to 6 women. Average follow-up was 13 months: - 20 patients represented partial response : 15 patients in luminal A , 3 patients in luminal B ,1 patients in basal-like and 1 patient in HER2-positive. - 11 patients (19%) were stable : 9 patients in luminal A and 2 patient in luminal B . -24 patients represented a progressive disease including 11 patients presented locoregional recurrence : 75 % in HER-positive, 40 % in basal-like, 50% in luminal B and 30% in luminal A (p=0.4). - 4 patients died in basal-like. The median local recurrence-free survival was 19 months and the median progression-free survival was 20 months. The local relapse is less observed in patients who: have a small tumor size (p = 0.003), had axillary lymph node dissection (p = 0.02) and loco regional radiotherapy (p = 0.03). The metastatic progression is less observed in patients with small tumor size (p = 0.01). Conclusions: Local Therapy of the primary tumor improves local control of disease, particularly in women with Small tumors. However, no significant correlation between impact of locale therapy and Molecular Subtypes was observed.

Introduction Signet ring cell carcinoma (SRCC) of the stomach is a histological type based on microscopic characteristics, and its clinicopathologic characteristics and treatment are still controversial. Methods In this retrospective study, we reviewed the records of 86 consecutive patients diagnosed with gastric SRCC and treated in the Medical Oncology Department of Hassan II university hospital (Fez, Moroocco) between January 2008 and January 2012. The aim of this study is to identify the epidemiological, clinical and therapeutic features of this type of gastric cancer in a Moroccan population. Results In our study, SRCC of the stomach represent 38 % of the gastric cancer and 11 % of all the digestive tract cancer. The mean age at the diagnosis was 46 years ranged from 25 to 80 years, 64 % were female. The clinical symptoms were mainly vomiting (73 %), epigastric pain (71 %) and deterioration of performance status (94 %). 69 % (n=59) of the patients were metastatic at the diagnosis, sites of metastasis were: peritoneum (85 %), lymphatic nodes (46 %), liver (39 %), lung (32 %), ovaries (10 %), adrenal glands (7 %), bone (5 %) and the kidney (1.6 %). 31 % of the patient had non metastatic disease: localized to the stomach in 19 cases and locally advanced in 8 cases. These patients were treated with curative strategy by total gastrectomy (+/- extended to adjacent organs) followed by adjuvant concomitant chemo radiotherapy (n=9), adjuvant chemotherapy (n=7) or perioperative chemotherapy (n=11). For the metastatic patients, chemotherapy regimens were distributed as following: ECC (Epirubicin 50 mg/m2, Cisplatin 60 mg/m2, Capecitabine 625 mg/m2/12h) was administered to 44 % of the cases; Capecitabine as monotherapy for 17 %, Cisplatine-5FU to 13 % of the cases; FUFOL Mayo clinic regimen for 9 % and EOX (Epirubicin 50 mg/m2, Oxaliplatin 130 mg/m2, Capecitabine 625 mg/m2/12h) for 9 % of the cases. Five metastatic patients were oriented to supportive care given the deterioration of their Performance Status. A second line of chemotherapy was administered to 11 patients based on XELIRI (Irinotecan 250 mg/m2 and Capecitabine 2000mg/d for 14 days) in 5 patients, XELOX (Oxaliplatin 85 mg/m2 and Capecitabine 2000mg/d for 14 days) in 3 patients and FOLFOX4 in the 2 other cases. Conclusion The gastric Signet ring cell carcinoma represents an entity with specific characteristics, which tends more toward tumor invasion depth, with nodal and peritoneal metastases. Our results are consistent with those of the literature concerning the epidemiological finding and diagnosis aspects. A multidisciplinary approach including cancer surgery and chemotherapy is recommended to improve the prognosis of patients with this disease

e11516 Background: Inflammatory breast cancer (IBC) is the most virulent type of breast cancer. It represents 1 to 6% of all the breast cancer in Western countries. It is speculated that the incidence of IBC is greater in emerging countries especially in North Africa. The management of this disease requires a multidisciplinary. Methods: We recorded the cases of 80 patients with IBC admitted in the Medical Oncology Unit between January 2007 and August 2011. We included patients with IBC classified as T4d using criteria based on the tumor-node-metastasis (TNM) classification . The aims of this study is to evaluate the epidemiological, clinical, histopathological and therapeutic aspects of this disease. Results: The median age of our patients was 44.5 years ranged from 24 to 88 years. The incidence of IBC in our study was 7.8%. The lymph node involvement was noted in 60% distributed as following: N0 in 40%, N1 in 30%, N2 in 19%, N3 in 11%. For histology, ductal carcinoma represents 96% of all cases. Human epithelial receptor 2 (HER 2) was positive in 32% of the cases. Hormonal receptors were negative in 22% of the cases. The grade of the tumor according to the Scarff Bloom Richardson classification was as following: grade I ( 2.5%), grade II (52%), grade III (45.5%). All patients received neoadjuvant chemotherapy. 45% received chemotherapy with anthracyclines, 35% were treated with docetaxel and anthracycline and 10% with the association chemotherapy Trastuzumab. According to RECIST classification, a partial or total clinical response was noted in 80% of cases, 10% of patients had stability, and 10% clinical progression. According to Sattalof classification, a histological response greater than 50% in the tumor (TB) was noted in 45%. A complete pathological response (TANA or TANB) was obtained in 15% of cases. After a median follow up of 2 years 35% of the patients had a metastatic or locoregional reccurence, 45% of the cases remain in complete remission. Conclusions: The result of our study is concordant with the litterature. The incidence of IBC was greater than the incidence in western countries. The IBC was also associated with high grade and younger age. Despite a good clinical and pathological response to chemotherapy, outcomes were poor.

e14726 Background: Biliary tract cancers (BTC) are relatively rare (3% of digestive cancers), they mainly affect older women and are located in the gallbladder in about 70% of the cases. Methods: In this retrospective study, we reviewed 63 cases of BTC admitted in the medical oncology unit of HASSAN II university center between January 2007 and December 2011. The aim of this study is to define epidemiologic, diagnostic and therapeutic aspects of this disease in a Moroccan population. Results: In our study, BTC account for 4,9% of digestive cancers. The mean age of our patients was 58,2 years ranged from 32 to 81 years, female gender represent 69%. The tumors were located in the gallbladder (GB) in 70% of the cases divided into adenocarcinoma (79%) and squamous cell carcinoma (21%). The other locations were hilar cholangiocarcinoma (24%) and intrahepatic cholangiocarcinoma (6%). Magnetic resonance cholangiographic was performed (n=15) and suspected cancer in all cases. Incidental finding of GB cancer at surgery was recorded in 21 patients: intraoperatively in 8 cases or after pathological study in 13 cases. Staging of the disease was divided into localized stage (7%), locally advanced stage (13%) and metastatic stage (80%). A complete surgery in GB cancer was performed in 13 patients, a palliative surgery was done in 20 patients: cholecystectomy (n=7) and biliary drainage (n=13). For metastatic patients (n=44), a palliative chemotherapy was administred as following: combination of cisplatin and gemcitabin (n=18), gemcitabin (n=7), combination of cisplatin and 5 fluoro uracile (n=5), combination of oxaliplatin and gemcitabin (n=3), capecitabine (n=3), FUFOL Mayo clinic (n=2) and combination of capecitabine and oxaliplatin (n=2). While 9% of the patients received supportive care because of their comorbidities and the deterioration of the performans status and liver blood tests. Conclusions: Because of the silent evolution of BTC, the diagnosis is therefore delayed, the prognosis is poor and treatment is usually palliative. Our results are consistent with those of the literature concerning the epidemiological finding and diagnosis aspects.A multidisciplinary approach is recommended to improve the prognosis of patients with BTC.

ABSTRACT Introduction The management of colorectal cancer in the elderly patients is becoming a major problem of public health. The principles of treatment of colorectal cancer in patients aged 70 years old and over are the same as those of younger ones, but therapeutic indications should be adjusted according to physiological age, general condition, and the existence of co morbidities. Methods In this retrospective study, we reviewed 62 cases of colorectal cancer in patient aged 70 years old and over admitted in the medical oncology unit of HASSAN II university hospital between January 2009 and January 2012. The aim of this study is to determinate epidemiologic, clinical and therapeutic aspects of this disease in the elderly Moroccan population. Results 62 cases of colorectal cancer were diagnosed in patients aged 70 years old and over representing 27, 5% of all colorectal cancers. 70% of our patients are aged between 70 and 74 years old (n= 43), 20% between 75 and 79 years old, and 10% 80 years old and over. 20% of cases had antecedent of cardiovascular disease, and 8 % had a history of cancer family. The average time of diagnosis was 7.3 months, the clinical symptoms were mainly rectal bleeding (53%), abdominal pain (43%). 37 % of the patients were metastatic at the diagnosis (n=23), sites of metastasis were liver in 10 cases (43%), lung in 7cases (30%), peritoneum in 6 cases (26%), lymph nodes in 5 cases (21%). 20% of patients (n=13) presented a stage III disease, stage II was noted in 35% (n=22), and stage I in 6% (n=4). Left resection of the colon was performed in 24 % of cases, right hemi-colectomy was done in 22%, surgery of rectum was performed in 20%, and metastatic liver resection was done in 5% of all metastatic patients. Preoperative concomitant chemo radiotherapy was performed in 13% for lower and middle rectum. Adjuvant chemotherapy based on Capecitabine alone was administrated in 12 cases, and XELOX in 4 cases, with 25% of diarrhea (n=4), 18 % of hand and foot syndrome (n=3), 18% of non-febrile neutropenia (n=3), and 12% of peripheral neuropathy (n=2). 11% of our patients received metastatic chemotherapy based on XELERI+BEVACIZUMAB (n=7) with 2 cases of diarrhea grade 2, 11% patients received chemotherapy based on XELOX with one death secondary to thrombocytopenia grade 4 after first cycle, and 3% chemotherapy with CAPECITABINE alone. We opted for no treatment in 11% of patients (n=7): Cardiac failure in four cases, 2 cases because of deterioration of performance status, and terminal renal failure in one case. Conclusion All patients with colorectal cancer aged 70 years old and over should receive the most appropriate treatment thought to be effective and safe, according to their biological age and co morbidities. Geriatric assessment is essential in the care for elderly patients with colorectal cancer.

ABSTRACT Introduction Colorectal cancer is predominantly a disease of the elderly population, but this disease is unusual in patients 45 years of age or under, and controversy persists as to prognosis in this subset of patients. The aim of this study was to determine the clinicopathologic features and their impact on patient's prognosis of colorectal cancer in patients aged 45 years or younger. Methods It is a retrospective study conducted at the department of medical oncology of Hassan II University hospital. It included 92 patients younger than 45 years treated for colorectal cancer between January 2007 and January 2012. Results 92 cases of colorectal cancer occurring before the age of 45 years old were noted. It represents 30% of all colorectal cancers collected during the period of study. The tumour was rectal in 58 % and colic in 42 %. The predisposing antecedents of colorectal carcinoma were noted among 12 % of the cases. The clinical symptomatology was dominated by rectal bleeding and abdominal pain. Tomor markers were elevated in 52% of cases. 16% of patients were operated for abdominal occlusion, and 6.5 % for perforation. The cancers were poorly differentiated in 37 % of the cases, 19 % had cell carcinoma signet ring, 10 % had mucosal colloid carcinoma 6.5 % had mucinous Adenocarcinoma, 2 cases of neuroendocrine carcinoma and one case of anal melanoma and were noted. Tumors were presented at advanced stages III and IV in 76% of cases. For patients with R0 resection, 16% had recurred. For metastatic patients, after a first line of chemotherapy, 30% had stable disease, 25% had a partial response. The median survival was 13 months. Conclusion Colorectal cancer in young patients has a poor prognosis with more undifferentiated tumors, advanced stages, complications and recurrences. It requires an early and multidisciplinary care.

e14725 Background: Signet ring cell carcinoma (SRC) of the stomach is a histological type based on microscopic characteristics, and its clinicopathologic characteristics and treatment are still controversial. Methods: In this retrospective study, we reviewed the records of 68 patients diagnosed with gastric SRC treated between January 2007 and July 2011. The aim of this study is to identify the epidemiological, clinical and therapeutic features of this type cancer in a Moroccan population Results: In our study, SRC of the stomach represents 39 % of the gastric cancer and 11 % of all the digestif tract cancer. The mean age at the diagnosis was 46 years ranged from 25 to 80 years, 68 % were female. The clinical symptoms were vomiting (72%), epigastric pain (70%) and deterioration of Performans Status (93%). 73% of the patients were metastatic at the diagnosis, sites of metastasis were: peritoneum (85 %), lymphatic nodes (43 %), liver (35%), lung (28 %), ovaries (7 %), adrenal glands (7 %), bone (4 %) and the kidney (2 %). 23% of the patients had a localized disease and locally advanced 8%. Among the 64 patients, 27% were treated with curative intent by total gastrectomy followed by adjuvant concomittant chemoradiotherapy (n=6), adjuvant chemotherapy (n = 4) or perioperative chemotherapy (n=7). For the metastatic patients, chemotherapy regimens were distributed as following: ECC (Epirubicine 50 mg/m2, Cisplatine 60 mg/m2, Capecitabine 625 mg/m2/12h) was administred to 45 % of the cases, cisplatine-5FU to 18 % of the cases, capecitabine as monotherapy for 16 %; FUFOL Mayo clinic regimen for 9 % and EOX (Epirubicine 50 mg/m2, oxaliplatine 130 mg/m2, capecitabine 625 mg/m2/12h) for 5%. 7% of the patients were oriented to supportive care. A second line of chemotherapy was administed to 4 patients based on XELIRI (irinotecan 250 mg/m2 and capecitabine 2000mg/d for 14 days) in 3 patients and XELOX (oxaliplatine 85 mg/m2 and capecitabine 2,000mg/d for 14 days) in one patient (n = 1). Conclusions: The gastric Signet ring cell carcinoma represents an entity with specific characteristics, which tends more toward tumor invasion depth, with nodal and peritoneal metastases. Our results are consistent with those of the literature concerning the epidemiological finding and diagnosis aspects.