The tumor cells are round and smaller

than intestinal type. Typical signet ring cells with hyperchromatic, Selleckchem Epigenetic inhibitor eccentric sharply pointed (crescentic) nuclei and large cytoplasmic mucin vacuoles are present (Figure 11). Some signet ring cells may have bland nuclei and be confused with histiocytes. Signet ring carcinoma can be very difficult to detect on both cytologic and histologic specimens. High power examination, attention to detail and a high degree of suspicion is the best safeguard against failure to detect this carcinoma. If Inhibitors,research,lifescience,medical necessary, keratin, epithelial membrane antigen (EMA) and mucin stains are helpful in differentiating the single tumor cells from histiocytes. Histiocytes will express CD68 and KP-1 Inhibitors,research,lifescience,medical antibody. Figure 11 Gastric adenocarcinoma, signet ring type with crescentichyperchromatic nuclei and large cytoplasmic mucin vacuoles (Pap stain, 400×) Endocrine tumor This is the second most common epithelial tumor of stomach. Usually presents as polypoid lesions. The tumor cells are dyshesive and monomorphic, with eccentric, stippled “salt and pepper” nuclei. Tumor cells have a moderate amount of granular

cytoplasm, and may have a spindle cell appearance. Many stripped, bare nuclei may be present. Composite adenocarcinoma-neuroendocrine (carcinoid) tumors may occur. Gastrointestinal endocrine tumors Inhibitors,research,lifescience,medical are classified into three categories: (I) Well-differentiated endocrine tumors; (II) Well-differentiated endocrine carcinomas; (III) Poorly differentiated endocrine (small cell) carcinoma. Cytologicatypia, mitotic index, proliferative rate (MIB-1 staining) are important parameters of this classification. The differential diagnosis includes adenocarcinoma and lymphoma. Inhibitors,research,lifescience,medical Endocrine differentiation Inhibitors,research,lifescience,medical can be confirmed by immunocytochemical stains for chromogranin, synaptophysin and CD 56. Adenocarcinoma cells will be both keratin and EMA positive. Lymphoma cells are positive for Leukocyte common antigen (LCA/CD45). Lymphoma Non-Hodgkin lymphoma is

the second most common malignancy of the stomach. It accounts for around 5% of gastric malignancies, and its incidence is increasing. The stomach is the most common site for extranodal non-Hodgkin Terminal deoxynucleotidyl transferase lymphomas. They are classified into low grade and high grade and have specific appearances. Lesions may be polypoid, fungating, ulcerative or infiltrative. Cytologically there is a single cell population with dispersed monotonous cells and scant cytoplasm and many lymphoglandular bodies (Figure 12). The nuclei have a lymphoid chromatin character. In cellular specimens the lymphocytes may appear clumped, resembling epithelial cell groups. The differential diagnosis may include chronic inflammation, endocrine tumor and poorly differentiated carcinoma. Marker studies are required to confirm the diagnosis.