However, the incidence of SRCC is rising and SRCC is found in 8% to 30% of gastric cancers. Since the advent of treatment to eradicate Helicobacter, the incidence of gastric adenocarcinoma has decreased.

Unlike non-SRCC, the incidence of SRCC of the stomach is rising But, conversely, not all gastric cancers classified as вЂњundifferentiatedвЂќ or вЂњdiffuseвЂќ are signet-ring cell cancers. It is important to understand that signet-ring cell adenocarcinomas are always classified, by definition, as вЂњundifferentiated typeвЂќ by Nakamura and as вЂњdiffuse typeвЂќ by Lauren. Now, signet-ring cell carcinoma is defined according to the WHOвЂ™s classification as a poorly cohesive carcinoma composed predominantly of tumor cells with prominent cytoplasmic mucin and a crescent-shaped nucleus eccentrically placed (Figure вЂ‹ (Figure1A). Previously, signet-ring cell adenocarcinoma was classified as вЂњdiffuse typeвЂќ according to LaurenвЂ™s classification, вЂњinfiltrative typeвЂќ by Ming, вЂњundifferentiated typeвЂќ by Nakamura and вЂњhigh gradeвЂќ by the UICC. Since the publication of the WHO classification of gastric cancers in 1990, signet-ring cell adenocarcinoma constitutes one specific histotype and therefore can be better identified among gastric cancers. This increase in the proportion of SRCC in cases of gastric adenocarcinoma can be explained by changes in the pathological classifications used to characterize these cancers. HETEROGENEITY OF PATHOLOGICAL CLASSIFICATIONS In this review we analyze recent data on the epidemiology, oncogenesis, prognosis and specific therapeutic strategies in both early and advanced SRCC of the stomach and in hereditary diffuse gastric cancer. It therefore remains unclear if a specific therapeutic strategy is justified, as the benefit of perioperative chemotherapy and the value of taxane-based chemotherapy are unclear. However, the prognosis of SRCC and its chemosensitivity with specific regimens are still controversial as SRCC is not specifically identified in most studies and its poor prognosis may be due to its more advanced stage. SRCC has a specific epidemiology and oncogenesis and has two forms: early gastric cancer, which can be resected endoscopically in some cases and which has a better outcome than non-SRCC, and advanced gastric cancer, which is generally thought to have a worse prognosis and lower chemosensitivity than non-SRCC. While the incidence of gastric cancer has decreased worldwide in recent decades, the incidence of signet-ring cell carcinoma (SRCC) is rising.

Signet ring