No mucosal escape of signet-ring cell carcinoma for ten years in a patient with familial aggregation of gastric cancer

A 31-year-old women with familial aggregation of gastric cancer had signet-ring cell carcinoma in random biopsies from the gastric corpus. Surgery was initially refused by the patient. Total gastrectomy was performed 10 years later and pathological examination of the specimen still revealed only intramucosal carcinoma. Microsatellite instability or decreased E-cadherin expression could not be identified. A missense mutation in the CDH1 gene was identified. She is alive without evidence of disease 6 years postoperatively.