S3434 A Case of Highly Aggressive Signet Ring Cell-Like Pancreatic Cancer

Introduction: Pancreatic signet ring cell carcinoma (PSRCC) represents an exceptionally aggressive subtype of pancreatic adenocarcinoma, typically marked by poor prognosis. This report details a case of PSRCC diagnosed within a phenomenally brief progression window, further complicating the already challenging early detection and management of pancreatic cancer. Case Description/Methods: A 50-year-old man presented to the emergency department reporting sudden and severe left and right lower quadrant abdominal pain. Accompanying symptoms included nausea, vomiting, and chills. The initial examination did not reveal any specific cause; however, a computed tomography scan of the abdomen and pelvis conducted during this visit showed signs of sigmoid colitis without any noticeable pancreatic or liver abnormalities. The patient was treated with antibiotics for colitis and discharged with instructions for outpatient follow-up, which included a colonoscopy that subsequently showed no signs of malignancy. Despite initial treatment, the patient revisited the emergency department 6 weeks later with unresolved and intensified epigastric pain radiating to the back, divergent from his initial pain. This time, a repeat computed tomography scan, revealed an ill-defined hypoattenuating area in the pancreatic body suggesting necrosis or a potential mass, and multiple new liver lesions indicative of metastases—significant findings absent in the earlier scans. An endoscopic ultrasound (EUS) was subsequently performed which identified a heterogeneous, irregular mass at the junction of the pancreatic body and tail, alongside evidence of liver metastasis. Fine needle biopsies were obtained from both the pancreatic mass and a liver lesion. The pathology confirmed infiltrating adenocarcinoma of the pancreatic tail with focal signet ring cell-like features. Following the diagnosis, the patient was referred to oncology for further management. Discussion: This case underscores the aggressive nature of PSRCC and the limitations of standard imaging techniques in early detection. The rapid evolution from an unremarkable initial computed tomography scan to widespread metastatic disease highlights the need for heightened clinical vigilance in atypical abdominal pain cases.