Vol.2, No.6, **-** (2013) Case Reports in Clinical Medicine Presentation of signet ring cell type at carcinoma ventriculi of the patient aged 20 years old * Afrim Avdaj 1 , Ugur Gozalan 2 , Nexhmi Hyseni 3# , Hatim Baxhaku 1 , Sherif Krasniqi 1 , Shpejtim Rramanaj 1 1 Division of Surgery, Regional Hospital “Primarius Daut Mustafa”, Prizren, Kosova; avdajafrim@yahoo.com , hatimbaxhaku@hotmail.com , oni_pz@hotmail.com , shpejtim@libero.it 2 American Hospital, Prizren, Kosova; ugur.gozalan@spitliamerikan.com 3 Department of Pediatric Surgery, University Clinical Center, Prizren, Kosova; # Corresponding Author: nexhmi_h@yahoo.com Received ************* 2013 Copyright © 2013 Afrim Avdaj et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Introduction: Diffuse variant of GC is composed of a gastric-type mucous cells, which generally do not form glands, but rather permit the mu- cosa and wall as scattered individual cells or small clusters in an “infiltrative” growth pattern. These cells appear to arise from the middle layer of the mucosa, and the presence of intestinal metaplasia is not a prerequisite. In this version, mucin formation expands the malignant cells and pushes the nucleus to the periphery, creat- ing a “signet ring” conformation. If the signet- ring cells are more than 50% of the tumor, the tumor is classified as signet-ring cell carcinoma [1]. This case is important for reporting because we encountered for the first time such a carci- noma type, due to the new age and its atypical presentation. Case Presentation: We report a case of a 20 years Albanian old patient with Signet Ring Cell Type of Gastric CA. The patient was brought at the urgency with severe ab- dominal pain, nausea and peritoneal irritation. Clinical examination has been made in emer- gency, where we conclude the signs of perito- neal irritation, from native Ro no signs of pneu- moperitoneum, while laboratory tests found a slight anemia (erythrocytes 3.36, HCT 25, HGB 8.6). Two hours later we repeated the native RTG and there were present the signs of pneumop- eritoneum. It was indicated urgent surgical in- tervention. Intra operatively, we found Ulcer duodenal perforation, and were undertaken the operation procedures by Roscoe Graham tech- nique. Conclusions: in this age is rare, and it is difficult to detect in its early stages, because the signs and symptoms are often non-existent, nonspecific, or mimic as an ulcer. The most common symptoms are early heartburn indiges- tion, abdominal pain or discomfort, vomiting, constipation, diarrhea or to feel of filling after a small meal, loss of appetite, weakness and fa- tigue. Less common symptoms are anemia and weight loss. Keywords: Signet Ring Cell Type; Gastric Adenenocarcinoma; Diffuse Variant of GC 1. INTRODUCTION Gastric Aden carcinoma is rare at young people, while the risk increases significantly after age 50, and in gastric biopsies ambulatory ring cell carcinoma is rare found due to atypical clinical presentation [2]. GCs are pre- sented in different histological characteristics, with a positive family history. While genes regulate the sensi- tivity of Helicobacter Pylori at different types of CG [3]. Histological confirmation is very important for deter- mining the method of treatment [4]. Signet ring cell car- cinoma is characterized by sub mucosal infiltration of different sizes and with distribution in distant lymph node, and metastasis in the skin [5,6]. Here we report the rare case of a 20-year-old girl presented with acute ab- domen, because of the perforated duodenal ulcer, with positive family history for GC and with Helicobacter Pylori positive. * Competing interests: The authors declare that they have no compet- ing interests. Contributions of authors: Our patient was admitted under the care of SHK, with the contribution of HB, was treated. The main contributors to this manuscript are all authors who have approved the final manu- script. Copyright © 2013 SciRes. Openly accessible at http://www.scirp.org/journal/crcm/