Edema of limbs as the primary symptom of gastric signet-ring cell carcinoma: A case report and literature review

Figure 1 The 55-year-old male patient with systemic edema. A: The images of fingers and legs of this patient at the initial visit; B: The images of fingers and legs of this patient at 3-mo visit; C: The images of fingers and legs of this patient at 12-mo visit.

Figure 2 99mTc-DX lymphoscintigraphy. Images were recorded 10 min, 1h, 3h, and 6h after infusion with the 99mTc-DX indicators at both feet. Lymphoscintigraphy showed an obvious accumulation of the radiotracer both the anterior and posterior sides of the right leg.

Figure 3 The immunohistochemistry and gastric endoscopy. A: H&E histological samples of the skin tissue on the right lower limb, 10 ×; B: H&E histological samples of the skin tissue on the right lower limb, 20 ×; C: Histological samples of the skin tissue on the right lower limb stained for panCK, 20 ×; D: Images of gastric endoscopy: Gastric body; E: Images of gastric endoscopy: Gastric antrum; F: H&E histological samples of the mucosa in gastric body, 10 ×; G: Gastric antrum, 20 ×; H: Histological samples of the mucosa in gastric body stained for panCK, 20 ×; I: Gastric antrum, 20 ×. Note the abundant signet-ring cells (black arrows) (B) and (G). H&E: Hematoxylin and eosin; panCK: Pan-cytokeratin.