Signet ring cells in the gastrointestinal tract: not always what it seems

We describe two cases of pseudo-signet ring cells in gastric biopsies of otherwise asymptomatic adult patients. One male patient was diagnosed during follow-up of a previous intestinal type gastric adenocarcinoma and underwent surgery before recognition of this non-malignant entity. He suffered from a secondary anastomotic stenosis requiring dilatation. A second male patient was spared from surgery thanks to timely recognition by the pathologist and is still declared cancer-free until today. This extremely rare nonmalignant mimicker of cancerous signet ring cells, as seen in diffuse type gastric cancer can potentially mislead the clinician. The absence of any endoscopic abnormality should prompt a revision by an experienced pathologist, digestive oncologist and surgeon to avoid unnecessary interventions and morbidity.