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Fig. 6.20 A Signet-ring cell carcinoma arising in an adenoma; intramucosal signet-ring cells adjacent to adenomatous glands. B Signet-ring cells infiltrating mus-cularis propria. C Lymph node metastasis of a signet-ring cell carcinoma.

noma has 50-95% glands; poorly differentiated (grade 3) adenocarcinoma has 5-50%; and undifferentiated (grade 4) carcinoma has < 5%. Mucinous adeno-carcinoma and signet-ring cell carcinoma by convention are considered poorly differentiated (grade 3). Medullary carcinoma with MSI-H appears undifferentiated. Additional studies of the biological behaviour of MSI-H cancers are needed to relate the morphological grade and molecular subtypes of mucinous, signetring cell and medullary carcinoma to outcome since MSI-H carcinomas have an improved stage-specific survival {788, 924, 1098}.

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