What is a stomach with a leather bottle and signet ring called?

A man wearing a Signet ring and drinking from a leather bottle would probably be a man from medieval era.

However the same cannot be told about stomach having a leather bottle appearance and Signet ring cells. Such a stomach is said to be cancerous, most commonly of the adenocarcinoma type.

In order to diagnose the diffuse type of adeno gastic carcinoma an endoscopy followed by microscopic examination of the sample are performed. During endoscopy the stomach looks like a leather bottle and under the microscope signet ring cells make an appearance. 

What could possibly be the reason behind these characteristic features?

The leather bottle appearance is due to the thick and rigid stomach wall due to tumor infiltrating the submucosa.

The Signet ring like appearance of the cells is due to mucin filled vacuoles pushing the nucleus to one side.

(FYI - the other type of gastric Ca is the Intestinal type which has better prognosis and does not show the above mentioned characteristics.)

If we look at the patient's history retrospectively, it may include:

• Early signs of post prandial fullness (or)
• Most common symptom of unexpected weight loss.

Since both of these symptoms may present in more than 40 other diseases, the TEN risk factors may be used to narrow it down to Gastric Ca.

Majority of the risk factors give me a panic attack since I have four of them :(

1. Blood group A 
2. Smoked, dried, salted food ingestion (Food items like kebab contain nitrates which upon mutation by bacteria become carcinogenic nitrites)
3. Smoking cigarette
4. Family history
   
   Other risk factors include
5. Vitamin C and E deficiency (cause weak coagulatory and immune system respectively)
6. Chronic gastritis
7. Partial gastrectomy (Can't be complete gastrectomy. Since no stomach, no cancer)
8. Gastric adenoma (Oma becomes carcinoma)
9. Barrett's esophagus (Only esophageal disease that can cause Ca in stomach)
10. Menetrier disease (If this is treated early, there is no way the patient can develop Ca stomach since its treatment is complete gastrectomy)

Other random facts about gastric cancer:

• Incidence is high in Chile, China, Ireland and Japan.
• The tumor can be classified based on macrascopic pattern as exophytic (mass), flat (no mass) and excavated (erosion).
• Early gastric Ca involves mucosa and submucosa, whereas late stage involves the muscular layer.
• First organ to metastasize is usually the liver, followed by lungs, bones, ovaries, periumblical lymph nodes, rectouterine shelf and left subclavicular lymph node.
• Initial diagnostic technique is double contract radiography. Any kind of abnormal lesion, including benign like necessitate endoscopy, biopsy and brush cytology.
• Curative treatment for gastric Ca is resection. In advanced cases, ECF regime is given (Epirubacin, Cisplatin and 5-Flurouracil).