ABSTRACT Introduction: Diffuse variant of GC is composed of gastric-type mucous cells, which generally do not form glands, but rather permit the mucosa 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, creating a “signet ring” conformation. If the signetring cells are more than 50% of the tumor, the tumor is classified as signetring cell carcinoma . This case is important for reporting because we encountered for the first time such a carcinoma 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 abdominal pain, nausea and peritoneal irritation. Clinical examination has been made in emergency, where we conclude the signs of peritoneal irritation, from native Ro no signs of pneumoperitoneum, 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 pneumoperitoneum. It was indicated urgent surgical in-tervention. Intraoperatively, we found Ulcer duodenal perforation and undertook the operation procedures by Roscoe Graham technique. Conclusions: At this age, it is rare, and it is difficult to detect in its early stages, because the signs and symptoms are often non-existent, non-specific, or mimic as an ulcer. The most common symptoms are early heartburn indigestion, abdominal pain or discomfort, vomiting, constipation, diarrhea or to feel of filling after a small meal, loss of appetite, weakness and fatigue. Less common symptoms are anemia and weight loss.
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