{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T09:07:00Z","timestamp":1783933620482,"version":"3.55.0"},"reference-count":12,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T00:00:00Z","timestamp":1763683200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T00:00:00Z","timestamp":1763683200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Clinical Ultrasound"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Appendiceal signet ring cell carcinoma (ASRC) is an exceptionally rare and aggressive malignancy, representing &lt;\u20090.1% of gastrointestinal neoplasms. Its nonspecific imaging manifestations frequently mimic inflammatory conditions such as appendicitis, leading to delayed diagnosis. We report a diagnostically challenging case of a 75\u2010year\u2010old woman with recurrent right lower abdominal pain over 6\u2009months. Initial ultrasonography revealed appendiceal wall thickening (19.5\u2009mm diameter) without layered structure loss, suggestive of chronic appendicitis. Follow\u2010up computed tomography (CT) demonstrated cystic distal appendiceal dilatation (5.6\u2009\u00d7\u20092.5\u2009cm) with mural nodular enhancement. Despite three ultrasound examinations and CT scans, no definitive malignant features were identified preoperatively. Intraoperative findings revealed an 8.0\u2009cm enlarged appendix with serosal infiltration, and histopathology confirmed the diagnosis of high\u2010grade appendiceal mucinous neoplasm (HAMN) with associated signet ring cell carcinoma. This case highlights the limitations of conventional imaging in detecting ASRC, particularly when mucinous components obscure tumor invasion. The key to distinguishing ASRC from appendicitis lies in recognizing its progressive nature on serial imaging. Discriminatory features include: rapid and asymmetric wall thickening (often &gt;\u200910\u2009mm), the evolution from a preserved to a lost \u201ctarget ring sign\u201d on ultrasonography, and the presence of mural nodular enhancement on CT.<\/jats:p>","DOI":"10.1002\/jcu.70128","type":"journal-article","created":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T12:26:07Z","timestamp":1763727967000},"page":"1016-1019","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Challenges in Diagnostic Imaging of Appendiceal Signet Ring Cell Carcinoma: A Case Report"],"prefix":"10.1002","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-0923-8641","authenticated-orcid":false,"given":"Jinling","family":"Gao","sequence":"first","affiliation":[{"name":"Department of Ultrasound Hangzhou Third People\u2019s Hospital, Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongsheng","family":"Xia","sequence":"additional","affiliation":[{"name":"Department of Ultrasound Hangzhou Third People\u2019s Hospital, Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanjun","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Radiology Hangzhou Children's Hospital  Zhejiang Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,11,21]]},"reference":[{"issue":"6","key":"e_1_2_12_2_1","article-title":"Clinicopathologic Features and Survival Outcomes of Signet Ring Cell Carcinoma of the Appendix: An Analysis of the Surveillance, Epidemiology, and End Results Database","volume":"12","author":"Abushalha K.","year":"2020","journal-title":"Cureus"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semdp.2024.08.005"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers15092497"},{"issue":"4","key":"e_1_2_12_5_1","article-title":"Appendiceal Signet Ring Cell Carcinoma Presenting as Acute Appendicitis: A Case Report","volume":"16","author":"Ina E. 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