{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:40:35Z","timestamp":1760060435298,"version":"build-2065373602"},"reference-count":6,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:00:00Z","timestamp":1756339200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National High Level Hospital Clinical Research Funding","award":["2022-PUMCH-B-064"],"award-info":[{"award-number":["2022-PUMCH-B-064"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Advanced Gastric Signet Ring Cell Carcinoma (SRCC) is characterized by aggressive behavior, high metastatic potential, and extremely poor prognosis. There is an urgent need for effective imaging modalities to evaluate systemic metastatic lesions and to dynamically monitor disease progression during treatment. We report a rare case of a 26-year-old female with advanced SRCC presenting with extensive systemic metastases, clinically staged as IV (cT4N3M1). High-frequency and conventional ultrasound imaging revealed metastatic lesions involving the scalp soft tissues, cervical lymph nodes, intercostal soft tissues, pancreatic-splenic hilum region, pelvic cavity, peritoneum and omentum. The ultrasonographic findings were highly consistent with contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) results. The patient received seven cycles of a modified BEMA regimen (oxaliplatin, leucovorin and 5-fluorouracil) combined with nivolumab. Serial ultrasound monitoring indicated continuous disease progression. Due to poor therapeutic response, the patient succumbed to acute obstructive renal failure caused by tumor progression seven months after diagnosis. This report provided a comprehensive ultrasonographic assessment of widespread and rare metastatic sites in advanced SRCC, a scenario seldom documented. The combination of high-frequency ultrasound and Super Microvascular Imaging (SMI) offered precise, radiation-free, and repeatable evaluation of both superficial and deep lesions, proving particularly valuable for real-time monitoring of treatment response in critically ill patients. These findings underscore the unique role of systemic ultrasound in enhancing metastatic detection and therapeutic evaluation for advanced SRCC.<\/jats:p>","DOI":"10.3390\/diagnostics15172177","type":"journal-article","created":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T07:43:16Z","timestamp":1756366996000},"page":"2177","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Ultrasonography of Widespread Metastases in Advanced Gastric Signet Ring Cell Carcinoma"],"prefix":"10.3390","volume":"15","author":[{"given":"Xiaocong","family":"Dong","sequence":"first","affiliation":[{"name":"Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1, Shuaifuyuan, Dongcheng District, Beijing 100730, China"},{"name":"Department of Ultrasound, Aerospace Center Hospital, No. 15, Yuquan Road, Haidian District, Beijing 100049, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1, Shuaifuyuan, Dongcheng District, Beijing 100730, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaohui","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Ultrasound, Beijing Sixth Hospital, No. 36, Jiaodaokou North 2nd Alley, Dongcheng District, Beijing 100007, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7318-3897","authenticated-orcid":false,"given":"Luying","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1, Shuaifuyuan, Dongcheng District, Beijing 100730, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianchu","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1, Shuaifuyuan, Dongcheng District, Beijing 100730, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"49","DOI":"10.21037\/qims-21-1149","article-title":"Grayscale ultrasound feature typing of metastatic ovarian tumors, particularly signet-ring cell carcinoma","volume":"13","author":"Liu","year":"2023","journal-title":"Quant. Imaging Med. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1186\/s13089-025-00444-2","article-title":"Advances and innovations in ultrasound-based tumor management: Current applications and emerging directions","volume":"17","author":"Rui","year":"2025","journal-title":"Ultrasound J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1007\/s10120-018-0860-8","article-title":"Clinicopathological differences in signet ring cell adenocarcinoma between early and advanced gastric cancer","volume":"22","author":"Kao","year":"2019","journal-title":"Gastric Cancer"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1007\/s10120-013-0234-1","article-title":"Clinicopathological characteristics and prognosis of signet ring cell carcinoma of the stomach","volume":"17","author":"Kwon","year":"2014","journal-title":"Gastric Cancer"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1002\/uog.29155","article-title":"Clinical utility of ultrasonography in pediatric and adolescent gynecology: Retrospective review of 1313 ultrasound examinations","volume":"65","author":"Cooper","year":"2025","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"18","DOI":"10.31662\/jmaj.2024-0203","article-title":"Clinical Application of Artificial Intelligence in Ultrasound Imaging for Oncology","volume":"8","author":"Komatsu","year":"2025","journal-title":"JMA J."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/17\/2177\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:34:13Z","timestamp":1760034853000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/17\/2177"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,28]]},"references-count":6,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["diagnostics15172177"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15172177","relation":{},"ISSN":["2075-4418"],"issn-type":[{"type":"electronic","value":"2075-4418"}],"subject":[],"published":{"date-parts":[[2025,8,28]]}}}