Vacuolated cell change (probably proton pump inhibitor related) has a very different appearance from that of in situ signet ring carcinoma associated with CDH1 (the gene that encodes E Cadherin) germline mutations. Vacuolated cell change results in vacuolated parietal cells whereas the in situ signet ring cell carcinoma cells sneak between the basement membrane and foveolar cells.
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