CDH1 and signet ring cell carcinoma: This is in concordance with other series, where the presence of one or more foci of signet ring cell carcinoma was reported in up to 92 % of all prophylactic gastrectomy pathologic resection specimens.3,16,17 The high percentage of intramucosal gastric cancer in both our series and the series from literature emphasizes the need for prophylactic gastrectomy for patients with germline CDH1 mutations.