Response:

My colleagues and I thank Matsushita et al1 for their response to our article entitled "Peritoneal carcinomatosis from signet-ring cell adenocarcinoma of the appendix."2 We agree that with signet-ring cell carcinoma, the primary tumor site is most commonly the stomach and that accurate diagnosis of a primary gastric cancer is difficult to make in patients without gastric symptoms. We also agree that positron emission tomography plays a less-useful diagnostic role in the detection of primary gastric cancer, especially in patients with signet-ring cell carcinoma.

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