Korean J Radiol.  2010 Dec;11(6):697-700. 10.3348/kjr.2010.11.6.697.

Epstein-Barr Virus-Associated Lymphoepithelioma-Like Gastric Carcinoma Presenting as a Submucosal Mass: CT Findings with Pathologic Correlation

Affiliations
  • 1Department of Radiology, Cheonan Hospital, Soonchunhyang University, Cheonan 330-721, Korea. rad2000@hanmail.net
  • 2Department of Pathology, Cheonan Hospital, Soonchunhyang University, Cheonan 330-721, Korea.
  • 3Department of Internal Medicine, Cheonan Hospital, Soonchunhyang University, Cheonan 330-721, Korea.

Abstract

A lymphoepithelioma-like carcinoma, characterized by a carcinoma with heavy lymphocyte infiltration, is one of the histological patterns observed in patients with Epstein-Barr virus (EBV)-associated gastric carcinoma. Less than half of invasive carcinomas with lymphoepithelioma-like histology can grow to make a submucosal mass. These tumors generally have a better prognosis than conventional adenocarcinomas. We report a case of an EBV-associated lymphoepithelioma-like gastric carcinoma that presented as a submucosal mass on multi-detector (MD) CT and correlate them with the pathology.

Keyword

Epstein-Barr virus infections; Stomach neoplasms; Tomography, X-ray computed

MeSH Terms

Carcinoma/*radiography/surgery/*virology
Contrast Media
Diagnosis, Differential
Epstein-Barr Virus Infections/*radiography/surgery
Gastroscopy
Humans
In Situ Hybridization
Male
Middle Aged
Stomach Neoplasms/*radiography/surgery/*virology
*Tomography, X-Ray Computed

Figure

  • Fig. 1 46-year-old man with Epstein-Barr virus-associated lymphoepithelioma-like gastric carcinoma. A. Gastroscopy revealed submucosal mass with two mucosal ulcerations (arrows) in gastric high body near cardia. B. Contrast-enhanced axial CT scan shows ovoid enhancing mass (arrows) in submucosal layer of gastric high body. Note overlying mucosa with contrast enhancement (arrowheads). C. Coronal reformatted image shows submucosal mass with contrast enhancement near cardia (arrows). Also note overlying mucosa (arrowheads). D. Low-power photomicrograph (Hematoxylin & Eosin stain, ×4) shows tumor infiltration in mucosa (arrows), mucosal ulcerations (U) and well-demarcated submucosal mass of lymphoid stroma (arrowheads). E. High-power photomicrograph (Hematoxylin & Eosin stain, ×200) shows multifocal small nests of poorly differentiated adenocarcinomas (arrows) that are uniformly distributed throughout lymphoid stroma. These findings of pathology were observed in all of mucosal and submucosal layers.


Reference

1. Arikawa J, Tokunaga M, Satoh E, Tanaka S, Land CE. Morphological characteristics of Epstein-Barr virus-related early gastric carcinoma: a case-control study. Pathol Int. 1997. 47:360–367.
2. Herath CH, Chetty R. Epstein-Barr virus-associated lymphoepithelioma-like gastric carcinoma. Arch Pathol Lab Med. 2008. 132:706–709.
3. Murphy G, Pfeiffer R, Camargo MC, Rabkin CS. Meta-analysis shows that prevalence of Epstein-Barr virus-positive gastric cancer differs based on sex and anatomic location. Gastroenterology. 2009. 137:824–833.
4. Lee JH, Kim SH, Han SH, An JS, Lee ES, Kim YS. Clinicopathological and molecular characteristics of Epstein-Barr virus-associated gastric carcinoma: a meta-analysis. J Gastroenterol Hepatol. 2009. 24:354–365.
5. Burke AP, Yen TS, Shekitka KM, Sobin LH. Lymphoepithelial carcinoma of the stomach with Epstein-Barr virus demonstrated by polymerase chain reaction. Mod Pathol. 1990. 3:377–380.
6. Iezzoni JC, Gaffey MJ, Weiss LM. The role of Epstein-Barr virus in lymphoepithelioma-like carcinomas. Am J Clin Pathol. 1995. 103:308–315.
7. Nishikawa J, Yanai H, Mizugaki Y, Takada K, Tada M, Okita K. Case report: hypoechoic submucosal nodules: a sign of Epstein-Barr virus-associated early gastric cancer. J Gastroenterol Hepatol. 1998. 13:585–590.
8. Shah KM, Young LS. Epstein-Barr virus and carcinogenesis: beyond Burkitt's lymphoma. Clin Microbiol Infect. 2009. 15:982–988.
9. Song HJ, Srivastava A, Lee J, Kim YS, Kim KM, Ki Kang W, et al. Host inflammatory response predicts survival of patients with Epstein-Barr virus-associated gastric carcinoma. Gastroenterology. 2010. 139:84–92.
10. Wu MS, Shun CT, Wu CC, Hsu TY, Lin MT, Chang MC, et al. Epstein-Barr virus-associated gastric carcinomas: relation to H. pylori infection and genetic alterations. Gastroenterology. 2000. 118:1031–1038.
11. Maeda E, Akahane M, Uozaki H, Kato N, Hayashi N, Fukayama M, et al. CT appearance of Epstein-Barr virus-associated gastric carcinoma. Abdom Imaging. 2009. 34:618–625.
12. Yanai H, Nishikawa J, Mizugaki Y, Shimizu N, Takada K, Matsusaki K, et al. Endoscopic and pathologic features of Epstein-Barr virus-associated gastric carcinoma. Gastrointest Endosc. 1997. 45:236–242.
Full Text Links
  • KJR
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr