Korean J Gastroenterol.  2012 Apr;59(4):321-323. 10.4166/kjg.2012.59.4.321.

A Case of Epstein-Barr Virus Negative Gastric Medullary Carcinoma Excised by Endoscopic Mucosal Resection

• Kwon YI
• Lee OY
• Paik SS

• KMID: 1364838
• DOI: http://doi.org/10.4166/kjg.2012.59.4.321

Abstract

No abstract available.

MeSH Terms

Aged
Carcinoma, Medullary/*diagnosis/surgery/ultrasonography
Epstein-Barr Virus Infections/diagnosis
Gastric Mucosa/pathology/surgery
Gastroscopy
Humans
Immunohistochemistry
Keratins/metabolism
Male
Stomach Neoplasms/*diagnosis/surgery/ultrasonography

Figure

• 

  Fig. 1 Endoscopic finding. Elevated submucosal lesion with apical ulceration at the anterior wall of the antrum was observed.

• 

  Fig. 2 Endoscopic ultrasonography. It showed about 1.1 cm-sized homogenous hypoechoic mass in the submucosal layer.

• 

  Fig. 3 (A) Endoscopic mucosal resection (EMR) site. EMR was done to obtain more specimen of submucosal mass. (B) Excised mass. 1.3×1.2×0.5 cm sized well demarcated oval, grayish mass was excised by EMR.

• 

  Fig. 4 (A) Pathologic study revealed gastric lymphoepithelioma-like carcinoma, with syncytial growth pattern of abundant lymphoid cell infiltrations in the stroma (H&E, ×200). (B) Immunohistochemical stain for cytokeratin showed strong positive on the epithelial tumor nests (×200).

Reference

1. Herath CH, Chetty R. Epstein-Barr virus-associated lymphoepithelioma-like gastric carcinoma. Arch Pathol Lab Med. 2008. 132:706–709.

2. Minamoto T, Mai M, Watanabe K, et al. Medullary carcinoma with lymphocytic infiltration of the stomach. Clinicopathologic study of 27 cases and immunohistochemical analysis of the subpopulations of infiltrating lymphocytes in the tumor. Cancer. 1990. 66:945–952.

3. Watanabe H, Enjoji M, Imai T. Gastric carcinoma with lymphoid stroma. Its morphologic characteristics and prognostic correlations. Cancer. 1976. 38:232–243.

4. Oda K, Tamaru J, Takenouchi T, et al. Association of Epstein-Barr virus with gastric carcinoma with lymphoid stroma. Am J Pathol. 1993. 143:1063–1071.

5. Nakamura S, Ueki T, Yao T, Ueyama T, Tsuneyoshi M. Epstein-Barr virus in gastric carcinoma with lymphoid stroma. Special reference to its detection by the polymerase chain reaction and in situ hybridization in 99 tumors, including a morphologic analysis. Cancer. 1994. 73:2239–2249.

6. Kume T, Oshima K, Yamashita Y, Shirakusa T, Kikuchi M. Relationship between Fas-ligand expression on carcinoma cell and cytotoxic T-lymphocyte response in lymphoepithelioma-like cancer of the stomach. Int J Cancer. 1999. 84:339–343.

7. Hsu DH, de Waal Malefyt R, Fiorentino DF, et al. Expression of interleukin-10 activity by Epstein-Barr virus protein BCRF1. Science. 1990. 250:830–832.

8. Lü BJ, Lai M, Cheng L, Xu JY, Huang Q. Gastric medullary carcinoma, a distinct entity associated with microsatellite instability-H, prominent intraepithelial lymphocytes and improved prognosis. Histopathology. 2004. 45:485–492.

9. Grogg KL, Lohse CM, Pankratz VS, Halling KC, Smyrk TC. Lymphocyte-rich gastric cancer: associations with Epstein-Barr virus, microsatellite instability, histology, and survival. Mod Pathol. 2003. 16:641–651.

10. Lee SH, Jang BI, Eun JR, Kim KO, Lee KH, Kim TN. A case of submucosal gastric lymphoepithelioma-like carcinoma. Korean J Med. 2009. 76:Suppl 1. S35–S39.

11. Cho JH, Lee WS, Lee KR, et al. Gastric lymphoepithelioma-like carcinoma diagnosed and treated by endoscopic submucosal dissection: review of the literature. Korean J Gastrointest Endosc. 2010. 40:256–260.

12. Goh PG, Kim ES, Kim YJ, et al. A case of gastric lymphoepithelioma-like carcinoma presenting as panperitonitis by perforation of stomach. Korean J Gastroenterol. 2011. 58:208–211.

13. Park WI, Kim HW, Park JH, et al. A case of gastric lymphoepithelioma-like carcinoma presenting as a submucosal tumor. Korean J Gastrointest Endosc. 2004. 28:123–126.

14. Woo H, Shin SJ, Kim YB, et al. A case of endoscopic enucleation for gastric lymphoepithelioma-like carcinoma. Korean J Gastrointest Endosc. 2010. 41:163–167.

15. Moon HS, Kang SH, Seong JK, Jeong HY, Song KS. Lymphoepithelioma-like gastric carcinoma resected by endoscopic submucosal dissection (ESD). Endoscopy. 2010. 42:Suppl 2. E73–E74.