J Korean Soc Radiol.  2015 Jan;72(1):20-28. 10.3348/jksr.2015.72.1.20.

Imaging Findings of Epstein-Barr Virus-Associated Gastric Lymphoepithelioma-Like Carcinoma

• Han TS
• Kim YC
• Chung YE
• Lee D
• Park MJ
• Lee JH
• Kim JK

• KMID: 1823930
• DOI: http://doi.org/10.3348/jksr.2015.72.1.20

Abstract

PURPOSE
To analyze the computed tomography (CT) features of Epstein-Barr virus (EBV)-associated lymphoepithelioma-like carcinoma (LELC).
MATERIALS AND METHODS
Between January 2004 and September 2014, radiologic features of 44 EBV-associated LELCs were analyzed. Lesion detectability, multiplicity, location, gross appearance, lesion thickness and margin, presence of a round edge, contrast enhancement pattern, and the degree of contrast enhancement were analyzed.
RESULTS
The most common location of LELC was the upper third of the stomach (n = 28; 63.64%). A high percentage of cases showed uniform peripheral thickness (n = 32; 88.89%). LELCs demonstrated well-defined margins in a high percentage of cases (n = 31; 86.11%). Additionally, a high percentage of cases showed the presence of a round edge (n = 28; 77.78%).
CONCLUSION
CT features, including tumor location in the upper third of the stomach and presence of uniform peripheral thickness with a round edge, may suggest the possibility of EBV-associated LELC.

MeSH Terms

Herpesvirus 4, Human
Stomach

Figure

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  Fig. 1 Technique for peripheral thickness measurement of a mass. Thickness of a mass was measured at the peripheral portion. When (a) and (b) show less than 10% difference in length, it is defined as positive presence of uniform thickness profile. In addition to uniform thickness profile, round edges (arrows) were seen in the masses resembling pizza crust.

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  Fig. 2 A 58-year-old female with Epstein-Barr virus-associated lymphoepithelioma-like carcinoma in the stomach. Precontrast (A) and venous phase contrast-enhanced (B) axial CT scans show fungating mass with round edge and moderate enhancement (arrows) in the antrum of stomach.

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  Fig. 3 A 63-year-old male with Epstein-Barr virus-associated lymphoepithelioma-like carcinoma in the stomach. Precontrast- (A), arterial phase contrast- (B) and venous phase contrast- (C) enhanced axial CT scans show ulcerative mass with uniform peripheral thickness, round edge and homogeneous enhancement (arrows) in the upper third of stomach. D. Low-power photomicrograph (hematoxylin & eosin stain, × 4) shows well-demarcated mass of lymphoid stroma with uniform thickness and round edge at both sides of tumor. E. High-power photomicrograph (hematoxylin & eosin stain, × 40) shows uniformly distributed multifocal nests of poorly differentiated adenocarcinomas in the lymphoid stroma.

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  Fig. 4 A 54-year-old female with Epstein-Barr virus-associated lymphoepithelioma-like carcinoma in the stomach. A. Esophageal gastroduodenoscopy revealed submucosal mass with mucosal ulcerations in the upper third of stomach. Contrast-enhanced coronal multiplanar reconstruction (B) and contrast-enhanced axial CT scan (C) show small polypoid mass with round edge and low enhancement (arrows).

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  Fig. 5 A 69-year-old male with Epstein-Barr virus-associated lymphoepithelioma-like carcinoma in the stomach. Arterial phase (A) and venous phase (B) contrast-enhanced axial CT scans show fungating mass with round edge, uniform peripheral thickness, and high enhancement (arrows) in the lower third of stomach. C. Low-power photomicrograph (hematoxylin & eosin stain, × 4) shows well-demarcated mass of lymphoid stroma. The mass shows uniform peripheral thickness with round well-demarcated edge. Reactive lymphoid follicles (open arrows) are scattered between tumor nests with dense lymphocytic infiltration.

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