J Gastric Cancer.  2020 Mar;20(1):106-114. 10.5230/jgc.2020.20.e1.

Bilateral Breast Metastases from Epstein-Barr Virus-Associated Gastric Cancer during Pregnancy: Is There a Method to Its Madness?

  • 1Medical Oncology Unit, IRCCS ICS Maugeri SpA SB, Pavia, Italy.
  • 2Department of Internal Medicine and Therapeutics, University of Pavia, PhD in Experimental Medicine, Pavia, Italy.
  • 3Anatomic Pathology Unit, Department of Molecular Medicine, University of Pavia, Pavia, Italy. alessandro.vanoli@unipv.it
  • 4Anatomic Pathology Unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy.
  • 5Translational Oncology Unit, IRCCS ICS Maugeri SpA SB, Pavia, Italy.
  • 6Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Unit of General Surgery 2, University of Pavia and IRCCS San Matteo Hospital Foundation, Pavia, Italy.


Breast metastases of extramammary malignant neoplasms are rare, with an incidence of 0.3%-2.7% among all malignant mammary tumors. Breast metastases from gastric carcinoma are very rare (<0.1%), and this event is even rarer during pregnancy. Herein, we describe a 39-year-old Caucasian woman with a history of an Epstein-Barr virus-associated gastric carcinoma (EBVaGC) that was characterized by prominent tumor infiltrating lymphocytes. Three years after undergoing radical surgery, the patient developed bilateral breast nodules during her pregnancy. A breast biopsy was performed, and histology confirmed a diagnosis of EBVaGC; tumor cells showed positivity for cytokeratin 8/18 and E-cadherin, and negativity for cytokeratin 7, cytokeratin 20, cytokeratin 5/6, caudal type homebox 2, androgen receptor, mammaglobin, gross cystic disease fluid protein-15, and estrogen and progesterone receptors. We also discuss the main diagnostic pitfalls. To our knowledge, this is the first report of an EBVaGC with lymphoid stroma that developed breast metastases during pregnancy.


Tumor-infiltrating lymphocytes; Pregnancy; Neoplasm metastasis; Gastric cancer; Epstein-Barr virus

MeSH Terms

Herpesvirus 4, Human
Lymphocytes, Tumor-Infiltrating
Neoplasm Metastasis*
Receptors, Androgen
Receptors, Progesterone
Stomach Neoplasms*
Receptors, Androgen
Receptors, Progesterone


  • Fig. 1 Histology of gastric carcinoma. The histologic examination revealed lymphoid stroma, prominent lymphocytic infiltration, and syncytial growth (hematoxylin and eosin staining; magnification ×100).

  • Fig. 2 Histology of gastric carcinoma at higher magnification. At higher magnification (×200), large tumor cell nuclei with open chromatin and prominent nucleoli (hematoxylin and eosin staining) can be observed.

  • Fig. 3 Histology of breast metastasis. Histology of gastric carcinoma metastatic to the breast: a non-neoplastic breast duct can be observed on the left (hematoxylin and eosin staining; magnification ×200).

  • Fig. 4 EBER-ISH. Tumor cells show strong ISH for EBER reactivity (magnification ×200).EBER = Epstein-Barr virus-encoded RNA; ISH = in situ hybridization; EBV = Epstein-Barr virus.

  • Fig. 5 CT scan of the breasts. CT scan shows inhomogeneous malignant lesions occupying the parenchyma in both the breasts.CT = computed tomography; R = right; L = left.


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