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Published in: Diagnostic Pathology 1/2013

Open Access 01-12-2013 | Case Report

Lymphoepithelioma-like carcinoma of the stomach: a case report and review of the literature

Authors: Zeid Bittar, Falko Fend, Leticia Quintanilla-Martinez

Published in: Diagnostic Pathology | Issue 1/2013

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Abstract

A lymphoepithelioma-like carcinoma (LLC), characterized by a carcinoma with stromal heavy lymphocyte infiltration, is one of the histological patterns observed in patients with Epstein-Barr virus (EBV)-associated gastric carcinoma. Although this entity is hard to be recognized in the biopsy specimens, pathologists and clinicians should acknowledge this subset of gastric cancer because it generally has a better prognosis than other forms of EBV-associated gastric carcinomas and conventional gastric carcinomas. This might be due to the fact that the patient's inflammatory response may prevent the spread of tumor through the gastric wall and to the lymph nodes or remote organs.
We report a case of EBV-positive, microsatellite stable LLC as a rare morphologic variant of gastric carcinoma.

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Literature
1.
go back to reference Watanabe H, Enjoji M, Imai T: Gastric carcinoma with lymphoid stroma: its morphologic characteristic and prognostic correlations. Cancer. 1976, 38: 232-243. 10.1002/1097-0142(197607)38:1<232::AID-CNCR2820380135>3.0.CO;2-4.CrossRefPubMed Watanabe H, Enjoji M, Imai T: Gastric carcinoma with lymphoid stroma: its morphologic characteristic and prognostic correlations. Cancer. 1976, 38: 232-243. 10.1002/1097-0142(197607)38:1<232::AID-CNCR2820380135>3.0.CO;2-4.CrossRefPubMed
2.
go back to reference Torlakovic G, Snover DC, Torlakovic E: Simultaneous EBV-positive lymphoepithelioma-like carcinoma and EBV-negative intestinal type adenocarcinoma in a patient with Helicobacter pylori–associated chronic gastritis. Am J Clin Pathol. 2004, 121: 237-243. 10.1309/MD3BD8Y1Q5X983LG.CrossRefPubMed Torlakovic G, Snover DC, Torlakovic E: Simultaneous EBV-positive lymphoepithelioma-like carcinoma and EBV-negative intestinal type adenocarcinoma in a patient with Helicobacter pylori–associated chronic gastritis. Am J Clin Pathol. 2004, 121: 237-243. 10.1309/MD3BD8Y1Q5X983LG.CrossRefPubMed
3.
go back to reference Horiuchi K, Mishima K, Ohsawa M, et al.: Carcinoma of stomach and breast with lymphoid stroma: localization of Epstein Barr virus. J Clin Pathol. 1994, 47: 538-540. 10.1136/jcp.47.6.538.PubMedCentralCrossRefPubMed Horiuchi K, Mishima K, Ohsawa M, et al.: Carcinoma of stomach and breast with lymphoid stroma: localization of Epstein Barr virus. J Clin Pathol. 1994, 47: 538-540. 10.1136/jcp.47.6.538.PubMedCentralCrossRefPubMed
4.
go back to reference Corvalan A, Koriyama C, Akiba S, et al.: Epstein-Barr virus in gastric carcinoma is associated with localization in the cardia and with a diffuse histology: a study in one area of Chile. Int J Canc. 2001, 94: 527-530. 10.1002/ijc.1510.CrossRef Corvalan A, Koriyama C, Akiba S, et al.: Epstein-Barr virus in gastric carcinoma is associated with localization in the cardia and with a diffuse histology: a study in one area of Chile. Int J Canc. 2001, 94: 527-530. 10.1002/ijc.1510.CrossRef
5.
go back to reference Grogg KL, Lohse CM, Pankratz VS, et al.: Lymphocyte-rich gastric cancer: association with Epstein-Barr virus, microsatellite instability, histology and survival. Mod Pathol. 2003, 16: 641-651. 10.1097/01.MP.0000076980.73826.C0.CrossRefPubMed Grogg KL, Lohse CM, Pankratz VS, et al.: Lymphocyte-rich gastric cancer: association with Epstein-Barr virus, microsatellite instability, histology and survival. Mod Pathol. 2003, 16: 641-651. 10.1097/01.MP.0000076980.73826.C0.CrossRefPubMed
6.
go back to reference Fukayama M, Ushiku T: Epstein-Barr virus-associated gastric carcinoma. Pathol Res Pract. 2011, 207: 529-537. 10.1016/j.prp.2011.07.004.CrossRefPubMed Fukayama M, Ushiku T: Epstein-Barr virus-associated gastric carcinoma. Pathol Res Pract. 2011, 207: 529-537. 10.1016/j.prp.2011.07.004.CrossRefPubMed
8.
go back to reference Hiroshi S, Akinori N, Masayuki K, et al.: Oesophageal and gastric cancer. J Gastroenterol Hepatol. 1999, 14: 534-539. Hiroshi S, Akinori N, Masayuki K, et al.: Oesophageal and gastric cancer. J Gastroenterol Hepatol. 1999, 14: 534-539.
9.
go back to reference Iwashita A, Ueyama T, Yamada Y, et al.: Clinicopathological study on medullary carcinoma with lymphoid stroma of the stomach. I to Cho (Stomach and Intestine). 1991, 10: 1159-1166. [Japanese with English abstract] Iwashita A, Ueyama T, Yamada Y, et al.: Clinicopathological study on medullary carcinoma with lymphoid stroma of the stomach. I to Cho (Stomach and Intestine). 1991, 10: 1159-1166. [Japanese with English abstract]
10.
go back to reference Minamoto T, Mai M, Watanabe K, et al.: Medullary carcinoma with lymphocytic infiltration of the stomach. Clinicopathologic study of the subpopulations of infiltrating lymphocytes in the tumor. Cancer. 1990, 66: 945-952. 10.1002/1097-0142(19900901)66:5<945::AID-CNCR2820660523>3.0.CO;2-X.CrossRefPubMed Minamoto T, Mai M, Watanabe K, et al.: Medullary carcinoma with lymphocytic infiltration of the stomach. Clinicopathologic study of the subpopulations of infiltrating lymphocytes in the tumor. Cancer. 1990, 66: 945-952. 10.1002/1097-0142(19900901)66:5<945::AID-CNCR2820660523>3.0.CO;2-X.CrossRefPubMed
11.
go back to reference Shibata D, Tokunaga M, Uemura Y, et al.: Association of Epstein-Barr virus with undifferentiated gastric carcinomas with intense lymphoid infiltration, lymphoepithelioma-like carcinoma. Am J Pathol. 1991, 139: 469-474.PubMedCentralPubMed Shibata D, Tokunaga M, Uemura Y, et al.: Association of Epstein-Barr virus with undifferentiated gastric carcinomas with intense lymphoid infiltration, lymphoepithelioma-like carcinoma. Am J Pathol. 1991, 139: 469-474.PubMedCentralPubMed
12.
go back to reference Beek JV, Hausen AZ, Kranenbarg EK, et al.: EBV-positive gastric adenocarcinomas: a distinct clinicopathologic entity with a low frequency of lymph node involvement. J Clin Oncol. 2004, 22: 664-670. 10.1200/JCO.2004.08.061.CrossRefPubMed Beek JV, Hausen AZ, Kranenbarg EK, et al.: EBV-positive gastric adenocarcinomas: a distinct clinicopathologic entity with a low frequency of lymph node involvement. J Clin Oncol. 2004, 22: 664-670. 10.1200/JCO.2004.08.061.CrossRefPubMed
13.
go back to reference Chang MS, Kim WH, Kim CW, et al.: Epstein-Barr virus in gastric carcinomas with lymphoid stroma. Histopathology. 2000, 37: 309-315. 10.1046/j.1365-2559.2000.01014.x.CrossRefPubMed Chang MS, Kim WH, Kim CW, et al.: Epstein-Barr virus in gastric carcinomas with lymphoid stroma. Histopathology. 2000, 37: 309-315. 10.1046/j.1365-2559.2000.01014.x.CrossRefPubMed
14.
go back to reference Kang GH, Lee S, Kim WH, et al.: Epstein-Barr virus–positive gastric carcinoma demonstrates frequent aberrant methylation of multiple genes and constitutes CpG island methylator phenotype-positive gastric carcinoma. Am J Pathol. 2002, 160: 787-794. 10.1016/S0002-9440(10)64901-2.PubMedCentralCrossRefPubMed Kang GH, Lee S, Kim WH, et al.: Epstein-Barr virus–positive gastric carcinoma demonstrates frequent aberrant methylation of multiple genes and constitutes CpG island methylator phenotype-positive gastric carcinoma. Am J Pathol. 2002, 160: 787-794. 10.1016/S0002-9440(10)64901-2.PubMedCentralCrossRefPubMed
15.
16.
go back to reference Uemura Y, Tokunaga M, Arikawa J, et al.: A unique morphology of Epstein-Barr virus related early gastric carcinoma. Canc Epidemiol Biomarkers Prev. 1994, 3: 607-611. Uemura Y, Tokunaga M, Arikawa J, et al.: A unique morphology of Epstein-Barr virus related early gastric carcinoma. Canc Epidemiol Biomarkers Prev. 1994, 3: 607-611.
17.
go back to reference Vo QN, Geradts J, Gulley ML, et al.: Epstein-Barr virus in gastric adenocarcinomas: association with ethnicity and CDKN2A promoter methylation. J Clin Pathol. 2002, 55: 669-675. 10.1136/jcp.55.9.669.PubMedCentralCrossRefPubMed Vo QN, Geradts J, Gulley ML, et al.: Epstein-Barr virus in gastric adenocarcinomas: association with ethnicity and CDKN2A promoter methylation. J Clin Pathol. 2002, 55: 669-675. 10.1136/jcp.55.9.669.PubMedCentralCrossRefPubMed
18.
go back to reference Osato T, Imai S: Epstein-Barr virus and gastric carcinoma. Semin Canc Biol. 1996, 7: 175-182. 10.1006/scbi.1996.0024.CrossRef Osato T, Imai S: Epstein-Barr virus and gastric carcinoma. Semin Canc Biol. 1996, 7: 175-182. 10.1006/scbi.1996.0024.CrossRef
19.
go back to reference Kaneda A, Kaminishi M, Yanagihara K, et al.: Identification of silencing of nine genes in human gastric cancers. Canc Res. 2002, 62: 6645-6650. Kaneda A, Kaminishi M, Yanagihara K, et al.: Identification of silencing of nine genes in human gastric cancers. Canc Res. 2002, 62: 6645-6650.
20.
go back to reference Hino R, Uozaki H, Murakami N, et al.: Activation of DNA methyltransferase 1 by EBV latent membrane protein 2A leads to promoter hypermethylation of PTEN gene in gastric carcinoma. Canc Res. 2009, 69: 2766-2774. 10.1158/0008-5472.CAN-08-3070.CrossRef Hino R, Uozaki H, Murakami N, et al.: Activation of DNA methyltransferase 1 by EBV latent membrane protein 2A leads to promoter hypermethylation of PTEN gene in gastric carcinoma. Canc Res. 2009, 69: 2766-2774. 10.1158/0008-5472.CAN-08-3070.CrossRef
21.
go back to reference Chang MS, Uozaki H, Chong JM, et al.: CpG island methylation status in gastric carcinoma with and without infection of Epstein-Barr virus. Clin Canc Res. 2006, 12: 2995-3002. 10.1158/1078-0432.CCR-05-1601.CrossRef Chang MS, Uozaki H, Chong JM, et al.: CpG island methylation status in gastric carcinoma with and without infection of Epstein-Barr virus. Clin Canc Res. 2006, 12: 2995-3002. 10.1158/1078-0432.CCR-05-1601.CrossRef
22.
go back to reference Lee JH, Park SJ, Abraham SC, et al.: Frequent CpG island methylation in precursor lesion and early lesions and early gastric adenocarcinomas. Oncogene. 2004, 23: 4646-4654. 10.1038/sj.onc.1207588.CrossRefPubMed Lee JH, Park SJ, Abraham SC, et al.: Frequent CpG island methylation in precursor lesion and early lesions and early gastric adenocarcinomas. Oncogene. 2004, 23: 4646-4654. 10.1038/sj.onc.1207588.CrossRefPubMed
23.
go back to reference Chang MS, Lee HS, Kin CW, et al.: Clinocopathologic characteristics of Epstein-Barr virus-incorporated gastric cancers in Korea. Pathol Res Pract. 2001, 197: 395-400. 10.1078/0344-0338-00052.CrossRefPubMed Chang MS, Lee HS, Kin CW, et al.: Clinocopathologic characteristics of Epstein-Barr virus-incorporated gastric cancers in Korea. Pathol Res Pract. 2001, 197: 395-400. 10.1078/0344-0338-00052.CrossRefPubMed
24.
go back to reference Chong JM, Fukayama M, Hayashi Y, et al.: Microsatellite instability in the progression of gastric carcinoma. Canc Res. 1994, 54: 4595-4597. Chong JM, Fukayama M, Hayashi Y, et al.: Microsatellite instability in the progression of gastric carcinoma. Canc Res. 1994, 54: 4595-4597.
25.
go back to reference Leung SY, Yuen ST, Chung LP, et al.: Microsatellite instability, Epstein Barr virus, mutation of type II transforming growth factor receptor and BAX in gastric carcinomas in Hong Kong Chinese. Br J Canc. 1999, 79: 582-588. 10.1038/sj.bjc.6690092.CrossRef Leung SY, Yuen ST, Chung LP, et al.: Microsatellite instability, Epstein Barr virus, mutation of type II transforming growth factor receptor and BAX in gastric carcinomas in Hong Kong Chinese. Br J Canc. 1999, 79: 582-588. 10.1038/sj.bjc.6690092.CrossRef
26.
go back to reference Ojima H, Fukuda T, Nakajima T, et al.: Infrequent overexpression of p53 protein in Epstein-Barr virus–associated gastric carcinomas. Jpn J Canc Res. 1997, 88: 262-266. 10.1111/j.1349-7006.1997.tb00376.x.CrossRef Ojima H, Fukuda T, Nakajima T, et al.: Infrequent overexpression of p53 protein in Epstein-Barr virus–associated gastric carcinomas. Jpn J Canc Res. 1997, 88: 262-266. 10.1111/j.1349-7006.1997.tb00376.x.CrossRef
27.
go back to reference Leung SY, Chau KY, Yuen ST, et al.: p53 overexpression is different in Epstein-Barr virus–associated and Epstein-Barr virus–negative carcinoma. Histopathology. 1998, 33: 311-317.PubMed Leung SY, Chau KY, Yuen ST, et al.: p53 overexpression is different in Epstein-Barr virus–associated and Epstein-Barr virus–negative carcinoma. Histopathology. 1998, 33: 311-317.PubMed
28.
go back to reference Fukayama M, Chong JM, Kaizaki Y: Epstein-Barr virus and gastric carcinoma. Gastric Canc. 1998, 1: 104-114. 10.1007/s101200050003.CrossRef Fukayama M, Chong JM, Kaizaki Y: Epstein-Barr virus and gastric carcinoma. Gastric Canc. 1998, 1: 104-114. 10.1007/s101200050003.CrossRef
29.
go back to reference Kijima Y, Ishigami S, Hokita S, et al.: The comparison of the prognosis between Epstein-Barr virus (EBV)–positive gastric carcinoma and EBV-negative ones. Canc Lett. 2003, 200: 33-40. 10.1016/S0304-3835(03)00410-5.CrossRef Kijima Y, Ishigami S, Hokita S, et al.: The comparison of the prognosis between Epstein-Barr virus (EBV)–positive gastric carcinoma and EBV-negative ones. Canc Lett. 2003, 200: 33-40. 10.1016/S0304-3835(03)00410-5.CrossRef
30.
go back to reference Beghelli S, de Manzoni G, Barbi S, et al.: Microsatellite instability in gastric cancer is associated with better prognosis in only stage II cancers. Surgery. 2006, 139: 347-356. 10.1016/j.surg.2005.08.021.CrossRefPubMed Beghelli S, de Manzoni G, Barbi S, et al.: Microsatellite instability in gastric cancer is associated with better prognosis in only stage II cancers. Surgery. 2006, 139: 347-356. 10.1016/j.surg.2005.08.021.CrossRefPubMed
Metadata
Title
Lymphoepithelioma-like carcinoma of the stomach: a case report and review of the literature
Authors
Zeid Bittar
Falko Fend
Leticia Quintanilla-Martinez
Publication date
01-12-2013
Publisher
BioMed Central
Published in
Diagnostic Pathology / Issue 1/2013
Electronic ISSN: 1746-1596
DOI
https://doi.org/10.1186/1746-1596-8-184

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