Lymphoepithelioma-like gastric carcinoma resected by endoscopic submucosal dissection (ESD)

CT findings and clinical features of Epstein-Barr virus-associated lymphoepithelioma-like gastric carcinoma

Epstein-Barr virus (EBV)-associated lymphoepithelioma-like gastric carcinoma (LELGC) is a rare primary stomach tumor, which has overlapping imaging features with mass forming gastric carcinoma (GC). The aim of our study was to present the computed tomography (CT) findings and clinical features of EBV-associated LELGC to increase awareness of this entity.The CT findings and clinical features of 4 patients with pathologically documented EBV-associated LELGC were retrospectively analyzed.Among the 4 patients, 3 were male, and 1 was female. The medium age was 51 years old. All cases were single lesions including 1 was in the gastric cardia, 1 was in the gastric body, and 2 were in the gastric antrum. A focal thickening of the gastric wall was conducted, with a large thickness-to-length ratio. The low-density stripe of the normal gastric wall abruptly terminated at the edge of the lesion. The CT images of 4 cases showed inhomogeneous density with the radiodensity values ranging from 25 to 48 HU. In addition, an ulcer was demonstrated with an irregular base and slightly raised borders in all cases. Enhancement after injection of contrast material was heterogeneous enhancement (n = 3) or homogeneous (n = 1). After enhancement, obvious enhancement was seen in 1 case, moderate enhancement was seen in 3 cases, with the peak value of the tumor in the portal phase. No evidence of lymph node involvement and distant invasion was observed.Although LELGC is quite rare, it should be considered in differential diagnosis of early GC, advanced GC, and lymphoma. The relatively typical CT appearance, combined the age and sex of patients, can suggest the diagnosis of LELGC.

A Single-Center Experience of Endoscopic Resection for Early Gastric Cancer with Lymphoid Stroma

Purpose

This study aimed to evaluate immediate outcomes and clinical courses of patients with early gastric carcinoma with lymphoid stroma (GCLS) who underwent endoscopic resection.

Materials and Methods

We retrospectively reviewed the medical records of 40 patients (mean age, 56.9 years; 90.0% male) who underwent endoscopic resection and were pathologically diagnosed with GCLS confined to the mucosa or to the submucosa between March 1998 and December 2017.

Results

Forty GCLS lesions in 40 patients were treated using endoscopic resection. Only 4 (10%) patients received diagnosis of GCLS before endoscopic resection. Fourteen (35.0%) lesions were intramucosal cancers and 26 (65.0%) exhibited submucosal invasion. En bloc resection (97.5%) was achieved for all lesions except one, with no significant complications. The complete resection rate was 85.0% (34 of 40 lesions). After endoscopic resection, 17 patients were referred for surgery and underwent gastrectomy with lymph node (LN) dissection because of deep submucosal invasion (n=16) and misclassification as undifferentiated cancer (n=1). No LN metastasis was determined in the specimens obtained during surgery. During a mean follow-up period of 49.7 months for 23 patients without surgical treatment, no regional LN enlargements, distant metastases, or gastric cancer-related deaths were found, although 1 metachronous lesion (undifferentiated adenocarcinoma, follow-up duration: 7 months) was observed.

Conclusions

In patients with early GCLS, endoscopic resection is technically feasible and has favorable clinical outcomes. Therefore, endoscopic resection might represent an alternative treatment modality in patients with early GCLS with a low likelihood of LN metastasis.

Epstein-Barr Virus Associated Lymphoepithelioma-like Carcinoma at the Lesser Curvature of the Upper Gastric Body: A Case Report

Lymphoepithelioma-like gastric carcinoma (LELGC) is a rare neoplasm of the stomach with dense lymphocytic infiltration. More than 80% of LELGCs are positive for the Epstein-Barr virus (EBV). Here, we report a 64-year old Chinese man with swallowing discomfort while eating food. Endoscopy and computed tomography both showed a submucosal lesion at the lesser curvature of the upper gastric body. The first diagnostic impression was a gastrointestinal stromal tumour. Subsequently, the patient received a wedge resection of the stomach. On histopathological examination, the tumour was found to consist of small nests of neoplastic cells within dense lymphocytic infiltration. Additionally, most of the neoplastic cells were positive for cytokeratin and Epstein-Barr virus-encoded RNA (EBER). Subsequently, the diagnosis of LELGC was made. We believe that physicians should be aware of the diagnosis of submucosal gastric lesions, particularly in older male patients.

[A case of gastric lymphoepithelioma-like carcinoma presenting as panperitonitis by perforation of stomach]

Gastric lymphoepithelioma-like carcinoma is a rare carcinoma among gastric malignant tumor but has a good prognosis. The carcinoma has histologic feature characterized by small nest of cancer cells mixed with lymphoid stroma. We report a case with lymphoepithelioma-like carcinoma of stomach initially presenting as panperitonitis because of spontaneous tumor perforation. A 56-year-old man visited our emergency room because of epigastric pain. A preoperative abdominal CT scan showed a massive pneumoperitoneum in the upper abdomen, and the presence of gastric cancer in the lesser curvature of the stomach. An emergent laparotomy was performed followed by radical subtotal gastrectomy. Pathologic examination revealed that the tumor was a lymphoepithelioma-like gastric carcinoma.