Kato Minoru, Hayashi Yoshito, Fukumoto Kenji, Nagai Kengo, Tsujii Yoshiki, Shinzaki Shinichiro, Iijima Hideki, Takehara Tetsuo
Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka Suita, Osaka, 565-0871, Japan.
Clin J Gastroenterol. 2018 Oct;11(5):382-385. doi: 10.1007/s12328-018-0855-3. Epub 2018 Apr 10.
A 53-year-old man underwent an esophagogastroduodenoscopy that showed a 20-mm subepithelial lesion in the middle gastric body. Endoscopic ultrasound revealed a hypoechoic mass located in the submucosa. Biopsy specimens revealed a benign gastric mucosa with severe lymphocytic infiltration in the submucosa. Malignant lymphoma or gastric cancer with lymphoid stroma was suspected. We performed endoscopic submucosal dissection for definitive diagnosis. Histological examination showed undifferentiated adenocarcinoma, which showed positive Epstein-Barr virus-encoded RNA in situ hybridization results, invading the submucosa mixed with dense lymphocytic infiltration. Thus, Epstein-Barr virus-positive gastric cancer with lymphoid stroma was diagnosed. Gastric cancer with lymphoid stroma is a rare subtype of gastric cancer, which is associated with Epstein-Barr virus infection; it sometimes appears as a subepithelial lesion, which makes it difficult to diagnose using standard biopsy. Endoscopic submucosal dissection was useful in obtaining a sufficient tissue for full histological assessment, including immunostaining.
一名53岁男性接受了食管胃十二指肠镜检查，结果显示胃体中部有一个20毫米的上皮下病变。内镜超声显示一个位于黏膜下层的低回声肿块。活检标本显示为良性胃黏膜，黏膜下层有严重的淋巴细胞浸润。怀疑为恶性淋巴瘤或伴有淋巴样间质的胃癌。我们进行了内镜黏膜下剥离术以明确诊断。组织学检查显示为未分化腺癌，原位杂交结果显示爱泼斯坦-巴尔病毒编码RNA呈阳性，肿瘤侵犯黏膜下层并伴有密集的淋巴细胞浸润。因此，诊断为爱泼斯坦-巴尔病毒阳性的伴有淋巴样间质的胃癌。伴有淋巴样间质的胃癌是胃癌的一种罕见亚型，与爱泼斯坦-巴尔病毒感染有关；它有时表现为上皮下病变，这使得使用标准活检难以诊断。内镜黏膜下剥离术有助于获取足够的组织进行全面的组织学评估，包括免疫染色。
