Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital & Institute, 52 Fucheng Road, HaiDian District, Beijing, 100142, China.
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Endoscopy, Peking University Cancer Hospital & Institute, Beijing, China.
BMC Gastroenterol. 2022 Jul 16;22(1):346. doi: 10.1186/s12876-022-02417-4.
Adenosquamous carcinoma (ASC)with concurrent gastric carcinoma with lymphoid stroma (GCLS) are extremely rare tumors. There are only limited cases reported in the literature. Epstein-Barr virus (EBV) infection was found in the concomitant GCLS, but none in the ASC. Here, we report the first case of gastric cancer with EBV infection detected in both ASC and GCLS.
A 59-year-old man complained of intermittent upper abdominal pain. The gastric endoscopy revealed a type IIc tumor located in the gastric body near the fundus of the stomach. Histological examination of the gastric tumor showed the coexistence of ASC and GCLS. Both components were positive for EBV-encoded RNA (EBER) in situ hybridization. Neoplastic nests of the former were positive for p63, p40 and CK5/6. The glandular components showed positive acid mucus in the Alcian-blue periodic-acid-schiff (AB-PAS) staining. There was significant difference in the expression of epidermal growth factor receptor (EGFR) between adenocarcinoma and squamous carcinoma, but not in other proteins such as human epidermal growth factor receptor 2 (HER2), p53 and mismatch repair proteins. The role of EGFR signaling pathway needs to be further explored in the differentiation of squamous carcinoma in the gastric ASC. Finally, a diagnosis of early EBV associated gastric ASC with concurrent GCLS (pT1bN1) was made. The patient took a single-drug S1 periodically for half a year after the surgery and has been disease free during 8 months of medical follow-up.
This is the first case of EBV associated gastric ASC with concurrent GCLS, and pathologists and clinicians should recognize and pay attention to this type of tumor.
具有淋巴间质的腺鳞癌（ASC）与同时发生的胃癌伴淋巴间质（GCLS）是极为罕见的肿瘤。文献中仅有限的病例报道。在同时发生的 GCLS 中发现了 Epstein-Barr 病毒（EBV）感染，但在 ASC 中没有发现。在这里，我们报告首例同时在 ASC 和 GCLS 中检测到 EBV 感染的胃癌病例。
一名 59 岁男性间歇性上腹痛。胃镜检查发现胃体近胃底部 IIc 型肿瘤。胃肿瘤的组织学检查显示 ASC 和 GCLS 共存。两种成分均对 EBV 编码的 RNA（EBER）原位杂交呈阳性。前者的肿瘤巢对 p63、p40 和 CK5/6 呈阳性。腺成分在酸性黏液的阿尔辛蓝过碘酸 Schiff（AB-PAS）染色中呈阳性。腺癌和鳞癌之间表皮生长因子受体（EGFR）的表达有显著差异，但在其他蛋白如人表皮生长因子受体 2（HER2）、p53 和错配修复蛋白中没有差异。EGFR 信号通路在胃 ASC 中鳞癌的分化中的作用需要进一步探讨。最后，诊断为早期 EBV 相关的胃 ASC 伴同时发生的 GCLS（pT1bN1）。患者手术后单独使用 S1 药物半年，在 8 个月的随访期间无疾病发生。
这是首例 EBV 相关的胃 ASC 伴同时发生的 GCLS，病理学家和临床医生应认识并关注这种类型的肿瘤。
