Tanaka Yoichi, Tajima Takayuki, Kajiwara Hiroshi, Sugiyama Tomoko, Nakamura Tomoki, Hanashi Tomoko, Chino Osamu, Makuuchi Hiroyasu
Department of Surgery, Tokai University Tokyo Hospital, Tokyo, Japan.
Department of Pathology, Tokai University School of Medicine, Kanagawa, Japan.
J Gastrointest Oncol. 2022 Oct;13(5):2608-2614. doi: 10.21037/jgo-22-469.
Epstein-Barr virus is associated with various malignancies. Epstein-Barr virus-associated gastric carcinoma (EBVaGC) was reported in 1990. While gastric carcinoma with lymphoid stroma (GCLS) is a rare gastric cancer, 80% to 90% of these tumors are associated with Epstein-Barr virus infection.
The patient was a 67-year-old male in 2004, when he underwent laparoscopy-assisted distal gastrectomy with Billroth I reconstruction to treat early stage 0-IIc gastric cancer; the pathological diagnosis was moderately differentiated adenocarcinoma, pT1b, pN0, stage IA with a negative margin. In 2009, endoscopic submucosal dissection (ESD) was performed on reoccurring stage 0-IIc gastric cancer; pathology results identified well-differentiated adenocarcinoma, pT1b, Ly0, V0, pHM0, pVM0. Although further gastric resection was recommended, the patient declined the procedure and opted to receive only follow-up evaluation. During the follow-up period, upper gastrointestinal (GI) endoscopy revealed a protruding mass on the remaining gastric fundus; biopsy indicated a poorly differentiated adenocarcinoma. Approximately 15 years after the initial treatment, the patient underwent total resection of the remnant stomach and Roux-en-Y reconstruction. The histopathological diagnosis was gastric cancer, pT1b, N0, no lymphatic and venous invasion, stage IA with lymphoid stroma and lymphocyte infiltration associated with formation of lymphoid follicles. Immunohistochemistry with EBV-encoded RNA in situ hybridization (EBER-ISH) was positive, resulting in diagnosis of EBVaGC. Retrospective EBER-ISH performed on resected specimens from the 2 prior surgeries yielded similar results. Furthermore, immunohistochemistry using anti-programmed death ligand 1 (PD-L1) antibody demonstrated an increase in the combined positive score (CPS) over time.
This report describes the rare case of a patient who experienced 3 occurrences of EBVaGC at different times and locations over 15 years and discusses the clinical relevance in the context of a literature review. It aims to increase awareness among clinicians and pathologists of the necessity of considering EBVaGC when deciding on the treatment strategy after reoccurrence of gastric cancer.
爱泼斯坦-巴尔病毒与多种恶性肿瘤相关。1990年报道了爱泼斯坦-巴尔病毒相关的胃癌（EBVaGC）。虽然伴有淋巴间质的胃癌（GCLS）是一种罕见的胃癌，但这些肿瘤中有80%至90%与爱泼斯坦-巴尔病毒感染有关。
该患者于2004年为一名67岁男性，当时他接受了腹腔镜辅助远端胃切除术及毕罗I式重建术以治疗早期0-IIc期胃癌；病理诊断为中分化腺癌，pT1b，pN0，IA期，切缘阴性。2009年，对复发性0-IIc期胃癌进行了内镜下黏膜下剥离术（ESD）；病理结果为高分化腺癌，pT1b，Ly0，V0，pHM0，pVM0。尽管建议进一步行胃切除术，但患者拒绝了该手术，选择仅接受随访评估。在随访期间，上消化道（GI）内镜检查发现胃底残余处有一突出肿块；活检显示为低分化腺癌。在初始治疗约15年后，患者接受了残余胃全切除术及Roux-en-Y重建术。组织病理学诊断为胃癌，pT1b，N0，无淋巴和静脉侵犯，IA期，伴有淋巴间质和淋巴细胞浸润并形成淋巴滤泡。采用爱泼斯坦-巴尔病毒编码RNA原位杂交（EBER-ISH）的免疫组织化学检测呈阳性，确诊为EBVaGC。对之前两次手术切除标本进行回顾性EBER-ISH检测也得到了类似结果。此外，使用抗程序性死亡配体1（PD-L1）抗体的免疫组织化学检测显示，联合阳性评分（CPS）随时间增加。
本报告描述了一例罕见病例，该患者在15年内在不同时间和部位发生了3次EBVaGC，并结合文献综述讨论了其临床意义。其目的是提高临床医生和病理学家在决定胃癌复发后治疗策略时考虑EBVaGC的必要性的认识。
