Matsunou H, Konishi F, Hori H, Ikeda T, Sasaki K, Hirose Y, Yamamichi N
Department of Pathology, Kanazawa Medical University, Ishikawa-ken, Japan.
Cancer. 1996 May 15;77(10):1998-2004. doi: 10.1002/(SICI)1097-0142(19960515)77:10<1998::AID-CNCR6>3.0.CO;2-D.
Gastric carcinoma with lymphoid stroma (GCLS), known to have a more favorable prognosis than ordinary gastric carcinoma, has been suggested to be closely associated with the Epstein-Barr virus (EBV). However, there are many clinicopathologic problems that remain unsolved.
In 21 patients, 26 GCLS lesions and 4 non-GCLS intramucosal adenocarcinomas that developed synchronously or metachronously with GCLS were examined for EBV involvement by in situ hybridization (ISH) and were analyzed clinicopathologically. In addition, nine patients who had advanced gastric carcinoma with massive liver metastases, who showed good response to chemotherapy and had prolonged survival, were examined for the presence or absence of EBV-associated GCLS.
On ISH with EBV-encoded small RNAs, diffuse hybridization signals were noted in 22 (84.6%) of 26 GCLS. Hybridization signals were also noted in all four non-GCLS adenocarcinomas accompanying GCLS. As a result, hybridization signals were noted in nine of ten cancerous lesions in four cases of synchronous multiple cancers and in all five cancerous lesions in two cases of metachronous multiple cancers. Long term survivors with liver metastases included two patients with EBV-associated GCLS.
Approximately 84.6% of GCLS were related to EBV. EBV-associated GCLS constitutes one-half of the EBV-infected stomach cancers in our institution. The complete response and long term survival after conventional chemotherapy of two patients with Stage IV GCLS suggests that this form of gastric carcinoma may be especially sensitive to this treatment. The identification of EBV-associated synchronous multicentric cancers of both GCLS and non-GCLS type suggests that EBV infection may be an early event in the induction process of these tumors.
具有淋巴样间质的胃癌（GCLS），已知其预后比普通胃癌更有利，有人认为它与爱泼斯坦-巴尔病毒（EBV）密切相关。然而，仍有许多临床病理问题尚未解决。
对21例患者中的26个GCLS病变以及与GCLS同时或异时发生的4个非GCLS黏膜内腺癌进行原位杂交（ISH）检测EBV感染情况，并进行临床病理分析。此外，对9例晚期胃癌伴大量肝转移、对化疗反应良好且生存期延长的患者，检测是否存在EBV相关的GCLS。
在用EBV编码的小RNA进行ISH检测时，26个GCLS中有22个（84.6%）出现弥漫性杂交信号。在所有4个与GCLS相关的非GCLS腺癌中也发现了杂交信号。结果，在4例同时性多原发癌的10个癌灶中有9个出现杂交信号，在2例异时性多原发癌的所有5个癌灶中均出现杂交信号。有肝转移的长期存活者中有2例为EBV相关的GCLS。
约84.6%的GCLS与EBV有关。在我们机构中，EBV相关的GCLS占EBV感染的胃癌的一半。2例IV期GCLS患者经传统化疗后完全缓解且长期存活，提示这种类型的胃癌可能对该治疗特别敏感。GCLS和非GCLS类型的EBV相关同时性多中心癌的鉴定表明，EBV感染可能是这些肿瘤诱导过程中的早期事件。
