Gastric submucosa-invasive carcinoma associated with Epstein-Barr virus and endoscopic submucosal dissection: A case report

doi:10.4251/wjgo.v11.i10.925

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World Journal of Gastrointestinal Oncology

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Case Report

World J Gastrointest Oncol. Oct 15, 2019; 11(10): 925-932
Published online Oct 15, 2019. doi: 10.4251/wjgo.v11.i10.925

Gastric submucosa-invasive carcinoma associated with Epstein-Barr virus and endoscopic submucosal dissection: A case report

Yu Kobayashi, Takehito Kunogi, Hiroki Tanabe, Yuki Murakami, Takuya Iwama, Takahiro Sasaki, Keitaro Takahashi, Katsuyoshi Ando, Yoshiki Nomura, Nobuhiro Ueno, Shin Kashima, Kentaro Moriichi, Mikihiro Fujiya, Toshikatsu Okumura, Division of Gastroenterology and Hematology/Oncology Department of Medicine, Asahikawa Medical University, Asahikawa 078-8510, Japan

Hidehiro Takei, Pathological Department of Asahikawa Medical University Hospital, Asahikawa Medical University, Asahikawa 078-8510, Japan

Author contributions: All authors contributed to this work.

Informed consent statement: All procedures were in accordance with the 1964 Helsinki Declaration and later versions. No identifying information of the patients or human subjects was included in the written descriptions, photographs, or pedigrees. The study participants provided their written informed consent prior to study enrollment.

CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).

Corresponding author: Hiroki Tanabe, MD, PhD, Doctor, Division of Gastroenterology and Hematology/Oncology Department of Medicine, Asahikawa Medical University, 2-1-1-1, Midorigaoka-Higashi, Asahikawa 078-8510, Japan. tant@asahikawa-med.ac.jp

Telephone: +81-166-682462 Fax: +81-166-682469

Received: March 6, 2019
Peer-review started: March 8, 2019
First decision: April 15, 2019
Revised: July 24, 2019
Accepted: August 26, 2019
Article in press: August 26, 2019
Published online: October 15, 2019
Processing time: 226 Days and 0.1 Hours

Abstract

BACKGROUND

Epstein-Barr virus (EBV)-associated carcinoma is a gastric cancer subtype with a morphology characterized by gastric carcinoma with lymphoid stroma (GCLS). Clinicopathological studies have indicated a better prognosis for GCLS than for common gastric carcinomas. Some previous cases of early gastric cancer associated with EBV had been diagnosed by endoscopic resection.

CASE SUMMARY

We present two GCLS cases subjected to endoscopic submucosal dissection (ESD) for a definitive diagnosis. A protruded gastric lesion was identified by routine endoscopic examination, but forceps biopsy showed no atypical cells before ESD. The resected specimen showed a poorly differentiated adenocarcinoma with lymphoid cells involving the mucosa and submucosa. The final diagnosis was submucosa-invasive poorly differentiated gastric adenocarcinoma. Accordingly, additional gastrectomy was recommended to obtain a complete cure. One patient underwent additional distal gastrectomy with lymph node dissection, but the other was refused because of cardiovascular complications. Both patients remained in remission for more than half a year. EBV positivity was determined by EBV-encoded RNA in situ hybridization. We also conducted a literature review of cases of early gastric cancer associated with EBV that had been diagnosed by ESD.

CONCLUSION

Submucosa-invasive GCLS could be dissected using ESD, and EBV positivity should be subsequently assessed to determine whether or not any additional curative surgery is required. Further prospective investigations on the prevalence of lymph node metastasis in EBV-associated carcinoma should be performed to expand the indications for endoscopic resection.

Keywords: Herpesvirus 4; Human; Stomach neoplasms; Gastric carcinoma with lymphoid stroma; Epstein-Barr virus-associated gastric carcinoma; Case report

Core tip: Two cases of Epstein-Barr virus (EBV)-associated gastric carcinoma were diagnosed by endoscopic submucosal dissection (ESD). Because of its low frequency of lymph node metastasis, EBV-associated carcinoma can be treated with ESD without additional surgery.