Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Gastric Lymphoepithelioma-like Carcinoma Diagnosed and Treated by Endoscopic Submucosal Dissection: Review of the Literature

내시경 점막하 박리술을 통해 진단, 치료한 위 림프상피종양 암종 1예

Cho, Jun-Ho;Lee, Wan-Sik;Lee, Kyoung-Rok;Jeong, Hye-Kyong;Cho, Sung-Bum;Joo, Young-Eun;Choi, Sung-Kyu;Rew, Jong-Sun
조준호;이완식;이경록;정혜경;조성범;주영은;최성규;류종선

  • Published : 20100400
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Abstract

Gastric lymphoepithelioma-like carcinoma (LELC) is a rare neoplasm of the stomach that features undifferentiated carcinoma mixed with lymphoid stroma, and it invariably has a good prognosis. Most gastric LELCs have been linked to Epstein-Barr virus (EBV) infection. We experienced a case of a patient with gastric LELC. A 57 years old female patient was found to have shallow irregular ulcerative lesion on the gastric antrum. Although repetitive endoscopic biopsy didn't yield any cancer, early gastric cancer (EGC) was strongly suspected. Endoscopic submucosal dissection (ESD) was performed for establishing the correct diagnosis and curatively resecting the lesion. The pathology revealed gastric LELC with vertical invasion to the submucosa. No remnant cancer and no lymph node metastasis were noted after surgery following ESD. Here, we are reporting on a case of gastric ELEC along with reviewing the relevant literature. We believe this is the first case of gastric ELEC that was successfully diagnosed and managed by ESD.

위의 림프상피종양 암종은 위암의 드문 형태로 림프 모양 조직 배경에 미분화된 악성 종양 세포가 침윤하는 특징을 보인다. 흔히 보이는 위샘암에 비해 예후가 비교적 좋고 Epstein- Barr 바이러스 감염과 높은 연관성을 보인다. 저자들은 57세 여자 환자에서 육안적으로 궤양형 조기위암 형태를 보이나 반복적인 생검에서는 음성이었던 환자에서 진단과 근치적 절제를 목적으로 내시경 점막하 박리술을 시행하여 위 림프상피종양 암종을 확진한 1예를 경험하였기에 문헌 고찰과 함께 보고한다.

Keywords

References

  1. Sashiyama H, Nozawa A, Kimura M, et al. Case report: a case of lymphoepithelioma-like carcinoma of the oesophagus and review of the literature. J Gastroenterol Hepatol 1999;14:534-539 https://doi.org/10.1046/j.1440-1746.1999.01911.x
  2. Watanabe H, Enjoji M, Imai T. Gastric carcinoma with lymphoid stroma. Cancer 1976;38:232-243 https://doi.org/10.1002/1097-0142(197607)38:1<232::AID-CNCR2820380135>3.0.CO;2-4
  3. MacCarty WC, Mahle AE. Relation of differentiation and lymphocytic infiltration to postoperative longevity in gastric carcinoma. J Lab Clin Med 1922;6:473-480
  4. Shibata D, Tokunaga M, Uemura Y, Sato E, Tanaka S, Weiss LM. Association of Epstein-Barr virus with undifferentiated gastric carcinomas with intense lymphoid infiltration. Lymphoepithelioma-like carcinoma. Am J Pathol 1991;139:469-474
  5. Chan JK, Hui PK, Tsang WY, et al. Primary lymphoepithelioma-like carcinoma of the lung. A clinicopathologic study of 11 cases. Cancer 1995;76:413-422 https://doi.org/10.1002/1097-0142(19950801)76:3<413::AID-CNCR2820760311>3.0.CO;2-X
  6. Chan JK, Yip TT, Tsang WY, Poon YF, Wong CS, Ma VW. Specific association of Epstein-Barr virus with lymphoepithelial carcinoma among tumors and tumorlike lesions of the salivary gland. Arch Pathol Lab Med 1994;118:994-997
  7. Park WI, Kim HW, Park JH, et al. A case of gastric lymphoepithelioma-like carcinoma presenting as a submucosal tumor. Korean J Gastrointest Endosc 2004;28:123-126
  8. Matsunou H, Konishi F, Hori H, et al. Characteristics of Epstein-Barr virus-associated gatric carcinoma with lymphoid stroma in Japan. Cancer 1996;77:1998-2004 https://doi.org/10.1002/(SICI)1097-0142(19960515)77:10<1998::AID-CNCR6>3.0.CO;2-D
  9. Tokunaga M, Land CE, Uemura Y, Tokudome T, Tanaka S, Sato E. Epstein-Barr virus in gastric carninoma. Am J Pathol 1993;143:1250-1254
  10. Nakamura S, Ukei T, Yao T, Ueyama T, Tsuneyoshi M. Epstein-Barr virus in gastric carcinoma with lymphoid stroma. Special reference to its detection by the polymerase chain reaction and in situ hybridization in 99 tumors, including a morphologic analysis. Cancer 1994;73:2239-2249 https://doi.org/10.1002/1097-0142(19940501)73:9<2239::AID-CNCR2820730902>3.0.CO;2-#
  11. Chang MS, Kim WH, Kim CW, Kim YI. Epstein-Barr virus-associated gastric carcinomas with lymphoid stroma. Histopathology 2000;37:309-315 https://doi.org/10.1046/j.1365-2559.2000.01014.x
  12. Burke AP, Yen TS, Shekitka KM, Sobin LH. Lymphoepithelial carcinoma of the stomach with Epstein-Barr virus demonstrated by polymerase chain reaction. Mod Pathol 1990;3:377-380
  13. Kume T, Oshima K, Yamashita Y, Shirakusa T, Kikuchi M. Relationship between Fas-ligand expression on carcinoma cell and cytotoxic T-lymphocyte response in lymphoepithelioma-like cancer of the stomach. Int J Cancer 1999;84:339-343 https://doi.org/10.1002/(SICI)1097-0215(19990820)84:4<339::AID-IJC1>3.0.CO;2-2
  14. Hsu DH, de Waal Malefyt R, Fiorentino DF, et al. Expression of interleukin-10 activity by Epstein-Barr virus protein BCRF1. Science 1990;250:830-832 https://doi.org/10.1126/science.2173142
  15. Harn HJ, Chang JY, Wang MW. Epstein-Barr virus associated gastric adenocarcinoma in Taiwan. Hum Pathol 1995;26:267-271 https://doi.org/10.1016/0046-8177(95)90056-X
  16. Osato T, Imai S. Epstein-Barr virus and gastric carcinoma. Semin Cancer Biol 1996;7:175-182 https://doi.org/10.1006/scbi.1996.0024
  17. Galetsky SA, Tsvetnov VV, Land CE, et al. Epstein-Barr virus associated gastric cancer in Russia. Int J Cancer 1997;73:786-789 https://doi.org/10.1002/(SICI)1097-0215(19971210)73:6<786::AID-IJC2>3.0.CO;2-Z
  18. Szaloki T, Toth V, Nemeth I, Tiszlavicz L, Lonovics J, Czako L. Endoscopic mucosal resection: Not only therapeutic, but a diagnostic procedure for sessile gastric polyps. J Gastroenterol Hepatol 2008;23:551-555 https://doi.org/10.1111/j.1440-1746.2007.05247.x
  19. Cho JY, Cho WY. The current status of endoscopic submucosal dissection. Korean J Gastrointest Endosc 2008;37:317-320
  20. Li C, Kim S, Lai JF, et al. Risk factors for lymph node metastasis in undifferentiated early gastric cancer. Ann Surg Oncol 2008;15:764-769 https://doi.org/10.1245/s10434-007-9707-y