Gastric Carcinoma With Lymphoid Stroma (Gastric Medullary Carcinoma): A Rare Case Report

Yıl 2019, Cilt: 6 Sayı: 2, 105 - 107, 29.08.2019

Sümeyye Ekmekcı , Yelda Dere , Mustafa Değirmenci Bülent Çalık Özgül Sağol , Sulen Sarıoglu

Öz

Gastric carcinoma associated with lymphoid stroma (GCLS), also known as gastric medullary carcinoma is a rare neoplasia of the stomach which is characterized with poorly developed tubular structures admixed within a lymphocyte-rich stroma. Most of the GCLS are found to be associated with Epstein-Barr virus (EBV) infection. Herein we present a case of GCLS in a 76-year-old patient. Gastroscopic examination revealed an ulcerated mass located at the cardia and the biopsy was diagnosed as poorly differentiated adenocarcinoma. After gastrectomy, the microscopic examination revealed an ulcerated tumor limited to the subserosa with pushing borders and dense lymphocytic infiltrate. The tumor diffusely consisted of sheets of pleomorphic tumor cells showing vesicular nuclei. In-situ hybridization analysis of EBV encoded RNA (EBER) was positive lymphoid cells. The disease was staged as T3N0M0. He had no relapse until now and he is under follow-up for 36 months treated with adjuvant systemic treatment.

Anahtar Kelimeler

EBV Related Cancers, Gastric Cancers, Gastric Medullary Carcinoma

GASTRIC CARCINOMA WITH LYMPHOID STROMA (GASTRIC MEDULLARY CARCINOMA): RARE CASE REPORT

Öz

Mide medüller karsinomu olarak da bilinen lenfoid stroma ilişkili mide karsinomu (GCLS), lenfositlerden zengin bir stroma içerisinde kötü düzenlenmiş tübül yapıları ile karakterize midenin nadir görülen bir neoplazisidir. Çoğu GCLS Epstein- Barr virüs (EBV) ile ilişkilidir. Burada 76 yaşında erkek GCLS olgusu sunulmaktadır. Gastroskopik muayenede kardiyada ülsere kitle saptanan olgu, endoskopik biyopsisinden kötü diferansiye adenokarsinom tanısı aldı. Gastrektomi sonrası mikroskobik incelemede subserozal alanda sınırlanmış, lenfositten zengin stromada, solid paternde gelişim göstermiş büyük ve pleomorfik, veziküler nükleuslu hücrelerden oluşan, itici sınırlara sahip tümör izlendi. In-situ hibridizasyonda EBV encoded RNA (EBER) lenfoid hücrelerde pozitifti. Hastalık evre T3N0M0’dı. Hasta sistemik adjuvan tedavi almıştır. 36 aylık takibinde, şu ana kadar nüks saptanmamıştır.

Anahtar Kelimeler

EBV İlişki Kanserler, Gastrik Kanserler, Gastrik Medüller Karsinom

Kaynakça

• 1. Ramos MFKP, Pereira MA, Dias AR, et al. Lymphoepithelioma-like gastric carcinoma: clinicopathological characteristics and infection status. J Surg Res. 2017;210:159-68.
• 2. Gonzalez RS, Cates JMM, Revetta F, McMahon LA, Washington K. Gastric carcinomas with lymphoid stroma: Categorization and comparison with solid-type colonic carcinomas. Am J Clin Pathol. 2017;148(6):477-84.
• 3. Aslan F, Yükrük FA, Buğdaycı BF, Durnalı A. Gastric medullary carcinoma: A rare case report. Case Rep Oncol Med. 2016; 2016:2875471.
• 4. Murphy G, Pfeiffer R, Camargo MC, Rabkin CS. Meta-analysis shows that prevalence of Epstein- Barr virus-positive gastric cancer differs based on sex and anatomic location. Gastroenterology. 2009;137(3): 824-33.
• 5. Ribeiro J, Oliveira A, Malta M, et al. Clinical and pathological characterization of Epstein-Barr virus-associated gastric carcinomas in Portugal. World J Gastroenterol. 2017;23(40):7292-302.
• 6. Bai Y, Gao Q, Ren G, Wang B, Xiang H. Epstein-Barr virus-associated lymphoepithelioma-like gastric carcinoma located on gastric high body: two case reports. Indian J Pathol Microbiol. 2014; 57(3): 436-63.
• 7. Adachi Y, Yasuda K, Inomata M, Sato K, Shiraishi N, Kitano S. Pathology and prognosis of gastric carcinoma: well versus poorly differentiated type. Cancer. 2000;89(7):1418-24.
• 8. Falzarano SM, Mourmouras V, Mastrogiulio MG, La Magra C, Vindigni C. Undifferentiated gastric carcinoma with lymphoid stroma (lymphoepithelioma-like carcinoma / medullary carcinoma). Pathologica. 2009;101(1):15-7.
• 9. Kim JG, Shin S, Park J. Comparison between mononucleotide and dinucleotide marker panels in gastric cancer with loss of hMLH1 or hMSH2 expression. Int J Biol Markers. 2017;32(3):352-6.
• 10. Stewart A. Genetic testing strategies in newly diagnosed endometrial cancer patients aimed at reducing morbidity or mortality from lynch syndrome in the index case or her relatives. PLoS Curr. 2013;5. doi:10.1371/currents.eogt.b59a6e84f27c536e50db4e46aa26309c.
• 11. Hampel H, Frankel WL, Martin E, Arnold M, Khanduja K, Kuebler P et al. Feasibility of screening for Lynch syndrome among patients with colorectal cancer. J Clin Oncol. 2008;26(35):5783-8.
• 12. Cho YJ, Chang MS, Park SH, Kim HS, Kim WH. In situ hybridization of Epstein-Barr virus in tumor cells and tumor-infiltrating lymphocytes of the gastrointestinal tract. Hum Pathol. 2001;32(3):297-301.
• 13. Chetty R. Gastrointestinal cancers accompanied by a dense lymphoid component: an overview with special reference to gastric and colonic medullary and lymphoepithelioma-like carcinomas. J Clin Pathol. 2012;65(12):1062-5.
• 14. Grogg KL, Lohse CM, Pankratz VS, Halling KC, Smyrk TC. Lymphocyte-rich gastric cancer: associations with Epstein-Barr virus, microsatellite instability, histology, and survival. Mod Pathol. 2003;16:641–51.
• 15. Leung SY, Yuen ST, Chung LP, et al. Microsatellite instability, Epstein-Barr virus, mutation of type II transforming growth factor β receptor and BAX in gastric carcinoma in Hong Kong Chinese. Br J Cancer. 1999;79:582–8.
• 16. Chuang CK, Chuang KL, Hsieh CH, Shen YC, Liao SK. Epstein-Barr virus-infected cell line TCC36B derived from B lymphocytes infiltrating renal pelvis urothelial carcinoma. Anticancer Res. 2010;30(9):3473-8.