Synchronous gastric cancer presenting different pathological features depending on the involvement of Epstein-Barr virus infection

摘要

An 81-year-old man presented with anorexia and anemia. Upper gastrointestinal endoscopy revealed a bulky tumor with deep ulcers in the upper gastric body (Fig. 1a) and a protruding lesion in the mid gastric body (Fig. 1b), suggestive of gastrointestinal stromal tumor (GIST) or lymphoma. Histology of biopsy specimens revealed intestinal type adenocarcinoma (Fig. 2a) in the mid body and diffuse type adenocarcinoma (Fig. 2b) in the upper body. Because the endoscopic findings were atypical of gastric cancer, we additionally performed Epstein-Barr virus (EBV)-encoded RNA (EBER-1) in situ hybridization which showed EBER-1 positivity (Fig. 2c) in the upper but not mid body specimens. EBV polymerase chain reaction was 9.0 x 10~6copy/ml_ for the upper body tumor. Serum anti-EBV antibody levels were EBV-EBNA x 320, EBVCA-IgG x 320, and EBVCA-lgM< 10. Contrast-enhanced computed tomography showed multiple masses in the liver and lung suspected to be metastases from the gastric tumor. Diagnosis was stage IV and personal status IV. The patient died 2 months later without treatment.