title: Epstein-Barr virus-positive multiple early gastric cancers and dysplastic lesions: a case report.
abstract: Epstein-Barr virus (EBV) has been implicated as a causal virus of gastric cancer with episomal monoclonality, elevated antibodies and a unique morphologic expression in the early intramucosal stage, but the infection mechanisms have not been demonstrated. EBV has been shown only in the cancerous lesions by the highly sensitive EBV-encoded small RNA in situ hybridization (EBER-ISH) method, not in the dysplastic mucosa adjacent to the cancer. A case is presented of multiple EBV-positive gastric cancer and dysplastic epithelium observed in a 52-year-old man. Serial cut sections of the gastrectomy specimen showed four small cancerous lesions, three of which were EBER-positive, and three EBER-positive, minute, non-cancerous dysplastic lesions. The three cancerous lesions were intramucosal cancer, with one having minimal submucosal invasion forming a lymphoepithelioma-like histology. All of these EBER-positive cancerous and dysplastic lesions showed intense CD8 T-lymphocytic infiltration. There was no such findings in the EBV-negative cancerous lesion. It was concluded that EBV infection may occur in the epithelial cells of atrophic gastric mucosa, and progress to cancer with monoclonal expansion through the EBV-positive dysplastic change. Cytotoxic T-lymphocytic reactions can occur even in the dysplastic lesions. Multifocal EBV infection in the gastric mucosa may occur and, if necessary, total gastrectomy is recommended in such a case.
authors.affiliation: Department of Pathology, Kagoshima City Hospital, Japan.
authors.forename: J
authors.initials: J
authors.lastname: Arikawa
authors.forename: M
authors.initials: M
authors.lastname: Tokunaga
authors.forename: Y
authors.initials: Y
authors.lastname: Tashiro
authors.forename: S
authors.initials: S
authors.lastname: Tanaka
authors.forename: E
authors.initials: E
authors.lastname: Sato
authors.forename: K
authors.initials: K
authors.lastname: Haraguchi
authors.forename: A
authors.initials: A
authors.lastname: Yamamoto
authors.forename: O
authors.initials: O
authors.lastname: Toyohira
authors.forename: A
authors.initials: A
authors.lastname: Tsuchimochi
mesh_terms: D006566:Herpesviridae Infections / Q000235:genetics* / Q000473:pathology; D004854:Herpesvirus 4, Human / Q000302:isolation & purification*; D006801:Humans; D017403:In Situ Hybridization; D008297:Male; D008875:Middle Aged; D012313:RNA / Q000032:analysis; D013272:Stomach Diseases / Q000473:pathology* / Q000821:virology*; D013274:Stomach Neoplasms / Q000473:pathology / Q000821:virology*; D014412:Tumor Virus Infections / Q000235:genetics* / Q000473:pathology
chemical_list: D012313:RNA