High prevalence of Epstein-Barr virus in gastric remnant carcinoma after Billroth-II reconstruction.
BACKGROUND
Epstein-Barr virus (EBV) has been detected in about 10% of gastric carcinoma cases worldwide, and a high prevalence of EBV involvement in gastric remnant carcinoma has been reported recently. Details of the background remnant stomach of EBV-positive lesions, however, have not been well clarified.


METHODS
We screened 17 consecutive gastric remnant carcinoma lesions resected surgically. To detect EBV, we used in situ hybridization (ISH) for EBV-encoded small RNA1 (EBER-1) and we compared the clinicopathologic feature between EBV-positive and -negative gastric remnant carcinoma cases.


RESULTS
EBV was detected in 41.8% (7 of 17) of the lesions by EBER-1 ISH. All 7 EBV-positive lesions developed in the anastomotic site had undergone Billroth-II reconstruction excess 20 years previously (mean 26.4 years). Histologically, all EBV-positive lesions were poorly differentiated adenocarcinomas with intense lymphocyte infiltration. In the adjacent mucosa of carcinomas, moderate or marked intestinal metaplasia was found in 85.7% (6 of 7) of EBV-positive lesions and in 40% (4 of 10) of EBV-negative lesions.


CONCLUSIONS
EBV infection is strongly associated with gastric remnant carcinoma. Atrophic change of remnant gastritis in Billroth-II anastomoses is considered to be the carcinogenic background for EBV-positive gastric remnant carcinoma.
Microbiology and Tumorbiology Center, Karolinska Institute, Stockholm, Sweden. Jun.Nishikawa@mtc.ki.se
J
J
Nishikawa
H
H
Yanai
A
A
Hirano
T
T
Okamoto
H
H
Nakamura
K
K
Matsusaki
T
T
Kawano
O
O
Miura
K
K
Okita
D000230:Adenocarcinoma / Q000453:epidemiology / Q000473:pathology / Q000821:virology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020031:Epstein-Barr Virus Infections / Q000453:epidemiology / Q000473:pathology / Q000821:virology*; D005260:Female; D005743:Gastrectomy / Q000379:methods; D005763:Gastroenterostomy; D005773:Gastroscopy; D004854:Herpesvirus 4, Human / Q000302:isolation & purification*; D006801:Humans; D017403:In Situ Hybridization; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D015995:Prevalence; D012367:RNA, Viral / Q000032:analysis; D013274:Stomach Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000821:virology*
D012367:RNA, Viral