Simultaneous EBV-positive lymphoepithelioma-like carcinoma and EBV-negative intestinal-type adenocarcinoma in a patient with Helicobacter pylori-associated chronic gastritis.
We report the case of a 72-year-old man with 2 simultaneous gastric carcinomas. The larger, ulcerated mass in the antrum was a conventional infiltrating intestinal-type adenocarcinoma. The associated antral-type mucosa showed moderate chronic gastritis, foci with complete and incomplete intestinal metaplasia, and mild to moderate Helicobacter pylori infection. The second, smaller tumor was found within fundic-type mucosa and was a lymphoepithelioma-like carcinoma associated with Epstein-Barr virus (EBV) infection shown by the EBV-encoded small RNA (EBER) test. The EBER test result was negative in the intestinal type adenocarcinoma. To our knowledge, this is the first report of simultaneous gastric carcinomas with 2 different morphologic phenotypes, in which only one tumor was associated with EBV infection, while the second tumor was related to H pylori-associated chronic gastritis. Our report demonstrates 2 different but simultaneous etiologic pathways of gastric carcinogenesis in the same patient.
Department of Pathology, Norwegian Radium Hospital, Oslo.
Goran
G
Torlakovic
Dale C
DC
Snover
Emina
E
Torlakovic
D000230:Adenocarcinoma / Q000737:chemistry / Q000556:secondary* / Q000821:virology; D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis; D002294:Carcinoma, Squamous Cell / Q000737:chemistry / Q000556:secondary* / Q000821:virology; D005757:Gastritis, Atrophic / Q000378:metabolism / Q000382:microbiology / Q000473:pathology*; D016481:Helicobacter Infections / Q000150:complications / Q000378:metabolism / Q000473:pathology*; D016480:Helicobacter pylori / Q000302:isolation & purification; D004854:Herpesvirus 4, Human / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D007124:Immunoenzyme Techniques; D008297:Male; D009378:Neoplasms, Multiple Primary; D012367:RNA, Viral / Q000302:isolation & purification; D013274:Stomach Neoplasms / Q000737:chemistry / Q000473:pathology* / Q000821:virology
D014408:Biomarkers, Tumor; C099537:Epstein-Barr virus encoded RNA 1; D012367:RNA, Viral