title: Epstein-barr virus-related gastric adenocarcinoma: an early secondary cancer post hemopoietic stem cell transplantation.
abstract: OBJECTIVE
  Epstein-Barr virus (EBV) infection has been associated with some cases of gastric cancer.
  
  
  METHODS
  We studied a case of early onset gastric adenocarcinoma after nonmyeloablative hematopoietic stem cell transplantation for myeloma in a 56-year-old man.
  
  
  RESULTS
  The development of gastric adenocarcinoma was preceded by severe graft-versus-host disease (GVHD) necessitating strong immunosuppression, which resulted in an intense reactivation of EBV infection. Three sequential gastric biopsy examinations performed at 100, 130, and 150 days after hematopoietic stem cell transplantation showed gastritis, dysplasia, and adenocarcinoma, respectively. There was no evidence of Helicobacter pylori infection. Quantitative polymerase chain reaction for circulating EBV showed a surge of EBV DNA peaking at the time of gastritis, followed by a gradual decrease afterward with adequate control of GVHD and tailing of immunosuppression. In situ hybridization for EBV-encoded early small RNA showed absence of EBV in the gastritis specimen, but the presence of EBV in the dysplastic and carcinoma specimens. Aberrant promoter methylation of E-cadherin was observed only in the carcinoma specimens, showing that infection with EBV preceded E-cadherin methylation.
  
  
  CONCLUSIONS
  Mucosal damage caused by GVHD, immunosuppression, and EBV reactivation combined to lead to EBV infection of the gastric cells and initiation of carcinogenesis, suggesting this case to be a genuine EBV-related opportunistic malignancy post-transplantation. An interesting proposition is that this case also might reflect a compacted timeline of events in EBV-related gastric cancers developing in immunocompetent patients.
authors.affiliation: Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
authors.forename: Wing-Yan
authors.initials: WY
authors.lastname: Au
authors.forename: Annie
authors.initials: A
authors.lastname: Pang
authors.forename: Eunice C
authors.initials: EC
authors.lastname: Chan
authors.forename: Kent-Man
authors.initials: KM
authors.lastname: Chu
authors.forename: Tony W H
authors.initials: TW
authors.lastname: Shek
authors.forename: Yok-Lam
authors.initials: YL
authors.lastname: Kwong
mesh_terms: D000230:Adenocarcinoma / Q000209:etiology* / Q000473:pathology; D001706:Biopsy; D015820:Cadherins / Q000378:metabolism; D020031:Epstein-Barr Virus Infections / Q000209:etiology* / Q000473:pathology; D006086:Graft vs Host Disease / Q000150:complications / Q000473:pathology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D004854:Herpesvirus 4, Human / Q000235:genetics / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000628:therapy; D016609:Neoplasms, Second Primary; D013274:Stomach Neoplasms / Q000209:etiology* / Q000473:pathology
chemical_list: D015820:Cadherins