title: Epstein-Barr virus-associated lymphoepithelioma-like early gastric carcinomas and endoscopic submucosal dissection: case series.
abstract: Epstein-Barr virus (EBV)-associated lymphoepithelioma-like gastric carcinoma (LELC) is characterized by a lower lymph node (LN) metastasis rate and a higher survival rate than other forms of gastric cancer. Although current prognosis for LELC is favorable, the most common approach is radical gastrectomy involving an extensive D2 lymph node dissection. Here, we report four cases of EBV-associated early LELC that were treated by an alternative approach, endoscopic submucosal dissection (ESD). The long-term outcome of this procedure is discussed. All patients were treated by ESD en bloc, and all ESD specimens showed tumor-free lateral resection margins. None of the lesions showed lymphovascular invasion. A pathological examination of ESD specimens revealed submucosal invasion of more than 500 μm in all four cases. One patient underwent additional radical surgery post-ESD; no residual tumor or LN metastasis was noted in the surgical specimen. The other three patients did not undergo additional surgery, either because of severe comorbidity or their refusal to undergo operation, but were subjected to medical follow-up. None of the ESD-treated patients reported local recurrence or distant metastases during the 27-32 mo of follow-up after ESD.
authors.affiliation: Ji Young Lee, Byung-Hoon Min, Jun Haeng Lee, Poong-Lyul Rhee, Jae Jun Kim, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, South Korea.
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Ji Young Lee, Byung-Hoon Min, Jun Haeng Lee, Poong-Lyul Rhee, Jae Jun Kim, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, South Korea.
authors.forename: Kyoung-Mee
authors.initials: KM
authors.lastname: Kim
authors.affiliation: Ji Young Lee, Byung-Hoon Min, Jun Haeng Lee, Poong-Lyul Rhee, Jae Jun Kim, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, South Korea.
authors.forename: Byung-Hoon
authors.initials: BH
authors.lastname: Min
authors.affiliation: Ji Young Lee, Byung-Hoon Min, Jun Haeng Lee, Poong-Lyul Rhee, Jae Jun Kim, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, South Korea.
authors.forename: Jun Haeng
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Ji Young Lee, Byung-Hoon Min, Jun Haeng Lee, Poong-Lyul Rhee, Jae Jun Kim, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, South Korea.
authors.forename: Poong-Lyul
authors.initials: PL
authors.lastname: Rhee
authors.affiliation: Ji Young Lee, Byung-Hoon Min, Jun Haeng Lee, Poong-Lyul Rhee, Jae Jun Kim, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, South Korea.
authors.forename: Jae Jun
authors.initials: JJ
authors.lastname: Kim
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery* / Q000821:virology; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D004210:Dissection / Q000379:methods*; D020031:Epstein-Barr Virus Infections / Q000150:complications* / Q000175:diagnosis; D005743:Gastrectomy / Q000379:methods*; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery* / Q000821:virology; D013997:Time Factors; D016896:Treatment Outcome
keywords: Endoscopic submucosal dissection; Epstein-Barr virus; Lymph node; Lymphoepithelioma-like gastric carcinoma; Prognosis