Clinical and pathological characterization of Epstein-Barr virus-associated gastric carcinomas in Portugal

Ribeiro, Joana; Oliveira, Andreia M. R.; Malta, Mariana; Oliveira, Cláudia; Silva, Fernanda; Galaghar, Ana; Afonso, Luís Pedro; Neves, Manuel; Medeiros, Rui; Pimentel‐Nunes, Pedro; Sousa, Hugo

doi:10.3748/wjg.v23.i40.7292

Cited by 36 publications

(23 citation statements)

References 45 publications

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“…It has been well recognized that the occurrence of GCLS is associated with EBV in most cases. Although only limited cases of ASC associated with EBV have been reported (5), the SCC components of the two previously reported cases and the present case were not associated with EBV infection. Therefore, additional studies are needed to clarify the clinicopathological features and pathogenesis of gastric ASC, including the association with GCLS.…”

Section: Discussioncontrasting

confidence: 41%

Simultaneous gastric adenosquamous carcinoma and gastric carcinoma with lymphoid stroma: A case report

et al. 2019

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Primary gastric adenosquamous carcinoma (ASC) is a rare tumor, and gastric carcinoma with lymphoid stroma (GCLS) is a distinct and relatively rare tumor, which is characterized histopathologically by prominent lymphoid infiltration and is commonly associated with Epstein-Barr virus (EBV) infection. The association between ASC and GCLS has been poorly understood, and only two cases of concomitant occurrence of ASC and GCLS have been reported previously. In this report, we describe the first documented case of simultaneous gastric ASC and GCLS. A 58-year-old Japanese male complained of loss of appetite. Gastric endoscopic examination revealed a type 3 tumor in the antrum. Distal gastrectomy with lymph node dissection was performed after neoadjuvant chemotherapy. Macroscopic examination of the resected specimen revealed two discontinuous lesions in the antrum. The first lesion, an ASC, was detected preoperatively by endoscopic examination. This type 3 tumor was composed of a mixture of squamous cell carcinoma (~75% of the tumor) and poorly-to-moderately differentiated adenocarcinoma (~25%). No EBV-encoded RNA (EBER)-positive neoplastic cells were noted. The tumor had invaded into the serosa. The second lesion was a GCLS, which was not preoperatively detected by endoscopic examination. The neoplastic cells of the GCLS were EBER-positive. The tumor had invaded into the muscularis propria. Accordingly, a diagnosis of simultaneous gastric ASC (pT4a) and GCLS (pT2) was made. The pathogenesis of gastric ASC has been under debate. Only limited cases of ASC associated with EBV have been reported. Notably, EBV has not been associated with the development of an ASC component in the previously reported concomitant cases of ASC and GCLS, as well as in the present case study. Therefore, additional studies are required to clarify the pathogenesis of gastric ASC, including its association with EBV.

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Section: Discussioncontrasting

confidence: 41%

Simultaneous gastric adenosquamous carcinoma and gastric carcinoma with lymphoid stroma: A case report

et al. 2019

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“…[7,16] Several studies in Asia, Europe, and America reveal the prevalence close to 9% for EBV-associated early and advanced gastric carcinomas. [16,[19][20][21] In our present study, the frequency of EBV infection in gastric carcinoma with lymphoid stroma (72.7%, 8/11) is in agreement with that of previous studies. [5-7, 10, 22] The prevalence of EBV infection in conventional early gastric carcinoma in our study (1.8%, 2/109) was lower than that previously reported.…”

Section: Prognosissupporting

confidence: 93%

“…[5-7, 10, 22] The prevalence of EBV infection in conventional early gastric carcinoma in our study (1.8%, 2/109) was lower than that previously reported. [20] The discrepancy may be related to the exclusion of gastric stump carcinoma and synchronous gastric carcinoma in our cohort, because up to 35% gastric stump carcinomas showed EBV infection and EBV-associated gastric carcinoma often have multiple synchronous gastric carcinomas. [19,23,24] As illustrated in the present study, EBV-GCLS demonstrated histopathologic patterns characterized by a pushing tumor invasion front, dense intra-tumoral lymphocytic in ltration, poor tumor cell differentiation, high nuclear grade, and sheet, cluster, or nest growth patterns, as described previously.…”

Section: Prognosismentioning

confidence: 74%

Very Low Risk of Lymph Node Metastasis in Epstein-Barr Virus-associated Early Gastric Carcinoma With Lymphoid Stroma

Cheng

Zhou

et al. 2020

Preprint

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Epstein-Barr virus-associated early gastric carcinoma with lymphoid stroma (EBV-GCLS) is a rare variant of early gastric carcinomas. Clinicopathological features of this variant remain obscure, especially in Chinese patients. By a retrospective review of 595 consecutive radical gastrectomies for early gastric carcinoma from 2006 to 2018, we identified 8 (1.3%, 8/595) EBV-GCLS cases. Clinicopathologic characteristics were compared between EBV-GCLSs and 109 conventional early gastric carcinomas, which were divided into 3 subgroups, according to the invasion depth. All 8 EBV-GCLSs occurred in male patients and invaded deep submucosa (SM2) without lymph node metastasis (LNM), four (50%) of which had synchronous non-gastric malignant tumors (3 gastric gastrointestinal stromal tumors and 1 primary clear cell renal cell carcinoma), and four (50%) arose in the proximal stomach. Compared to conventional early gastric carcinomas, EBV-GCLS was more frequent with SM2 invasion, poor differentiation, and synchronous non-gastric carcinoma tumor, but not in age, gender, macroscopic type, location, size, perineural invasion, lymphovascular invasion, and pathologic stage. In invasion-depth stratified comparisons with the SM2 subgroup, the frequency of LNM in EBV-GCLS was significantly lower than that of conventional early gastric carcinomas ( p < 0.05) and the 5-year survival rate of patients with EBV-GCLS was better than that of conventional early gastric carcinomas in 3 subgroups (100% vs 91.5%, 85.7%, 83.9%, respectively), although the differences did not reach a statistically significant level due to the small sample size. In conclusion, Even with poor differentiation and SM2 invasion, EBV-GCLS showed very low risk of LNM and may be a candidate for endoscopic therapy.

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“…The gold standard technique for the detection of EBV in tissues is ISH with EBV EBERs (EBER-ISH) due to its high sensitivity and specificity to determine the precise intranuclear localization of the EBVinfected cells. The diagnosis of EBV-associated gastric cancer is confirmed by the presence of EBER within the tumor cells and its absence in the normal tissue adjacent to the tumor [3]. Many studies have reported the higher prevalence of EBV among gastric cancer patients by PCR assay than EBER-ISH technique [83].…”

Section: Discussionmentioning

confidence: 99%

Association between Epstein-Barr Virus Infection and Gastric Cancer: A Systematic Review and Meta-analysis

Tavakoli

Monavari

Mohammadi

et al. 2020

Preprint

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Background: Numerous studies conducted over the past 30 years have pointed to the presence of Epstein–Barr virus (EBV) in gastric cancer samples. This study was aimed to provide a meta-analytic review of the prevalence of EBV in gastric cancer patients, and to clarify the relationship between EBV infection and gastric cancer. Methods: A literature search was performed electronically using online databases for English language publications until July 1, 2019. The pooled EBV prevalence and 95% confidence intervals (CIs) were estimated using a random effects model. To determine the association between EBV and gastric cancer, pooled odds ratio (OR) and its 95% CI were computed for case-control studies with matched pairs design. Results: The pooled prevalence of EBV in 20411 gastric cancer patients was 8.78% (95% CI: 7.75-9.93%; I 2 =83.0%). The proportion of EBV-associated gastric cancer among male cases was significantly higher than among female cases (10.85%, vs 5.72%) ( P <0.01). EBV was more prevalent in the cardia (12.47%) and in the body (11.68%) compared to the antrum (6.29%) ( P <0.01). There were 20 studies with matched pairs design, including tumor and tumor-adjacent normal tissue pairs from 4116 gastric cancer patients. The pooled OR between EBV infection and gastric cancer risk was 18.56 (95% CI: 15.68–21.97; I 2 = 55.4%). Conclusion: EBV infection is associated with more than 18 times increase risk of gastric cancer. Although the prevalence of EBV was higher in male patients than in female patients with gastric cancer, women are more likely than men to develop EBV-associated gastric cancer.

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Clinical and pathological characterization of Epstein-Barr virus-associated gastric carcinomas in Portugal

Cited by 36 publications

References 45 publications

Simultaneous gastric adenosquamous carcinoma and gastric carcinoma with lymphoid stroma: A case report

Simultaneous gastric adenosquamous carcinoma and gastric carcinoma with lymphoid stroma: A case report

Very Low Risk of Lymph Node Metastasis in Epstein-Barr Virus-associated Early Gastric Carcinoma With Lymphoid Stroma

Association between Epstein-Barr Virus Infection and Gastric Cancer: A Systematic Review and Meta-analysis

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