Lymphoepithelioma-Like Carcinoma of the Stomach with Epithelioid Granulomas

Abstract

An 83-year-old Japanese man was admitted to our hospital for gastric adenocarcinoma mimicking a submucosal tumor in the gastric body. Considering his general condition, partial resection of the stomach and dissection of regional lymph nodes were performed; a dome-shaped tumor that was largely covered by normal mucosa and having a shallow central stellate ulcer was removed. Histopathologically, the carcinoma cell nests were surrounded by prominent lymphoid stroma. Sarcoid-like epithelioid granulomas were noted both in the tumor stroma and in the regional lymph node with metastasis. Epstein-Barr virus (EBV)-encoded RNA (EBER) in situ hybridization showed an intense and diffuse positive reaction in the carcinoma cells and no reaction in the surrounding gastric and lymphoid tissues. While the presence of lymphoid stroma is a characteristic finding in EBV-associated lymphoepithelioma-like carcinoma, sarcoid-like epithelioid granulomas might be associated with latent EBV infection.

Cytopathologic features and differential diagnostic considerations of primary lymphoepithelioma‐like carcinoma of the lung

“…The presence of EB virus in the aspirated material or smears can be positive in both entities. Outside the nasopharynx, the analogous tumor termed LELC is rare and has been reported in other organs 2–9, 12–17. Hence, a high index of suspicion is required to diagnose LELC and to recognize it as having a pulmonary origin 18.…”

Pathological and computed tomography findings of lymphoepithelioma-like gastric carcinoma with epithelioid granulomas: A case report

“…However, numerous epithelioid granulomas with multinucleated giant cells are extremely rare in the tumor tissue, particularly of LELCs. To the best of our knowledge, only two studies have been published in English concerning epithelioid granulomas occurring in LELC of the stomach (5,6). In the present case, there was no lymph node or distant organ metastasis.…”

“…LELC has a more favorable prognosis than other forms of EBV-associated gastric carcinoma, as well as ordinary gastric carcinomas, although the tumor cells are often of the poorly differentiated type (14,15). The presence of epithelioid granulomas in the stroma with prominent lymphocyte infiltration may represent a host defense reaction against the cancer and is recognized as a favorable prognostic factor with regard to the immune response to the tumor (5). …”

“…The majority of these tumors have been revealed to be associated with Epstein-Barr virus (EBV) infection (4). The development of epithelioid granulomas, named sarcoid-like reactions, is extremely rare in LELCs (5). The mass lesion may be misdiagnosed as a lymphoma, gastrointestinal stromal tumor (GIST) or carcinoid tumor.…”

Variants of Gastric Carcinoma: Morphologic and Theranostic Importance

“…However, a sharp demarcation between the tumor nests and lymphocyte stroma that is composed of variable amounts of lymphocytic infiltration, sometimes with lymphoid follicles, is noted (Regaud type) but no desmoplastic reaction is identified. Rarely, giant cells and epithelioid granulomas are observed within the lymphoid stroma [13,14]. In the early lesion, LELCS shows a "lace pattern", which consists of columnar arrangement and intercolumnar fusion of neoplastic glands between dense lymphocytic infiltration at the intermediate zone of lamina propria [15].…”