Medullary carcinoma with lymphocytic infiltration of the stomach. Clinicopathologic study of 27 cases and immunohistochemical analysis of the subpopulations of infiltrating lymphocytes in the tumor

Abstract

The current study attempts to clarify the possible immune response that occurs in medullary carcinoma with lymphocytic infiltration of the stomach by an immunohistochemical analysis of the subpopulations of tumor-infiltrating lymphocytes. This carcinoma was histologically characterized by the sparse population of small nests consisting of poorly differentiated carcinoma cells, widely separated by intervening nondesmoplastic stroma infiltrated uniformly with abundant lymphocytes frequently accompanied by lymph follicles. An immunohistochemical analysis revealed that T-cells were evenly distributed throughout the tumor with intimate contact with individual carcinoma cells, except the lymph follicles consisted mainly of B-cells. Because of the similarities of morphologic features and subpopulations of tumor-infiltrating lymphocytes of this carcinoma to the normal lymphoid tissue, an organized immune response combined with cell-mediated and humoral immunities against the invading carcinoma cells seemed to occur in this type of gastric carcinoma, resulting in a excellent prognosis compared with that in ordinary gastric carcinoma. Cancer 66:945-952.1990. N CARCINOMAS of the stomach and other organs, many I investigations have been conducted to correlate the mode of lymphocytic infiltration in the tumor with the postoperative survival of patients. '-' As for breast carci-noma, it is well known that medullary carcinoma with lymphoid infiltration has a less ominous prognosis. With its close histologic resemblance to and its similar favorable prognosis compared with the medullary carcinoma of breast, a unique type of gastric carcinoma with significant stromal lymphocytic infiltration has been noticed. Several

The contribution of cell phenotype to the behavior of gastric cancer

“…These phenotype-linked prognostic differences confirm and further develop previous results [2,3,7,9,11,13,17,18]. An important new finding of our study is the identification of two different histological subsets, the anaplastic and the lymphocyte-rich HLR subsets, of cancers with poorly expressed phenotype, showing opposite behavior, in keeping with the known ominous prognosis of the anaplastic histotype [23,25] and the relatively favorable behavior of the HLR histotype [19,20,25,26]. Indeed, distinction of these two histological subsets allowed more appropriate appreciation of the prognostic value of poor expression of markers.…”

“…Alternatively, nine prognostically informative subtypes of more recent characterization were considered, such as muconodular (mucinous cancer with expansile growth) [22], well-differentiated tubular [21,25] and diffuse cancer with entrapping desmoplasia [23], which, together with the high CD8-positive lymphocyte response (HLR) cancer [19,20,26], formed the low grade (grade 1) group. Ordinary cohesive, diffuse, and mucinous cancers formed the intermediate grade (grade 2) group, and highly invasive mucinous and anaplastic cancers [23,26] formed the high grade (grade 3) group in a system shown to provide stageindependent prognostic information [25,26].…”

“…In parallel investigations, several histological types and subtypes of prognostic value have been identified [19][20][21][22][23] that showed correlation with number and severity of genomic alterations [24] and permitted the development of a simple grading system, predictive of patient survival [25]. The system proved highly effective for a substantial proportion (about 30 %) of tumors fitting in the low-or high-grade groups, although leaving the intermediate-grade group largely unpredictable [26].…”

Epstein-Barr virus infection serves as an independent predictor of survival in patients with lymphoepithelioma-like gastric carcinoma

“…Some studies have shown that EBV-positive GCs have prognosis comparable to that of their EBV-negative counterparts [15][16][17]. However, other studies have reported significantly better prognosis for EBV-positive GC than for EBV-negative GC [7,8,[18][19][20]. A recent large-scale, multinational, pooled analysis showed that tumor EBV positivity was associated with lower mortality in patients with GC [12].…”

Immune Cell Responses in Gastric Carcinoma

“…2C). The prognosis for typical cases is better than that for conventional gastric cancer cases (Watanabe et al 1976;Minamoto et al 1990). This suggests that the lymphoid stroma may produce an antitumor immune response.…”