Epstein-Barr virus-positive multiple early gastric cancers and dysplastic lesions: a case report.


Epstein-Barr virus (EBV) has been implicated as a causal virus of gastric cancer with episomal monoclonality, elevated antibodies and a unique morphologic expression in the early intramucosal stage, but the infection mechanisms have not been demonstrated. EBV has been shown only in the cancerous lesions by the highly sensitive EBV-encoded small RNA in situ hybridization (EBER-ISH) method, not in the dysplastic mucosa adjacent to the cancer. A case is presented of multiple EBV-positive gastric cancer and dysplastic epithelium observed in a 52-year-old man. Serial cut sections of the gastrectomy specimen showed four small cancerous lesions, three of which were EBER-positive, and three EBER-positive, minute, non-cancerous dysplastic lesions. The three cancerous lesions were intramucosal cancer, with one having minimal submucosal invasion forming a lymphoepithelioma-like histology. All of these EBER-positive cancerous and dysplastic lesions showed intense CD8 T-lymphocytic infiltration. There was no such findings in the EBV-negative cancerous lesion. It was concluded that EBV infection may occur in the epithelial cells of atrophic gastric mucosa, and progress to cancer with monoclonal expansion through the EBV-positive dysplastic change. Cytotoxic T-lymphocytic reactions can occur even in the dysplastic lesions. Multifocal EBV infection in the gastric mucosa may occur and, if necessary, total gastrectomy is recommended in such a case.


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@article{Arikawa1997EpsteinBarrVM, title={Epstein-Barr virus-positive multiple early gastric cancers and dysplastic lesions: a case report.}, author={Jiro Arikawa and Masayoshi Tokunaga and Yasura Tashiro and Sachiko Tanaka and Eisuke F. Sato and Kazutaka Haraguchi and Akiko Yamamoto and O Toyohira and A. Tsuchimochi}, journal={Pathology international}, year={1997}, volume={47 10}, pages={730-4} }