CASE REPORT
A Case of Medullary Carcinoma with Lymphoid Stroma of the Stomach Showing 2 Tumors Which were Connected with Intraepithelial Spread
Motoo Shinohara1), Munetaka Mori1), Akihiro Mimuro1), Michiaki Yagyu1), Nobuaki Sakamoto1), Hidenori Tomioka1), Yoshiro Ebihara2), Akihiko Tsuchida3), Tatsuya Aoki3) and Hideaki Ishii4)
Department of Surgery1) and Pathology2), Toda-Chuo General Hospital
Department of Surgery3) and Pathology4), Tokyo Medical University
A 60-year-old man medicated for a gastric ulcer and admitted due to an abnormality seen in gastroendoscopic examination was found in endoscopic and radiographic examination of the stomach to have 2 elevated adjacent lesions, on the lesser curvature of the gastric body. The proximal lesion was covered partially with normal epithelium having a linear depression in the center with gradual marginal elevation. The distal lesion had a deep circular depression in the center of the lesion with round marginal elevation resembling a small Borrmann type 2 tumor. The epithelium between the 2 lesions, which seemed separate appeared normal under a diagnosis of early gastric cancer, we conducted proximal gastrectomy. Histopathologically, both tumors were poorly differentiated adenocarcinoma, with severe lymphocytic infiltration and lymphoid follicles. The 2 tumors were connected with intraepithelial spread. Epstein-Barr virus encoded RNA (EBER-1) was detected in both tumor cells by in situ hybridization. This suggests that Epstein-Barr virus infection is related to carcinogenesis.
Key words
gastric cancer, medullary carcinoma with lymphoid stroma, Epstein-Barr virus
Jpn J Gastroenterol Surg 37: 1823-1828, 2004
Reprint requests
Motoo Shinohara Department of Surgery, Toda-Chuo General Hospital
1-19-3 Honcho, Toda-shi, 335-0023 JAPAN
Accepted
June 30, 2004
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