Gastric Lymphoepithelioma-like Carcinoma: A Singular Case Challenging the Boundaries of Diagnosis and Treatment
DOI:
https://doi.org/10.22516/25007440.1252Keywords:
Epstein-Barr virus infections, gastric cancer, Epstein-Barr virus, microsatellite instability, immunohistochemistryAbstract
Background: Lymphoepithelioma-like carcinoma is a rare presentation of gastric cancer, with an incidence of less than 4%. It has been associated with Epstein-Barr virus (EBV) in approximately 80% of cases. In the remaining cases, microsatellite instability has been documented, with loss of mismatch repair enzyme expression of the hMLH-1 gene in 39% of cases. Chemotherapy is not standardized globally, and surgical management is considered first-line treatment.
Case Report: We report the case of a 41-year-old male who presented with episodes of upper gastrointestinal bleeding, associated with a constitutional syndrome characterized by a 5-kg weight loss over the course of one month. An esophagogastroduodenoscopy revealed a Borrmann type III gastric adenocarcinoma. The patient underwent total gastrectomy, and the histological analysis revealed an infiltrating gastric carcinoma of the lymphoid stroma subtype, also known as lymphoepithelioma-like carcinoma. A notable finding was the reduced lymph node involvement, with only 2 of 25 lymph nodes affected. Immunohistochemistry was positive for CKAE1/AE3 and CAM5. The tumor was ultimately concluded to be a true lymphoepithelioma-like carcinoma, and Epstein-Barr virus positivity was confirmed using the EBER-ISH technique.
Conclusion: Gastric lymphoepithelioma-like carcinoma is a rare entity with distinctive clinical and pathological features. Its strong association with Epstein-Barr virus highlights the need for a comprehensive diagnostic and therapeutic approach. This case underscores the importance of surgical management and immunohistochemical characterization to guide appropriate treatment.
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