Gastric carcinoma with lymphoid stroma: association with Epstein virus genome demonstrated by PCR (original) (raw)
Related papers
Carcinomas with Lymphoid Stroma within the Gastrointestinal Tract: Histology and Molecular Pathology
2015
Carcinomas with lymphoid stroma represent a distinct morphological subtype of gastrointestinal cancer. They occur most often in the stomach or in the colon. On the morphological level, they may be separated into medullary and lymphoepithelioma-like cancers. The former are characterized by predominantly syncytial growth and dense lymphocytic infiltration that prevails at the tumour periphery. Lymphoepithelioma-like cancers are made up of small clusters and aggregates of tumour that are broken up by large numbers of intratumoural lymphocytes. Differential diagnosis may be challenging and often requires immunohistochemistry. Several markers are often necessary to separate medullary colon carcinoma from poorly differentiated non-medullary carcinoma, as the immunophenotypes are overlapping. Diagnosis of gastrointestinal carcinoma with lymphoid stroma should always prompt further investigations, aiming at the detection of EBV infection and MSI-H. The majority of carcinomas with lymphoid s...
Features of Gastric Carcinoma with Lymphoid Stroma Associate with Epstein-Barr Virus
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2015
BACKGROUND & AIMS: Gastric carcinoma with lymphoid stroma (GCLS) is a distinct histologic subtype of gastric cancer that is characterized by undifferentiated carcinoma mixed with prominent lymphoid infiltration. More than 80% of GCLS cases are associated with Epstein-Barr virus (EBV) infection, but it is unclear if the virus affects disease progression. We investigated how EBV infection affects the clinical and pathologic features of GCLS, as well as patients' outcomes. METHODS: We performed a retrospective analysis of 274 patients (mean age, 56.8 y; 85.4% male) diagnosed with GCLS, based on pathology findings, from March 1998 through December 2012 at the Asan Medical Center in Seoul, South Korea. Their data were compared with those from 822 ageand sex-matched patients who underwent resection for gastric adenocarcinoma. EBV was detected in tumor samples by in situ hybridization. RESULTS: Of the 274 patients with GCLS, 236 had EBV-positive tumors (86.1%) and 38 had EBV-negative tumors (13.9%). EBV-positive GCLS was more prevalent than EBV-negative GCLS in younger patients, tended to be located proximally, and was more frequently of an early stage macroscopic type. The 10-year, disease-specific rates of survival were 89.1% for patients with EBV-positive GCLS and 66.9% for patients with EBV-negative GCLS (P [ .009). Patients with EBV-negative GCLS had clinical and pathologic features and survival times similar to those of patients with conventional adenocarcinoma. By multivariate analysis, longer survival time was associated with EBV-positive tumors (P [ .007), younger patient age (P [ .002), smaller tumor size (P [ .046), lower stage (based on American Joint Committee on Cancer classification; P < .001), and lack of lymphovascular invasion (P [ .012). The proportion of undifferentiated tumor cells was not associated significantly with patient survival time. CONCLUSIONS: Clinical and pathologic features of GCLS differ based on EBV infection status. EBV-negative GCLS is similar to conventional adenocarcinoma, and patients have similar survival times. EBV status may be more important than the proportion of undifferentiated tumor cells in the diagnosis of GCLS and management of patients.
Journal of B.U.ON. : official journal of the Balkan Union of Oncology
Undifferentiated gastric carcinoma with intense lymphoid stroma has a close resemblance to nasopharyngeal lymphoepithelioma and is classified as "lymphoepithelioma- like carcinoma" (LELC). Carcinomas with morphologic features that are identical to those of nasopharyngeal lymphoepithelioma are seen in organs derived from the foregut and are designated as LELC. Most common anatomic sites are the stomach, salivary glands, lung and thymus.
Gastric Carcinoma With Lymphoid Stroma (Gastric Medullary Carcinoma): A Rare Case Report
2019
Mide meduller karsinomu olarak da bilinen lenfoid stroma iliskili mide karsinomu (GCLS), lenfositlerden zengin bir stroma icerisinde kotu duzenlenmis tubul yapilari ile karakterize midenin nadir gorulen bir neoplazisidir. Cogu GCLS Epstein- Barr virus (EBV) ile iliskilidir. Burada 76 yasinda erkek GCLS olgusu sunulmaktadir. Gastroskopik muayenede kardiyada ulsere kitle saptanan olgu, endoskopik biyopsisinden kotu diferansiye adenokarsinom tanisi aldi. Gastrektomi sonrasi mikroskobik incelemede subserozal alanda sinirlanmis, lenfositten zengin stromada, solid paternde gelisim gostermis buyuk ve pleomorfik, vezikuler nukleuslu hucrelerden olusan, itici sinirlara sahip tumor izlendi. In-situ hibridizasyonda EBV encoded RNA (EBER) lenfoid hucrelerde pozitifti. Hastalik evre T3N0M0’di. Hasta sistemik adjuvan tedavi almistir. 36 aylik takibinde, su ana kadar nuks saptanmamistir.
Epitheliotropism in high-grade lymphomas of mucosa-associated lymphoid tissue
Histopathology, 1993
Epitheliotropism in high-grade lymphomas of mucosa-associated lymphoid tissue Low-grade lymphomas of mucosa-associated lymphoid tissue (MALT) characteristically show centrocyte-like cells, plasmacytic differentiation, follicular colonization and lymphoepithelial lesions (epitheliotropism). High-grade lymphomas of MALT are thought to lack these features and can only be identified as MALT lymphomas with confidence if they are admixed with residual low-grade tumours. We studied 23 cases of MALT lymphoma of the thyroid. Six were predominantly low-grade, 12 were predominantly high-grade, and five contained both low-and high-grade areas. All cases were stained for cytokeratin, epithelial membrane antigen and laminin using an immunoperoxidase technique. The low-grade lymphomas all contained lymphoepithelial lesions, generally in the form of clusters of intra-acinar centrocyte-like cells. Eleven of the 12 high-grade MALT lymphomas of the thyroid also showed lymphoepithelial lesions. These appeared in three forms: follicles or clusters of epithelial cells infiltrated by groups of centrocyte-like cells, intra-acinar clusters of blast cells, or irregular invasion of islands of epithelial cells by blast cells, The first pattern presumably represented residual low-grade tumour overrun by high-grade lymphoma. The second two patterns indicated that the factors that result in epitheliotropism in low-grade MALT lymphomas are also present in high-grade tumours. Following this study we identified epitheliotropism in single examples of highgrade MALT lymphomas of the bronchus and small intestine. Previous failure to recognize epitheliotropism in highgrade MALT lymphomas of the gastrointestinal tract may be due to loss of the affected epithelium. The localization and relatively good prognosis of high-grade MALT lymphomas may be related to retention of MALT characteristics including epitheliotropism.
journal of medical science and clinical research, 2017
Context: Diagnosis of lymphoma constitutes a difficult task in context to subtyping. Accurate diagnosis is essential because the treatment options, responses to therapy and prognosis vary widely depending on the diagnosis. However to make a definitive diagnosis of a lymphoma based solely on the H & E light microscopy, findings may be exceedingly difficult because of frequent absence of distinguishing features. IHC represents a tool that can provide a clear distinction among the different types of lymphoma. The purpose of IHC is to categorize the patient in order to ensure appropriate and specific treatment, as well as to identify tumours at higher risk of recurrence and fatal outcomes. Aims: To study histomorphology of different lymphomas and correlation of it with immunohistochemical findings. Settings and Design: The present study is a retrospective as well as prospective study of lymphoma cases diagnosed based on routine histopathology as well as correlation of it with immunohistochemistry in surgical pathology section of the Central Diagnostic Laboratory, Shree Krishna Hospital, Karamsad from September 2010 to August 2015. Materials and Methods: A detail clinical history, nature of specimen and other investigations were noted in the proforma. Macroscopic and microscopic findings or any incidental findings were documented in the final report. Results: Total 47 cases of lymphoma were diagnosed in study period among them 42 cases were of B cell lymphoma and 7 cases were of T cell lymphoma. All B cell lymphoma were positive immunihistochemically for CD 20 and LCA. Out of 47 cases 25(53.19%) were of lymphoid origin and 22(46.81%) were of extralymphoid site. Conclusion: From this study it was concluded that: In all the cases diagnosis of hematoxyllin and eosin stained sections were correlated with immunohistochemical findings Non Hodgkin's Lymphoma were most common than Hodgkin's lymphoma Lymphnodes are the most common site of origin.
Problematic 'high grade' lesions in lymphoproliferative pathology
Materia Medica, 2012
High error rate in primary lymphoma diagnosis by generalist pathologists has imposed a requirement for a redesign of diagnostic services in this subspecialty. 1 In all developed countries and in most of the countries in transition, diagnosis of lymphoid proliferations has become centralised, relying on regional panels of experts and dedicated specialised laboratories. However, the initial steps in the management and subspecialist referral of patients with suspected lymphoma still rely on diagnostic skills of general histopathologists. Their detailed awareness of classification changes, diagnostic requirements and standards is essential for the success of the diagnostic pathway. Here a range of scenarios are highlighted where the outcome of the initial pathological assessment, before any specialist investigations have been carried out, could "sidetrack" the referral process and adversely affect management. The term "High Grade" in this context is used for lesions histologically characterised by high pleomorphism and "blastic" appearance and also for processes with an aggressive clinical behaviour. Over the past two decades the wealth of accumulated knowledge on the biology of lymphoid cells and lymphomas culminated in a series of classifications which emphasised the need for extensive immunophenotypic and genetic interrogation of lymphoid proliferation in the course of pathological diagnosis. 2 as a consequence gone past are the days when treatment of lymphomas could commence after morphological assessment alone. On morphological grounds so many different aggressive lymphomas may show striking similarity. Burkitt lymphoma (BL), blastoid variant of mantle cell lymphoma, lymphomas of the "grey zone" between BL and diffuse large B-cell lymphoma (dLBCL), lymphoblastic lymphoma, plasmacytoid dendritic cell neoplasm and many others may show very similar morphology. This morphological mimicry is further complicated by similarities aggressive lymphoid malignancies may in certain circumstances show with non-haematological malignancies and reactive, inflammatory conditions. Examples of this contentious spectrum are provided together with an update of the most recent classification changes and the impact this has made on the practicalities of pathological diagnosis and management. Abundant reactive lymphoid infiltrate is seen in a range of different tumours: Follicular dendritic cell tumour / sarcoma is an example of this category. This is an uncommon entity displaying a spectrum of biological behaviour involving lymph nodes and a range of extranodal sites. The tumour cells amongst the abundant reactive lymphoid infiltrate could show spindle cell morphology, epithelioid or reed-sternberg-cell features. accurate diagnosis relies on the recognition of the specific immunophenotype (Cd21, Cd23, Cd35, clusterin). 2-4 This is of benefit only if this tumour is included in the initial differential diagnosis which should also consider tumours such as classical Hodgkin lymphoma, T-cell rich B-cell lymphoma, "lymphoepithelioma-like" carcinoma, inflammatory myofibroblastic tumour, metastatic germ cell tumour, medullary carcinoma of breast, "B-type" thymomas, inflammatory pleomorphic sarcoma or interdigitating dendritic cell sarcoma. Aggressive lymphomas may be negative for commonly used lymphoid lineage markers: ALK positive large B-cell lymphoma is a rare entity characterised by a high degree of pleomorphism and epithelioid morphology. 5 This aggressive lymphoma in addition displays an aberrant phenotype, lacking expression of Cd45 and other lineage markers. The initial use of broad immunocytochemical screens may classify this lymphoma as undifferentiated malignancy. a range of haematolymphoid neoplasms may display loss of expression or are by definition characterised by the absence of markers generally considered to be robust lineage discriminators. such tumours are myeloma, plasmablastic lymphomas, anaplastic large cell lymphoma and classical Hodgkin lymphoma which may all pose a difficult differential diagnosis with non-haematological malignancies. Plasma cell myeloma as well as other haematological malignancies may also aberrantly express cytokeratins, which in the context of paucity of expression of other B-cell lineage markers could be highly confusing. 6 In addition, a common tumour such as small cell carcinoma of lung on occasions expresses
Lymphoepithelioma-like Gastric Carcinoma (LELGC): A Case Report and Review of Literature
2018
Lymphoepithelioma-like gastric carcinoma (LELGC), is a rare type of gastric cancer characterized by a carcinoma with intense stromal lymphocytic infiltration. It is one of the histological patterns observed in patients with Epstein-Barr virus (EBV)-associated gastric carcinoma. According to the World Health Organisation classification of tumors of digestive sysytem 2010, LELGC is a rare type of tubular carcinoma. Although this entity is hard to be recognized in the biopsy specimens, pathologists and clinicians should acknowledge this subset of gastric cancer because it generally has a better prognosis than other forms of EBV-associated gastric carcinomas and conventional gastric carcinomas. This might be due to the fact that the patient's inflammatory response may prevent the spread of tumor through the gastric wall and to the lymph nodes or remote organs.(21) In order to gain a detailed understanding of this rare disease, we reviewed the literature and report here a recent cas...
Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association, 2017
Gastric carcinoma with lymphoid stroma (GCLS) is characterized by undifferentiated carcinoma mixed with prominent lymphoid infiltration. GCLS has unique clinicopathological features and a better prognosis compared to other types of gastric cancer. We analyzed the clinicopathological features of early GCLS in relation to lymph node metastasis (LNM). We performed a retrospective analysis of 241 patients diagnosed with GCLS confined to the mucosa or the submucosa between March 1998 and December 2015. Their data were compared with those from 1219 patients who underwent resection for differentiated early gastric cancer (EGC). Of the 241 patients analyzed, 33 (13.7%) had intramucosal cancers and 208 (86.3%) had cancers that penetrated the submucosa. Compared to differentiated EGC, early GCLS was more prevalent in younger individuals and in men, tended to be proximally located, was highly associated with Epstein-Barr virus (EBV) infection (89.2%), and had a lower risk of LNM. The 5-year di...