Acta Medica Okayama 79巻 5号
2025-10 発行
Isozaki, Hiroshi
Department of Surgery, Oomoto Hospital
Matsumoto, Sasau
Department of Surgery, Oomoto Hospital
Takama, Takehiro
Department of Surgery, Oomoto Hospital
Isozaki, Yuka
Department of Surgery, Oomoto Hospital
Murakami, Shigeki
Department of Surgery, Oomoto Hospital
Gastric cancer with lymphoid stroma (GCLS) accounts for 1%-7% of gastric cancers; ~80% are Epstein-Barr virus (EBV)-positive. The rate of lymph node metastasis is relatively low, even when an early GCLS has invaded the submucosa. We report an early GCLS with massive submucosal invasion mimicking a submucosal tumor (SMT), diagnosed by endoscopic submucosal resection (ESD) and treated with local resection and sentinel node navigation surgery (SNNS). The patient was a 40-year-old Japanese man. A protruding lesion on the greater curvature of the middle part of his stomach was detected by X-ray, and an endoscopic examination revealed a 2.5-cm protruding tumor covered with a normal mucosa and small ulcers at the apex. ESD was performed for a diagnosis. The pathological diagnosis was lymphoepithelioma-like gastric cancer (GCLS), pT1b(SM2), Ly0, V0, pHM1, pVM1. EBV infection in the cancer cells was confirmed pathologically by EBV-encoded RNA. The local resection was performed using SNNS. The patient has had no recurrence or post-gastrectomy syndrome 4 years postsurgery. EBV-associated early GCLS resembling an SMT is relatively rare, and clinicians need to be aware of this disease. Local resection using SNNS may be a surgical option for GCLS cases with a low rate of lymphatic metastasis.
gastric cancer
gastric cancer with lymphoid stroma
lymphoepithelioma-like carcinoma
Epstein Barr virus
sentinel node navigation surgery