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Case Reports
. 2016 Jun 14;10(2):292-301.
doi: 10.1159/000444277. eCollection 2016 May-Aug.

Concurrent Gastric Adenocarcinoma of Fundic Gland Type and Carcinoma with Lymphoid Stroma: A Rare Case Report

Hee Jeong Cha  1 , Kyungbin Kim  1 , Misung Kim  1 , Hyejeong Choi  1 , Young Min Kim  1 , Jae Hee Suh  1
Affiliations
Case Reports

Concurrent Gastric Adenocarcinoma of Fundic Gland Type and Carcinoma with Lymphoid Stroma: A Rare Case Report

Hee Jeong Cha et al. Case Rep Gastroenterol. .

Abstract

Both gastric adenocarcinoma of fundic gland type (ADC-FG) and carcinoma with lymphoid stroma (lymphoepithelioma-like carcinoma, LELC) are relatively rare. Epstein-Barr virus (EBV) has been implicated in the pathogenesis of LELC. However, the pathogenesis of ADC-FG, as well as the role of EBV in the carcinogenesis of LELC, remain unclear and under debate. The current study presents a case of concurrent ADC-FG and LELC in the stomach in a 69-year-old man. Total gastrectomy was performed, and two separate masses were identified. Upon histological and immunohistochemical examination, the mass located in the lower body was determined to be LELC and the mass in the upper body was diagnosed as ADC-FG. The lesions were characterized by different mucin phenotypes and EBV in situ results. In the lower-body mass, EBV in situ hybridization expression was diffusely strongly positive, but MUC2, MUC5AC, MUC6, and CD10 were all negative. On the other hand, in the upper-body mass, the results were positive for MUC6 but negative for MUC2, MUC5AC, CD10, and EBV by in situ hybridization. The remaining gastric tissue was unremarkable, and perigastric lymph node metastases were absent. Seven months after the gastrectomy, a postoperative computed tomography scan revealed no recurrence or metastasis.

Keywords: Adenocarcinoma of fundic gland type; Carcinoma with lymphoid stroma; Stomach.

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Figures

Fig. 1
Fig. 1
Endoscopic observation revealing two masses: one of them was a huge ulceroinfiltrative mass located in the lower body (a) and the other was a submucosal mass with surface ulceration placed in the upper body (b).
Fig. 2
Fig. 2
Gross finding revealing two separate masses in the upper and lower body of the stomach, respectively.
Fig. 3
Fig. 3
a The lower-body tumor, diagnosed as LELC, was a poorly differentiated carcinoma with prominent lymphoid stroma. H&E. ×200. b Tumor cells of the lower body showed diffuse and strong positivity for EBV by in situ hybridization. ×200.
Fig. 4
Fig. 4
a The upper-body tumor, diagnosed as ADC-FG, was a well-differentiated carcinoma, reminiscent of fundic gland cells. H&E. ×200. b Tumor cells of the upper body were negative for EBV by in situ hybridization. ×400.
Fig. 5
Fig. 5
Mucin expression of the ADC-FG. Tumor cells exhibited positivity for MUC6 (a) but negativity for CD10 (b), MUC2 (c), and MUC5AC (d). ×200.
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