A Case of Eight Multiple Epstein-Barr Virus-associated Early Gastric Cancers

Abstract

A 52-year-old man presented to our department for further examination of anemia. Upper gastrointestinal endoscopy showed multiple early gastric cancer lesions in the antrum. Endoscopic submucosal dissection was performed, and on histological examination, the lesions were positive for Epstein-Barr virus (EBV)-encoded RNA (EBER), leading to a diagnosis of EBV-associated gastric cancer. One lesion had a depth of SM2 and extensive venous invasion ; therefore, additional surgical resection was performed. Laparoscopic total gastrectomy showed new EBV-positive early gastric lesions in the surgically resected specimen, resulting in a total of eight lesions. In addition to the cancerous lesions, a collection of EBER-positive atypical gland ducts suggestive of precancerous lesions was observed. A surgical case of EBV-associated, multiple, early gastric cancers, is reported along with a literature review. When treating cases with multiple gastric cancers, it is important to consider the possibility of EBV-related gastric cancer and determine treatment strategies based on patient background and potential simultaneous or metachronous carcinogenesis.