Two Cases of Epstein-Barr Virus-associated Gastric Cancer with Three Simultaneous Lesions

Abstract

In recent years, stratified therapy targeting molecular characteristics has gained attention in gastric cancer treatment, and Epstein-Barr virus (EBV) -associated gastric cancer is one such subtype. Two cases of EBV-associated multiple gastric cancers, each presenting with three synchronous lesions, are presented along with a literature review.

The first case involved a 92-year-old woman who underwent total gastrectomy for advanced gastric cancer in the antrum and body of the stomach. The surgical specimen showed signet ring cell carcinoma in two lesions and lymphoepithelioma-like carcinoma, which was positive for Epstein-Barr virus-encoded RNA (EBER), resulting in a diagnosis of multiple gastric cancers with a total of three lesions. The second case involved an 81-year-old man who underwent total gastrectomy for early gastric cancer in the cardia and upper body. The specimen showed poorly differentiated adenocarcinoma, tubular adenocarcinoma, and EBER-positive lymphoepithelioma-like carcinoma, leading to a diagnosis of multiple gastric cancers with three lesions.

EBV-associated gastric cancer is characterized by significant lymphocytic infiltration around the cancer cells and is reported to account for about 7% of all gastric cancers. However, the incidence rises to approximately 17% in cases of multiple gastric cancers. In cases like these, EBV-associated gastric cancer should always be considered.