A 75-year-old man was referred to our hospital with suspected gastric cancer. Endoscopy revealed a 10 mm-sized, reddish, depressed lesion in the middle gastric body. Biopsy tissue suggested a poorly differentiated adenocarcinoma. Since submucosal invasion could not be ruled out, the patient underwent laparoscopic distal gastrectomy. Resected specimen showed a poorly differentiated adenocarcinoma with significant lymphocytic infiltrate, and 390 μm of submucosal invasion. There was no lymph node metastasis or lymphovascular invasion. Epstein-Barr virus-encoded RNA in situ hybridization was positive, and the diagnosis of Epstein-Barr virus-associated gastric carcinoma with lymphoid stroma (GCLS) was made. GCLS has a low incidence of lymph node metastasis and a relatively good prognosis. In this case, if we had diagnosed GCLS preoperatively, endoscopic submucosal dissection may have been an option for treatment.
