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[Lymphoepithelioma-like carcinoma. ¸²ÇÁ¾ç»óÇÇÁ¾¾ç ¾ÏÁ¾ = Gastric carcinoma with lymphoid stroma] - ðû

1. Introduction

2. Esophageal LELC

3. EBV positive LELC of the stomach

4. EBV negative LELC of the stomach

5. Colon LELC

6. References


1. Introduction to lymphoepithelioma-like carcinoma (LELC)

Á¤¸®: ÀÓ»ó°­»ç ¹é³²¿µ

Lymphoepithelioma-like carcinoma(LELC)´Â ºñÀεξϰú Á¶Á÷ÇÐÀûÀ¸·Î À¯»çÇÏ°í, ¸²ÇÁ±¸¼º °£ÁúÀ» °¡Áø ¹ÌºÐÈ­µÈ À§Á¾¾çÀÔ´Ï´Ù. Epstein-Barr ¹ÙÀÌ·¯½º¿ÍÀÇ ¿¬°ü¼ºµµ ¾ð±ÞµÇ°í ÀÖ½À´Ï´Ù. LELCÀº ½Äµµ, À§, ´ã°ü, Ÿ¾× ¼±, Æó, ÀÚ±Ã, ÇǺΠµî¿¡¼­ ¹ß»ýÇÕ´Ï´Ù.

À§ LELC´Â Àüü À§¾ÏÀÇ l-4%¸¦ Â÷ÁöÇϴµ¥ Á¶±âÀ§¾ÏÀÇ °æ¿ì IIa + IIcÇüÀÌ ¸¹À¸¸ç ÁøÇ༺ À§¾ÏÀÇ °æ¿ì Borrmann type IV ÇüÀÌ ¸¹´Ù°í ÇÕ´Ï´Ù. º´¸®ÇÐÀÚµéÀº medullary carcinoma·Î ºÎ¸£±âµµ ÇÕ´Ï´Ù. Á¶±âÀ§¾ÏÀÇ ÇüÅ·Π³ªÅ¸³¯ °æ¿ì´Â ÀϹÝÀûÀÎ Á¶±âÀ§¾Ï°ú ¿¹ÈÄ°¡ ºñ½ÁÇϳª ÁøÇ༺ À§¾ÏÀÇ ÇüŸ¦ ÃëÇÒ °æ¿ì ÀϹÝÀûÀÎ ÁøÇ༺ À§¾Ï¿¡ ºñÇÏ¿© ¿¹ÈÄ°¡ ÈξÀ ÁÁÀº °ÍÀ¸·Î ¾Ë·ÁÁ® ÀÖ½À´Ï´Ù. Á¡¸·ÇÏ Á¾¾çÀÇ ÇüÅ·Π³ªÅ¸³ª´Â °æ¿ìµµ ÀÖ¾î ÁÖÀÇ°¡ ÇÊ¿äÇÕ´Ï´Ù. 85%´Â EBV ¾ç¼ºÀε¥, EBV À½¼ºÀÎ °æ¿ì´Â »ó´ëÀûÀ¸·Î ¿¹ÈÄ°¡ ³ª»Þ´Ï´Ù.

º´¸® ¼Ò°ß (https://www.pathologyoutlines.com/)

¿À·¡µÈ Àú³Î Çϳª ¼Ò°³ÇÕ´Ï´Ù.

Lymphoepithelioma-like carcinoma of the stomach: a subset of gastric carcinoma with distinct clinicopathological features and high prevalence of Epstein-Barr virus infection (Hepatogastroenterology 1999)

METHODOLOGY: Of 379 patients with gastric adenocarcinoma, from 1993 to 1996, 6 of them with lymphoepithelioma-like carcinoma of stomach were retrospectively studied.

RESULTS: Five patients were females and one patient was male. Their age ranged from 51-75 years with a mean age of 61.5 years. Endoscopically, 2 patients were initially diagnosed as early gastric cancer and the other 4 were diagnosed as advanced gastric cancer. Three patients had tumors located in the lower third of the stomach, while the other three tumors were located in the middle and upper third. Two tumors invaded into the serosal layer and the other four lesions were confined at submucosal and muscular layers. Using the in situ hybridization method, all 6 patients (100%) had positive nuclear Epstein-Barr virus-encoded small RNA signals in the tumor cells but not in the surrounding lymphoid stroma and non-neoplastic gastric mucosa. Helicobacter pylori was found in 4 (66.7%) of the cases. The mean follow-up period of the 6 patients was 27 months. Five patients were free of the disease. Lymph node involvement and mesenteric implantation was noted in one patient in which cancer recurred 1 year after gastrectomy.

CONCLUSIONS: Lymphoepithelioma-like carcinoma of stomach in this study revealed a female predominance, preferential localization in the proximal part of the stomach, better prognosis, and a high association with Epstein-Barr virus infection.


2. Esophageal LELC

Korean J Gastrointest Endosc 2010 - »ï¼º¼­¿ïº´¿ø¿¡¼­ º¸°íÇÏ¿´´ø Áõ·Ê

2019³â WHO ºÐ·ù¿¡ ±â¼úµÈ º´¸® ¼Ò°ß: lymphoepithelioma-like carcinoma is considered to be a distinct subtype of undifferentiated carcinoma. It is characterized by a sheet-like arrangement of large epitheloid cells with prominent nuclei and indistinct borders. The tumor is surrouded by a characteristic inflammatory infiltrate that is rich in lymphocyte and plasma cells.


3. EBV positive lymphoepithelioma-like carcinoma. EBV ¾ç¼º ¸²ÇÁ¾ç»óÇÇÁ¾¾ç ¾ÏÁ¾

EBV in situ hybridization


Depth of invasionÀº SM3¿´½À´Ï´Ù.

EBV (+)



1. Location : upper third, center at cardia (Siewert III)
2. Gross type : Borrmann type 2
3. Histologic type : Medullary carcinoma (lymphoepithelioma-like carcinoma)
4. Histologic type by Lauren : indeterminate
5. Size : 2.2x2.2 cm
6. Depth of invasion : invades muscularis propria
7. Resection margin: free from carcinoma, safety margin: proximal 1.4 cm, distal 2 cm
8. Lymph node metastasis : no metastasis in 52 regional lymph nodes
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. Result of in-situ hybridization: Epstein-Barr virus: Positive

Á¶Á÷°Ë»ç¿¡¼­´Â poorly differentiated adenocarcinoma¿´°í EUS¿¡¼­ SM invasionÀÌ ¶Ñ·ÇÇß½À´Ï´Ù.
Stomach, subtotal gastrectomy:
. Early gastric carcinoma
1. Location : lower third, Center at proximal antrum and anterior wall
2. Gross type : EGC type IIc
3. Histologic type : lymphoepithelioma-like carcinoma
4. Histologic type by Lauren : mixed
5. Size : 1.8x1.4 cm
6. Depth of invasion : invades submucosa (sm3) (pT1b)
7. Resection margin: free from carcinoma, safety margin: proximal 1 cm, distal 8.7 cm
8. Lymph node metastasis : no metastasis in 34 regional lymph nodes (pN0)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. AJCC stage by 7th edition: pT1b N0
13. Epstein-Barr virus : positive


Stomach, subtotal gastrectomy:
. Early gastric carcinoma
1. Location : middle third, Center at body and posterior wall
2. Gross type : EGC type IIb
3. Histologic type : carcinoma with lymphoid stroma (medullary carcinoma)
4. Histologic type by Lauren : indeterminate
5. Size : 1.8x1 cm
6. Depth of invasion : invades submucosa (sm3) (pT1b)
7. Resection margin: free from carcinoma, safety margin: proximal 1.2 cm, distal 13 cm
8. Lymph node metastasis : no metastasis in 33 regional lymph nodes (pN0)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. AJCC stage by 7th edition: pT1b N0

2´Þ °£°ÝÀ¸·Î 3¹ø ³»½Ã°æ °Ë»ç¸¦ ¹ÞÀ¸¼Ì°í, ¸¶Áö¸· Á¶Á÷°Ë»ç¿¡¼­ signet ring cell carcinoma°¡ ³ª¿Ô½À´Ï´Ù. ÃÖÁ¾ º´¸®´Â carcinoma with lymphoid stroma·Î ³ª¿Ô½À´Ï´Ù. Lymphoepithelioma-like carcinoma¶ó°í ºÎ¸£´Â ŸÀÔÀÔ´Ï´Ù. Lymphoid stroma »çÀÌ¿¡ ¹ÌºÐÈ­Á¶Á÷Çü À§¾ÏÀÌ ¹ÚÇôÀÖ´Â ÇüÅÂÀ̹ǷÎ, À°¾ÈÀûÀ¸·Î´Â SMT ºñ½ÁÇÏ°Ô º¸ÀÌ°í, Á¶Á÷°Ë»çÀÇ false negative°¡ ¸¹Àº °Í °°½À´Ï´Ù.
Early gastric carcinoma
1. Location : lower third, Center at antrum and greater curvature
2. Gross type : EGC type IIc
3. Histologic type : carcinoma with lymphoid stroma
4. Histologic type by Lauren : mixed
5. Size : 3.8x1.9 cm
6. Depth of invasion : invades mucosa (muscularis mucosae) (pT1a)
7. Resection margin: free from carcinoma
8. Lymph node metastasis : no metastasis in 17 regional lymph nodes (pN0)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. AJCC stage by 8th edition: pT1a N0

Nasopharyngeal cancer·Î Ä¡·á¹Þ´ø Áß PET¸¦ ½ÃÇàÇÏ¿´´Âµ¥ ¿ì¿¬È÷ À§¾ÏÀÌ ¹ß°ßµÇ¾î ¼ö¼úÀ» ¹Þ¾ÒÀ½.
Stomach, subtotal gastrectomy: Early gastric carcinoma
1. Location : middle third, center at body and greater curvature
2. Gross type : EGC type I
3. Histologic type : lymphoepithelioma-like carcinoma
4. Histologic type by Lauren : intestinal
5. Size : 3.2x2.3x0.9 cm
6. Depth of invasion : extension to submucosa (sm2) (pT1b)
7. Resection margin: free from carcinoma, safety margin: proximal, 3.2 cm; distal, 8.8 cm
8. Lymph node metastasis : no metastasis in 36 regional lymph nodes (pN0) (0/36: lesser curvature, 0/10; greater curvature, 0/9; "1", 0/2; "3", 0/1; "4sb", 0/0; "5", 0/2; "6", 0/0; "7", 0/1; "8a", 0/2; "9", 0/6; "11p", 0/2; "12a", 0/1)
9. Lymphatic invasion : not identified
10.Venous invasion : not identified
11.Perineural invasion : not identified


4. EBV negative lymphoepithelioma-like carcinoma. EBV À½¼º ¸²ÇÁ¾ç»óÇÇÁ¾¾ç ¾ÏÁ¾

ÀÓ»ó»ó ¹× ³»½Ã°æ ¼Ò°ß

65¼¼ ³²¼ºÀÌ °ÇÁø³»½Ã°æ¿¡¼­ ¹ß°ßµÈ À§¾Ï ÀÇ½É ¼Ò°ßÀ¸·Î ÀǷڵǾú´Ù. Á¶Á÷°Ë»ç °á°ú´Â Atypical cells, suspicious for poorly differentiated adenocarcinoma¿´´Ù. ³»½Ã°æ Àç°Ë(¿À¸¥ÂÊ »çÁø)¿¡¼­ À§Ã¼ÇϺΠ¼Ò¸¸¿¡ 4cm Å©±âÀÇ À¶±âµÈ º´¼Ò°¡ ÀÖ¾ú°í Á߽ɺΰ¡ ÇÔ¸ôµÇ¾î ÀÖ¾ú´Ù. ÀÌ º´¼ÒÀÇ ±ÙÀ§ºÎÀÎ À§Ã¼Áߺο¡ ¸î °³ÀÇ ¸¶Ä¡ ¹«´ý°ú ºñ½ÁÇÑ 1-3cm Å©±âÀÇ ¸î °³ÀÇ À¶±âºÎ°¡ ÀÖ¾ú´Ù. À§Ã¼ÇϺΠÇÔ¸ôÀ» µ¿¹ÝÇÑ À¶±âºÎ Á¶Á÷°Ë»ç´Â tubular adenocarcinoma, moderately differentiated (cytokeratin AE1/AE3 positive) ¿´À¸¸ç À̺¸´Ù ±ÙÀ§ºÎ Á¡¸·ÇÏÁ¾¾ç À¯»çÇÑ À¶±âºÎµéÀÇ Á¶Á÷°Ë»ç´Â gastritis »ÓÀ̾ú´Ù. ¼ö¼úÀ» ½ÃÇàÇÏ¿´´Ù.

Áø´Ü ¹× °æ°ú

EBV negative, lymphoepithelioma-like carcinoma. ¼ö¼úÀå¿¡¼­ subtotal gastrectomy °èȹÀ¸·Î À§¸¦ ÀýÁ¦ÇÏ¿´À¸³ª °Ëü È®ÀÎ ½Ã proximal marginÀÌ 1cm Á¤µµ¿´À¸¸ç ½ÄµµÀ§Á¢ÇÕºÎ¿Í °¡±î¿ö total gastrectomy·Î ÀüȯÇÏ¿´´Ù. º´¸® °á°ú advanced gastric cancer, lymphoepithelioma-like carcinoma, Lauren indeterminate, 5x8x4.8cm, penetrated subserosal connective tissue, resection margin negative, no lymph node metastasis out of 40À̾ú´Ù (AJCC 8th pT3NO). ±Ë¾çºÎ ÀÌ¿Ü´Â Á¤»óÁ¡¸· ¾Æ·¡·Î ³Ð°Ô ħÀ±À» º¸¿´´Ù. Epstein-Barr virus À½¼ºÀ̾ú´Ù.

Çؼ³

Lymphoepithelioma-like carcinoma´Â Á¶Á÷ÇÐÀûÀ¸·Î ºñÀεξϰú À¯»çÇÏ°í ¸²ÇÁ±¸¼º °£ÁúÀ» °¡Áø ¹ÌºÐÈ­µÈ À§Á¾¾çÀ¸·Î SMT-like cancer Áß ÇϳªÀÌ´Ù. ¿¹ÈÄ´Â ÀϹÝÀûÀÎ À§¾Ïº¸´Ù ÁÁ´Ù. º» Áõ·Êó·³ EBV À½¼ºÀÎ ¿¹´Â »ó´ëÀûÀ¸·Î ¿¹ÈÄ°¡ ³ª»Ú´Ù (Min. Gastric Cancer 2016).


5. Colon LELC

2022³â 3¿ù KASID ±³À°ÀÚ·á. ¼³¸í Áß ÇÕÆ÷ü´Â syncytiumÀ» ¸»ÇÔ (¼¼Æ÷ À¶ÇÕÀ¸·Î ³ªÅ¸³ª´Â ´ÙÇÙ¼º ¼¼Æ÷)

2022³â 3¿ù KASID ±³À°ÀÚ·á


[References]

1. EndoTODAY EBV-associated gastric cancer

2. Epstein-Barr virus °ü·Ã À§¾Ï À̺ÀÀº. Korean J Helicobacter Up Gastrointest Res 2021 (PDF)

© ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng.