EBV-associated gastric cancer. EndoTODAY 이준행

EndoTODAY | EndoATLAS | Outpatient Clinic

Parasite | Esophagus | Stomach | Cancer | ESD

Home | Guide | Author | Subscription | Links

[EBV-associated gastric cancer]

1. Introduction

2. SMC Monday GI conference 2017-5-15. EBV-associated gastric cancer (임상강사 홍지택)

EBV-associated gastric cancer

Incidence: about 10% of gastric carcinoma
Mean age: 60
Male predominance
Gross feature: Ulerated suacer(납작한 접시)-like mass, Marked thickening of gastric wall
Predisposition to the non-antrum of the stomach: Proximal stomach, Remnant stomach after subtotal gastrectomy
Characteristic microscopic features: Gastric carcinoma with lymphoid stroma (GCLS), Lymphoepithelioma-like carcinoma, Carcinoma with Crohn's disease-like lymphoid reaction, Lace pattern in the mucosal layer
Behavior: low rate of lymph node metastasis, better prognosis

Cell free virus는 감염능력이 낮으나 한 세포에서 다른 세포로 옮기는 효율은 훨씬 높습니다.
Latent protein 발현 양상에 따라 세 가지 type을 나눌 수 있습니다. 위암은 latency type I과 type II과 관련된 것으로 생각됩니다. 처음에는 latency type III로 시작하다가 latent protein 발현을 down regulation 하여 latency type II와 type I으로 변형됩니다.

Remnant gastric cancer에서의 감염율이 그냥 proximal gastric cancer보다 훨씬 더 많습니다. Billroth II에서 더 높다고 합니다.

한번 감염되면 cure 되는 경우는 없습니까?

언제 면역형광염색을 시행합니까? 어떤 항체를 이용하여 검사를 하는 것입니까?

Saucer-like mass라고 하셨는데...

LECL의 얼마나 감염되어 있나요? 80% 이상이라고 했는데요...

Submucosal invasion이 많은 이유는?

[Cases]

Early gastric carcinoma
1. Location : body, postero greater curvature
2. Gross type : EGC type IIb
3. Histologic type : tubular adenocarcinoma, moderately differentiated (EBV-positive)
4. Histologic type by Lauren : intestinal
5. Size of carcinoma : (1) longest diameter, 34 mm (2) vertical diameter, 29 mm
6. Depth of invasion : invades submucosa, (depth of sm invasion : 600 ㎛) (pT1b)
7. Resection margin : free from carcinoma(N), safety margin : distal 3 mm, proximal 200 ㎛, anterior 4 mm, posterior 2 mm, deep 100 ㎛ (sm only)
8. Lymphatic invasion : not identified(N)
9. Venous invasion : not identified(N)
10. Perineural invasion : not identified(N)
11. Microscopic ulcer : absent
12. Histologic heterogeneity: absent
13. in situ hybridization: Epstein-Barr virus : Positive ( CLR, Crohn's-like reaction )

[References]