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[Gastric cancer 889. EBV associated gastric cancer]

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EBV-associated gastric cancer is usually diagnosed by careful pathologic examination and immunohistochemistry after gastrectomy. In this case, however, association with EBV was found by forceps biopsy specimen.

Stomach, radical total gastrectomy: Early gastric carcinoma
1. Location : upper third, Center at cardia (Siewert II) and lesser curvature
2. Gross type : EGC type IIa
3. Histologic type : tubular adenocarcinoma, poorly (solid) differentiated
4. Histologic type by Lauren : indeterminate
5. Size : 4.5x2.8 cm
6. Depth of invasion : invades submucosa (sm3) (pT1b)
7. Resection margin: free from carcinoma, safety margin: proximal 0.2 cm, distal 20.2 cm
8. Lymph node metastasis : metastasis to 1 out of 25 regional lymph nodes (pN1) (perinodal extension: absent) (1/25: "1", 1/1; "2", 0/0; "3", 0/7; "4", 0/5; "5", 0/0; "6", 0/1; "7", 0/2; "9", 0/6; "8a", 0/1; "11p", 0/0; "12a", 0/1; "4sb", 0/0; "11", 0/1)
9. Lymphatic invasion : present
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. Associated findings : gastritis cystica profunda
13. Peritoneal cytology : negative
14. AJCC stage by 8th edition: pT1b N1
. c-erbB-2(HER2) : Negative ( 1+ )
. Epstein-Barr virus in-situ hybridization: Positive (Inflamed / TSP - High)

In this patient, a large retroperitoneal mass was incidentally found in the initial staging workup. Mass excision was done at the same time of radical gastrectomy.


Retroperitoneum, mass excision: Composite paraganglioma (paraganglioma component, 70%; ganglioneuroma component, 30%):
1) tumor size: 9x7x4.2 cm
2) large nests or diffuse growth (more than 10% of tumor volume): present
3) central or confluent tumor necrosis: absent
4) tumor cellularity: moderate
5) cellular monotony: absent
6) tumor cell spindling (even if focal): absent
7) mitotic figures: 0/10 HPFs
8) atypical mitotic figures: absent
9) extension into adipose tissue: present
10) vascular invasion: absent
11) capsular invasion: present
12) profound nuclear pleomorphism: absent
13) nuclear hyperchromasia: absent
14) pheochromocytoma of the adrenal gland scoring scale (PASS): 5/20
(total≥4 is concerning for metastatic potential)

* Reference: EndoTODAY EBV-associated gastric cancer

© 일원내시경교실 바른내시경연구소 이준행. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng. (2021-3-18)