Resident Program - Case of the Month

Presented by Dr. Jake Donnelly (Mentored by Dr. Kurt Schaberg)

Discussion

Gastric carcinomas are malignant epithelial neoplasms that account for ~8% of all cancers. The overall 5-year survival rate is <30%. Japan, Korea, eastern Europe and Latin American are areas with a high propensity for gastric carcinomas (>60 per 100,000 males). The incidence of gastric carcinomas increases with age. Smoking, diets that are high in salt-preserved or smoked foods and low in fresh fruit and vegetables, and infection with Helicobacter pylori increase the risk for developing gastric cancer.

Gastric carcinoma with lymphoid stroma, sometimes also referred to as medullary carcinoma or lymphoepithelial-like carcinoma, is a rare histologic subtype associated with a better prognosis than conventional gastric adenocarcinoma that makes up ~4% of all gastric carcinomas. The average age of the patient population is 70 years old. This gastric cancer variant is characterized by poorly differentiated tubular structures and irregular sheets of polygonal cells, syncytial growth, and prominent lymphocytic infiltrate. This subtype is often found in males and is located at the proximal stomach. Epstein-Barr virus (EBV) infection is present in >80% of these cases. A subset of these tumors that are EBV-negative demonstrate a mismatch repair protein deficiency. These tumors often express PD-L1, raising the possibility that these tumors may be susceptible to checkpoint inhibitors. These tumors lack HER2 overexpression.

Works Cited

• Ciarpaglini, Carolina Martinez. “Gastric Carcinoma with Lymphoid Stroma.” Pathology Outlines - PathologyOutlines.com, 25 Dec. 2020, www.pathologyoutlines.com/topic/stomachLEL.html.
• Hissong E et al. Gastric Carcinomas With Lymphoid Stroma: An Evaluation of the Histopathologic and Molecular Features. Am J Surg Pathol. 2018 Apr;42(4):453-462.
• Lauwers, Gregory Y. Adenocarcinoma, Special Variants, ExpertPath, 18 Mar. 2019, app.expertpath.com/document/adenocarcinoma-special-variants/81fb8aea-6ced-4fa9-ae32-5581090ebf66.
• Lim H et al. Features of Gastric Carcinoma With Lymphoid Stroma Associated With Epstein-Barr Virus. Clin Gastroenterol Hepatol. 2015 Oct;13(10):1738-1744.
• F.T. Bosman, WHO Classification of Tumours of the Digestive System, International Agency for Research on Cancer, 2010, pp. 48–58. 

References:

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