Lymphoepithelioma-like Gastric Carcinoma Research Articles

Clinicopathological characteristics and lymph node metastasis rates in early gastric lymphoepithelioma-like carcinoma: Implications for endoscopic resection.

321 Background: We aimed to clarify the clinicopathological features and the rate of lymph node metastases (LNM) of early gastric lymphoepithelioma-like carcinoma (LELC). Methods: We compared the clinicopathological characteristics of 82 LELC and 5758 well- or moderately differentiated (WD or MD) tubular adenocarcinoma patients who received gastrectomy for single early gastric cancer (EGC). Results: Compared to the control group, early LELC patients were younger, had a higher prevalence of proximally located tumors, more frequent Epstein-Barr virus (EBV) infection, more frequent deep submucosal invasion (SM2 or SM3, 85.4% versus 29.9%, P < 0.001) but less frequent lymphatic invasion (4.9% versus 16.2%, P = 0.009). Among tumors with deep submucosal invasion, early LELC patients had smaller tumor sizes, less frequent lymphatic invasion (5.7% versus 40.1%, P < 0.001) and a lower rate of LNM (7.1% versus 19.4%, P = 0.016) than the control group. LNM rates of LELC patients with mucosal, shallow submucosal invasion (SM1) and deep submucosal invasion were 0%, 0%, and 7.1%, respectively. Lymphatic invasion was the only significant risk factor in the regression analysis for LNM in LELC patients. Among 12 patients with mucosal or shallow submucosal invasion and 27 patients with deep submucosal invasion having small tumor sizes (less than 2 cm) and no lymphatic invasion, there was no LNM. Conclusions: Given the low rate of LNM, the same curability criteria of ESD for WD or MD EGC may be applied to early LELC and even more flexibly for those considered non-curative ESD only because of deep submucosal invasion.

Lymphoepithelioma-like carcinoma: a rare case of rectal cancer.

Lymphoepithelioma-like carcinoma (LELC) is a histological variant that resembles nasopharyngeal lymphoepithelioma and occurs in various locations such as the salivary glands and lung. LELCs in the digestive tract are rare, accounting for only 2% of cases, being exceptional in the rectum. We present the case of an 84-year-old man with rectorrhagia, whitish malodorous discharge and constipation of one month's duration. Rectal examination identified a tumour. Colonoscopy revealed a rectal lesion that was confirmed by biopsy as malignant, and MRI showed an extensive rectal tumour. Histopathology revealed undifferentiated carcinoma with acute inflammatory infiltrate, consistent with LELC. Immunohistochemistry was positive for keratins 5/6, 18, 20, CEA and BER.EP4, while in situ hybridisation for Epstein-Barr virus (EBV) RNA was negative. The multidisciplinary decision included neoadjuvant radiotherapy and anterior rectal resection. The patient remains in complete response two years after treatment. Histologically, LELC is characterised by an acute inflammatory infiltrate interspersed with poorly differentiated neoplastic cells. The stomach is the most commonly affected region in the gastrointestinal tract, with more than 80% of gastric LELCs associated with EBV. To date, only four cases of rectal LELC have been reported, and its association with EBV was demonstrated in only one case. There are no standard treatments for rectal LELC, underscoring the need to gather more cases to understand its pathogenesis and develop effective treatment strategies.

Perspectives for immunotherapy of EBV-associated GLELC: A relatively "hot" tumor microenvironment.

Epstein-Barr virus (EBV)-associated gastric lymphoepithelioma-like carcinoma (EBVaGLELC) represents a small number of gastric cancer (GC), and research on tumor microenvironment (TME) and treatment strategy are still lacking. Here, we aim to elucidate the immune features of this rare disease and further help to develop more effective treatment options. A retrospective analysis was conducted between 2019 to 2022 in West China Hospital to reveal the immunological characteristics of EBV-positive GLELC. The difference of immune cell subset and tumor vascular structure between gastric denocarcinoma (GAC) and EBVaGLELC will be pointed out. 13 patients with GELEC and 8 patients with GAC were retrospectively studied. The heterogeneity of the immune cell profile was then confirmed through multiplexed immunofluorescence staining (mIF), which revealed a higher proportion of CD3+ T cells, CD8+ T cells, and Treg cells in the EBV-associated GLELC group. Such a distinct TME may provide therapeutic advantages, and patients with this rare subtype of GC could be good candidates for immune checkpoint inhibitors (ICIs). Angiogenesis in EBV-positive GLELC may be less intense than that in gastric adenocarcinoma (GAC), a feature that might decrease their susceptibility to antiangiogenic therapy. Furthermore, we reported a 52-year-old male with advanced EBV-positive GLELC who showed a favorable response to the combined therapy with . A repeat evaluation showed sustained partial response (PR), and the progression-free survival (PFS) was more than 34 months until now. Compared with GAC, EBVaGLELC revealed higher T cell infiltration and less intense of angiogenesis. It displays relatively "hot" TME that may provide the rationality to treat with immunotherapy in EBV-related GLELC.

Presentation of 4 cases of Lymphoepithelioma-like gastric carcinoma

Presentation of 4 cases of Lymphoepithelioma-like gastric carcinoma

A computed tomography-based preoperative risk scoring system to distinguish lymphoepithelioma-like gastric carcinoma from non-lymphoepithelioma-like gastric carcinoma.

PurposeThe aim of this study was to develop a preoperative risk scoring model for distinguishing lymphoepithelioma-like gastric carcinoma (LELGC) from non-LELGC based on contrast-enhanced computed tomography (CT) images.MethodsClinicopathological features and CT findings of patients with LELGC and non-LELGC in our hospital from January 2016 to July 2022 were retrospectively analyzed and compared. A preoperative risk stratification model and a risk scoring system were developed using logistic regression.ResultsTwenty patients with LELGC and 40 patients with non-LELGC were included in the training cohort. Significant differences were observed in Epstein–Barr virus (EBV) infection and vascular invasion between the two groups (p < 0.05). Significant differences were observed in the distribution of location, enhancement pattern, homogeneous enhancement, CT-defined lymph node status, and attenuations in the non-contrast, arterial, and venous phases (all p < 0.05). Enhancement pattern, CT-defined lymph node status, and attenuation in venous phase were independent predictors of LELGC. The optimal cutoff score of distinguishing LELGC from non-LELGC was 3.5. The area under the receiver operating characteristic curve, sensitivity, specificity, and accuracy of risk identification model in the training cohort were 0.904, 87.5%, 80.0%, and 85.0%, respectively. The area under the receiver operating characteristic curve, sensitivity, specificity, and accuracy of risk identification model in the validation cohort were 0.705 (95% CI 0.434–0.957), 75.0%, 63.6%, and 66.7%, respectively.ConclusionA preoperative risk identification model based on CT imaging data could be helpful for distinguishing LELGC from non-LELGC.

Incidence and survival rates of lymphoepithelioma-like gastric carcinoma: analysis of the Korea Central Cancer Registry Database

Background Lymphoepithelial carcinoma of the stomach (LEGC) is a rare type of gastric carcinoma. There is a limited understanding of the incidence and survival rates of LEGC. The aim was to investigate the nationwide incidence and survival rates of LEGC in Korea using the Korea Central Cancer Registry. Methods The data on LEGC were retrieved from the Korea Central Cancer Registry of Korean Cancer Center. The age and sex of the patients and the Surveillance, Epidemiology, and End Results (SEER) summary stage of the tumor were analyzed, and the relative survival rates (RSRs) were calculated. The Korea Central Cancer Registry has data of patients with LEGC from 1993 to 2017 but is approved to use personal information only from 2006 to 2017 due to privacy restrictions of the institute. The RSRs, as calculated data, were able to be disclosed from 1993 to 2017. Results Between 2006 and 2017, the total number of LEGC was 1,030, and the trend of incidence increased ty time (p = .002). In the SEER stage, the proportion of localized stage was 54.3% in 2006, and 73.9% in 2017, which increased from 2006 to 2017 significantly (p = .002). The RSR was higher in men than in women. The cumulative 5-year RSRs were 98.0% in the localized stage and 88.0% in the regional stage during 1993–2017. The 5-year RSRs increased 79.5% in 1996–2000 to 93.4% in 2013–2017. Conclusions The incidence of LEGC is low, which has been increasing in recent years in South Korea. The prognosis of LEGC is good even at advanced stages and gets better as time goes by. Our findings provide useful insights to clinicians about LEGC and inform patients about the survival rate.

Lymphoepithelioma-like Gastric Carcinoma a Rare Condition: A case report

Background: Lymphoepithelioma-like gastric carcinoma (LELGC) is a rare type of gastric cancer characterized by a carcinoma with intense stromal lymphocytic infiltration. It comprises approximately 4% of all gastric neoplasms and occurs mainly in men and in the proximal stomach. LELGCs have a better prognosis than other gastric carcinomas due to its lower invasive and metastatic capacity. Unfortunately, there is a lack of diagnostic criteria that help identifying this tumor and differentiating it from medular and tubular adenocarcinoma with lymphoid stroma. Epstein-Barr Virus (EBV) and microsatellite instability have a predominant role in the physiopathology of the disease. The clinical manifestations are similar to those of other gastric neoplasms.

Lymphoepithelioma-like gastric carcinoma treated with partial gastrectomy: Two case reports.

Lymphoepithelioma-like gastric carcinoma (LELGC) is a rare type of gastric cancer characterized by intense lymphocytic infiltration of the stroma. LELGC is associated with Epstein-Barr virus infection and has a favorable prognosis compared with other types of gastric carcinoma. The clinical symptoms of LELGC are usually similar to those of conventional gastric carcinoma. The diagnosis of LELGC is established based on pathological, histological and immunohistochemical findings. The present report describes the cases of two patients with LELGC who underwent esophagogastroduodenoscopy and computed tomography scans prior to surgery. The two patients accepted surgical treatment, and postoperative pathological and immunohistochemical analyses confirmed LELGC. Neither patient experienced local recurrence or distant metastasis during the postoperative period.

CT findings and clinical features of Epstein-Barr virus-associated lymphoepithelioma-like gastric carcinoma.

Epstein–Barr virus (EBV)-associated lymphoepithelioma-like gastric carcinoma (LELGC) is a rare primary stomach tumor, which has overlapping imaging features with mass forming gastric carcinoma (GC). The aim of our study was to present the computed tomography (CT) findings and clinical features of EBV-associated LELGC to increase awareness of this entity.The CT findings and clinical features of 4 patients with pathologically documented EBV-associated LELGC were retrospectively analyzed.Among the 4 patients, 3 were male, and 1 was female. The medium age was 51 years old. All cases were single lesions including 1 was in the gastric cardia, 1 was in the gastric body, and 2 were in the gastric antrum. A focal thickening of the gastric wall was conducted, with a large thickness-to-length ratio. The low-density stripe of the normal gastric wall abruptly terminated at the edge of the lesion. The CT images of 4 cases showed inhomogeneous density with the radiodensity values ranging from 25 to 48 HU. In addition, an ulcer was demonstrated with an irregular base and slightly raised borders in all cases. Enhancement after injection of contrast material was heterogeneous enhancement (n = 3) or homogeneous (n = 1). After enhancement, obvious enhancement was seen in 1 case, moderate enhancement was seen in 3 cases, with the peak value of the tumor in the portal phase. No evidence of lymph node involvement and distant invasion was observed.Although LELGC is quite rare, it should be considered in differential diagnosis of early GC, advanced GC, and lymphoma. The relatively typical CT appearance, combined the age and sex of patients, can suggest the diagnosis of LELGC.

Lymphoepithelioma-Like Gastric Carcinoma Misdiagnosed as a Submucosal Tumor

Lymphoepithelioma-Like Gastric Carcinoma Misdiagnosed as a Submucosal Tumor

Clinical usefulness of F-18 FDG PET in lymphoepithelioma-like gastric carcinoma

PurposeLymphoepithelioma-like carcinoma (LELC) is a rare type of gastric cancer. We evaluated the clinical usefulness of F-18 FDG positron emission tomography/computed tomography (PET/CT) in LELC of stomach. Materials and methodsA total of 28 patients (mean age=59years) who underwent preoperative F-18 FDG PET/CT were enrolled retrospectively. Nine patients underwent follow-up F-18 FDG PET/CT. Pathologic information was obtained through gastrectomy and the association with Epstein-Barr virus (EBV) was investigated in 26 patients. ResultsPET/CT detected 85.0% (17/20) of advanced gastric cancers (AGC) and 12.5% (1/8) of early gastric cancers (EGC). Most tumors (23/26, 88.5%) were EBV-associated. The maximum standardized uptake value of FDG-avid tumors was 7.5±3.0. The sensitivity and specificity of PET/CT for the presence of lymph node metastasis was 47.8% (11/23) and 100.0% (13/13), respectively. PET/CT also detected a hepatic sarcomatoid carcinoma in one patient. The specificity of PET/CT for distant metastasis or second malignancy was 96.3%. Follow-up PET/CT detected malignant lesions in 3 of 9 patients; a liver metastasis, recurrent hepatic sarcomatoid carcinomas and a metachronous cholangiocarcinoma. PET/CT correctly excluded recurrence in the rest of the patients (6/6). The sensitivity and specificity of PET/CT for detecting recurrence or second malignancy was 100% and 100%, respectively. ConclusionF-18 FDG PET/CT would be a useful tool in evaluating distant metastasis or recurrence in patients with gastric LELC.

Lymphoepithelioma-like gastric carcinoma: clinicopathological characteristics and infection status

BackgroundLymphoepithelioma-like gastric carcinoma (LLGC) is a rare subtype of gastric carcinoma (GC) characterized by prominent lymphocytic infiltration. LLGC may be associated with latent Epstein–Barr virus (EBV) infection or microsatellite instability (MSI). This study aims to assess the clinicopathological characteristics, EBV infection, and MSI status in LLGC. MethodsA retrospective analysis of GC patients submitted to potentially curative resection between 2009 and 2014 was performed. The LLGC subtype specimens were examined for EBV by in situ hybridization and MSI by immunohistochemical analysis. The LLGC profile was analyzed accordingly to clinicopathological parameters. ResultsFrom 255 patients, seven were identified on the pathological report as LLGC. Six cases were EBV-positive and one had MSI, showing loss of MLH1 and PMS2 expression. LLGC was more frequently seen in men, and the mean age was 69 years. When compared to non-LLGC, LLGC cases were larger (∼5.8 cm) poorly differentiated tumors and had lower incidence of lymph node metastasis (P = 0.045). Mean number of lymph nodes dissected in the LLGC group was 39.5, and only one patient had a single positive lymph node. In addition, two patients presented associated lesions. LLGC was not associated with HER-2, chromogranin and synaptophysin positivity or Helicobacter pylori infection. ConclusionsDistinct pathological aspects and clinical behavior of LLGC reinforce the need for proper recognition of this histological subtype to choose better therapeutic approaches.

18F-FDG PET/CT in gastric lymphoepithelioma-like carcinoma

18F-FDG PET/CT in gastric lymphoepithelioma-like carcinoma

Carcinoma gástrico de tipo linfoepitelioma: criterios diagnósticos

Gastric lymphoepithelioma-like carcinoma is a rare and poorly characterized condition which historically has not been considered a specific entity, usually being considered synonymous with medullary carcinoma and conventional gastric carcinoma with lymphoid stroma. However, the differentiation of this entity is of clinical and prognostic importance. We report a case of a 77 year old man who presented with a gastric ulcer in the fundus. Histological examination revealed the presence of neoplastic glandular structures with marked lymphoid stroma. The immunohistochemical staining showed strong expression for Epstein-Barr virus and DNA repair proteins with a distinctive lymphoid cell distribution. The aim of our study is to determine criteria useful in the recognition of this unusual condition and assess the inmunophenotype of the lymphoid population.

Lymphoepithelioma-like gastric carcinoma in a patient with rectal laterally spreading tumor: A case report.

Lymphoepithelioma-like gastric carcinoma (LELGC) is a rare neoplasm of the stomach that accounts for 1-4% of all gastric cancer cases. It is characterized by the presence of a lymphoid stroma with cells arranged primarily in micro alveolar, thin trabecular and primitive tubular patterns or isolated cells. In the present study, the case of a 50-year-old male patient with LELGC and rectal laterally spreading tumor is presented. Following endoscopic submucosal dissection, a diagnosis of carcinoma was reached and the patient underwent total radical gastrectomy. The postoperative pathological stage was IA T1bN0cM0 according to the Tumor-Node-Metastasis classification of gastric carcinoma, and the patient recovered well. The present case is reported to summarize the endoscopic and pathological characteristics of LELGC.

Epstein-Barr Virus Associated Lymphoepithelioma-Like Carcinoma of the Esophagogastric Junction and Stomach: A Case Report and Review of the Literature

A 63-year-old man was admitted to our hospital with 2 months history of dysphagia. Endoscopic examination revealed an ulserovegetan tumor starting from distal esophagus and extending to the cardia. Pathological examination of the biopsy revealed an epithelial malignant tumor without further classification. The patient underwent a surgery following neo-adjuvant chemotherapy with oxaliplatin, 5-fluorouracil and leucoverin (FOLFOX) regimen. Postoperative pathological analyses showed high grade EBV-associated lymphoepithelioma-like carcinoma of the gastroesophagial junction and stomach. After surgery, we planned to administered 6 cycles of FOLFOX regimen as an adjuvant treatment. Lymphoepithelioma-like gastric carcinoma is a rare type of gastric carcinoma and has distinct clinic-pathologic characteristics, including male predominance, preferential location in the gastric cardia, lymphocytic infiltration, a lower frequency of lymph node metastases and more favorable prognosis. Surgical resection is the most effective treatment modality. Chemotherapy may be considered for patients who have high risk factors.

Lymphoepithelioma-like gastric carcinoma located in the lesser curvature of the gastric body: A case report and review of the literature.

Lymphoepithelioma-like gastric carcinoma (LELC) is a type of Epstein-Barr virus (EBV)-associated gastric cancer, characterized by the presence of a lymphoid stroma with cells arranged primarily in microalveolar, thin trabecular and primitive tubular patterns, or isolated cells. In situ hybridization is usually used to confirm the presence of EBV. LELC is a rare type of cancer, with an incidence of 1-4% among all gastric cancers. Despite its rarity, this tumor has attracted attention due to its distinct clinicopathological characteristics and its association with the immune system. This is the report of a rare case of gastric LELC located in the lesser curvature of the gastric body.

Computed tomography findings for a gastric lymphoepithelioma-like carcinoma: How often does it present as a submucosal mass?

To describe the anatomical location, size, tumour characteristics and morphology on CT of gastric lymphoepithelioma-like carcinoma (LELC) in order to determine the proportion of lesions that present as submucosal masses, and to review the clinicopathological findings. This retrospective study reviewed CT images of 186 lesions from 178 patients with LELC. CT morphologies and other findings were also analyzed. Pathology and medical records were reviewed. A pathology slide review of the lesions that presented with submucosal masses was performed. Gastric LELC presenting as a submucosal mass was found in 9.1%. The most common CT morphology was eccentric wall thickening (67.7%). On the pathology review, 14/17 submucosal mass lesions (82.4%) had a central ulceration. 105 lesions were T1/T2 stage (94.1%), and N0 stage was diagnosed in 66.1%. Fifty-six of 63 metastatic lymph nodes (LNs) (88.9%) demonstrated homogeneous enhancement, regardless of size. Male predominance (85.4%), upper stomach location (45.7%) and multiplicity (4.5%) were found. Gastric LELC presenting as a submucosal mass is only detected in a small portion of all patients, and the most common finding is eccentric wall thickening. Central ulceration and enlarged LNs with homogeneous enhancement are occasionally other features on CT. • LELCs as submucosal masses on CT were detected in only 9.1 %. • The most common CT finding was eccentric wall thickening (67.7 %). • Central ulceration and enlarged LNs with homogeneous enhancement might be seen.

Lymphoepithelioma-like Carcinoma: Case of a Rare Gastric Cancer

An elderly female underwent outpatient EGD for a long history of RUQ pain. She had a history of GERD and prior cholecystectomy. A 2cm pedunculated polyp was noted in the gastric body and snare polypectomy was performed. Histological examination demonstrated small nests and chords of tumor cells separated by dense inflammatory infiltrate predominantly composed of lymphocytes and neutrophils. The malignant cells had invaded the submucosa extending into the cauterized margin of resection. Immunohistochemistry staining for expression of cytokeratin was positive. In situ hybridization for Epstein-Barr virus-encoded small RNAs (EBER) showed intensive nuclear hybridization signal within the tumor cells. Final pathological diagnosis was poorly differentiated EBV associated lymphoepithelioma-like gastric carcinoma (LELC) with submucosal invasion. CT of chest, abdomen and pelvis demonstrated no new enlarged lymph nodes or masses. The patient agreed for follow up surveillance with plans to repeat upper endoscopy in 3 months. LELC is a rare subtype of gastric neoplasm comprising approximately 1-4% of all gastric cancers (GCs). They are characterized histologically by dense stromal lymphocyctic infiltrate with small nests of tumor cells. More than 80% are associated with EBV. Typically these tumors occur in elderly males and are usually located in the cardia or body of the stomach. They can present as projecting masses, mucosal thickening or submucosal mass with or without ulceration. Generally they tend to have a better prognosis when compared to other GCs, especially when associated with EBV, as demonstrated by lower propensity for lymph node invasion as well as longer overall survival and disease survival. It is postulated that this favorable prognosis stems from the immunological response to EBV proteins expressed on the tumor cells. A recent case series highlighted endoscopic submucosal dissection (ESD) along with medical follow up as being an adequate conservative approach compared to historic radical gastrectomy for patients with early EBV associated LELC despite submucosal invasion of greater than 500μm. In conclusion, clinicians should be aware of this rare variant of GC and recognize its distinct clinicopathological features. They have a more favorable prognosis compared to other GCs and EBV is present in the majority of cases. Endoscopic resection is recommended for diagnosis and can be potentially curative even in cases of deep submucosal invasion.Figure 1Figure 2

Epstein-Barr virus infection serves as an independent predictor of survival in patients with lymphoepithelioma-like gastric carcinoma

The pathogenesis and clinicopathologic characteristics of Epstein-Barr virus (EBV)-negative lymphoepithelioma-like gastric carcinoma (LELC) are still unclear. In addition, it remains controversial whether EBV infection itself affects the prognosis of LELC. Between 1995 and 2011, 145 LELC patients (124 patients with EBV infection and 21 patients without EBV infection) underwent radical gastrectomy with D2 lymph node dissection. The clinicopathologic features and prognosis of EBV-negative LELC cases were compared with those of EBV-positive LELC cases. The median duration of follow-up after surgery was 55months. Microsatellite instability (MSI) analysis was performed on 20 EBV-negative LELC cases. EBV-negative LELC accounted for 14.5% of the total LELC cases. EBV-negative LELC was significantly associated with older age, female sex, advanced T stage, and advanced American Joint Committee on Cancer (AJCC) tumor stage compared with EBV-positive LELC. In univariate analysis, patients with EBV-negative LELC had significantly shorter overall, disease-specific, and recurrence-free survival than those with EBV-positive LELC. The 5-year overall survival rates were 81.0% for patients with EBV-negative LELC and 96.2% for patients with EBV-positive LELC. In a Cox proportional hazards model, EBV infection, age, and AJCC tumor stage were identified as independent predictors of overall survival. MSI-high, MSI-low, and microsatellite-stable tumors accounted for 25, 10, and 65% of EBV-negative LELC cases, respectively. MSI status did not affect the prognosis of EBV-negative LELC cases. EBV infection serves as an independent predictor of survival in patients with LELC. EBV-negative LELC exhibited clinicopathologic features and prognosis distinct from those of EBV-positive LELC.