Clinicopathological Feature and Developmental Process of Metachronous Gastric Remnant Carcinoma : From the Standpoint of Epstein-Barr Virus-associated Gastric Carcinoma Yasuharu Kaizaki 1 , Osamu Hosokawa 2 , Masakazu Hattori 2 , Hiroyuki Hayashi 2 , Kenji Dohden 2 1Department of Pathology, Fukui Prefectural Hospital 2Department of Surgery, Fukui Prefectural Hospital Keyword: 残胃癌 , 胃癌術後 , Epstein-Barr virus , Helicobacter pylori , 組織発生 pp.1009-1019
Published Date 2004/6/25
DOI https://doi.org/10.11477/mf.1403100521
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 Epstein-Barr virus(EBV)-associated gastric carcinoma(EBVaGC)has been reported to account for10% or less of gastric carcinoma in Japan. It occurs predominantly in the proximal stomach. A high frequency of EBVaGC was observed in de novo carcinoma in the remnant stomach. However, the clinicopathological features of EBV-associated gastric remnant carcinoma after gastrectomy for gastric carcinoma have yet to be clearly demonstrated. In45cases, in so far as tissue specimens of the initial operation could be obtained, the primary and secondary carcinomas were analyzed retrospectively for EBV-encoded mRNA(EBER)-in situ hybridization(ISH), mucous phenotype of the tumor, Helicobacter pylori(H. pylori), and the pathological feature of the background mucosa. Seven of45secondary carcinomas(16%)were positive for EBER-ISH. EBV involvement in the secondary carcinomas was not significantly different from that found in the ordinary gastric carcinoma. In patients in whom the primary carcinoma was EBV-positive, the second carcinoma was also EBV-positive in six of11cases. Clinicopathologically, during the interval between the surgeries,EBV-positive cases were significantly different from EBV-negative cases in EBV prevalence in the primary carcinoma, and also in tumor size. Grade of atrophy, lymphocytic infiltration, neutrophilic infiltration and H. pylori infection in the background mucosa of the secondary carcinoma was lower than that found in the primary carcinoma. In conclusion, we can say that the risk factor for EBV-associated gastric remnant carcinoma after gastrectomy for gastric carcinoma is EBV involvement in the primary carcinoma. The short period after the initial surgery and the background mucosa changing after the initial operation would be unlikely to give rise to a new occurrence of EBV-associated gastric remnant carcinoma. So it is possible that, at the initial surgery, a minute EBVaGC that could not be discovered macroscopically, may have existed at the oral side of the resected stomach.

 1) Department of Pathology, Fukui Prefectural Hospital, Fukui, Japan

 2) Department of Surgery, Fukui Prefectural Hospital, Fukui, Japan

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