Early gastric cancer with lymphoid stroma presenting as a subepithelial lesion diagnosed by endoscopic submucosal dissection

  • Minoru Kato
  • Yoshito Hayashi
  • Kenji Fukumoto
  • Kengo Nagai
  • Yoshiki Tsujii
  • Shinichiro Shinzaki
  • Hideki Iijima
  • Tetsuo Takehara
Case Report


A 53-year-old man underwent an esophagogastroduodenoscopy that showed a 20-mm subepithelial lesion in the middle gastric body. Endoscopic ultrasound revealed a hypoechoic mass located in the submucosa. Biopsy specimens revealed a benign gastric mucosa with severe lymphocytic infiltration in the submucosa. Malignant lymphoma or gastric cancer with lymphoid stroma was suspected. We performed endoscopic submucosal dissection for definitive diagnosis. Histological examination showed undifferentiated adenocarcinoma, which showed positive Epstein–Barr virus-encoded RNA in situ hybridization results, invading the submucosa mixed with dense lymphocytic infiltration. Thus, Epstein–Barr virus-positive gastric cancer with lymphoid stroma was diagnosed. Gastric cancer with lymphoid stroma is a rare subtype of gastric cancer, which is associated with Epstein–Barr virus infection; it sometimes appears as a subepithelial lesion, which makes it difficult to diagnose using standard biopsy. Endoscopic submucosal dissection was useful in obtaining a sufficient tissue for full histological assessment, including immunostaining.


Gastric cancer Epstein–Barr virus Subepithelial lesion Endoscopic submucosal dissection 


Compliance with ethical standards

Conflict of interest

Minoru Kato, Yoshito Hayashi, Kenji Fukumoto, Kengo Nagai, Yoshiki Tsujii, Shinichiro Sinzaki, Hideki Iijima, and Tetsuo Takehara declare that they have no conflict of interest.

Human and animal rights statements

All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from all patients for being included in the study.


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Copyright information

© Japanese Society of Gastroenterology 2018

Authors and Affiliations

  • Minoru Kato
    • 1
  • Yoshito Hayashi
    • 1
  • Kenji Fukumoto
    • 1
  • Kengo Nagai
    • 1
  • Yoshiki Tsujii
    • 1
  • Shinichiro Shinzaki
    • 1
  • Hideki Iijima
    • 1
  • Tetsuo Takehara
    • 1
  1. 1.Department of Gastroenterology and HepatologyOsaka University Graduate School of MedicineOsakaJapan

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