Gastric glands lined by foveolar epithelium with intestinal metaplasia are seen immersed within a cellular background of lymphoid cells.
Reactive foveolar glands merge with a malignant proliferation of enlarged cells surrounded by a mature lymphoid stroma.
Tumor cells consist of sheets of cells without any glandular differentiation.
The malignant cells are large with vesicular chromatin and uniformly large nucleoli; a chronic inflammatory infiltrate is intimately admixed.
Epstein–Barr virus-associated gastric carcinoma is defined as the presence of EBV in the tumor cells, which is identified by performing EBV-encoded RNA (EBER) in situ hybridization. A low power of the underlying infiltrating component for EBER is seen here. The mature appearing lymphoid cells are EBER negative while the enlarged cells are staining.
The normal glands are negative for EBER but the tumor cells are markedly positive.
Lymphoepithelioma-like gastric carcinomas associated with EBV show a male predominance(Shibata).
There remains controversy with respect to the effects of EBV-related gastric cancer on survival. van Beek et al. reported that these tumors are significantly associated with better cancer-specific survival and a longer disease-free period (van Beek). Other studies fail to show any relationship between survival and EBV related tumors, as compared with EBV-negative gastric cancers (Kume; Chang).
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Shibata, D. , M. Tokunaga , Y. Uemura , E. Sato , S. Tanaka , and L. M. Weiss . Association of Epstein-Barr virus with undifferentiated gastric carcinomas with intense lymphoid infiltration, lymphoepithelioma-like carcinoma. Am J Pathol 1991. 139:469–474.
Van Beek J, Zur Hausen A, Klein Kranenbarg E et al. EBV-positive gastric adenocarcinomas: a distinct clinicopathologic entity with a low frequency of lymph node involvement. J. Clin. Oncol. 2004; 22: 664–70.
Kume T, Oshima K, Shinohara T et al. Low rate of apoptosis and overexpression of bcl-2 in Epstein-Barr virus-associated gastric carcinoma. Histopathology 1999; 34: 502–9.
Chang MS, Lee HS, Kim CW, Kim YI, Kim WH. Clinicopathologic characteristics of Epstein-Barr virus-incorporated gastric cancers in Korea. Pathol. Res. Pract. 2001; 197: 395–400.