Gastric submucosa-invasive carcinoma associated with Epstein-Barr virus and endoscopic submucosal dissection: A case report

Figure 1 Endoscopic and ultrasonographic images of gastric carcinoma with lymphoid stroma (Case 1). A: A protruding lesion with central depression is covered with mucosa, the surface of which shows slight hyperemia; B: Magnifying narrow-band imaging reveals regular round and oval pits on the surface of the tumor; C: A 7.5-MHz endoscopic ultrasound image shows hypo-echoic lesions projecting into the third hyperechoic layer (white arrows).

Figure 2 Findings on histological examination of the endoscopically resected specimen (Case 1). A: The low-magnification view shows gastric carcinoma with lymphoid stroma (GCLS) located in the mucosa to deep submucosa (hematoxylin and eosin: HE); B: A microscopic view of the GCLS reveals normal epithelium overlying the tumor (HE, × 100); C: Epstein-Barr virus-encoded RNA in situ hybridization shows intense staining in carcinoma cells (× 100). GCLS: Gastric carcinoma with lymphoid stroma; HE: Hematoxylin and eosin.

Figure 3 Endoscopic and ultrasonographic images of gastric carcinoma with lymphoid stroma (Case 2). A: Submucosal tumor-like lesion with dilated capillary vessels is found in the lower gastric body at the first endoscopic examination; B: Indigo carmine dye spraying emphasizes the protruded tumor with central depression; C: A 20 MHz endoscopic ultrasound image shows a multinodular hypoechoic mass located in the submucosal layer.

Figure 4 Findings on histological examination of the endoscopically resected specimen (Case 2). A: The low-magnification view shows gastric carcinoma with lymphoid stroma mainly located in the submucosal layer (hematoxylin and eosin: HE); B: A microscopic view reveals massive infiltration of lymphoid cells (HE, × 100); C: Epstein-Barr virus-encoded RNA in situ hybridization shows intensely positive staining in the nests of cancer cells (× 100). HE: Hematoxylin and eosin.