P3370 - A Rare Case of EBV-Associated Gastric Carcinoma With Lymphoid Stroma

Kishore Karri, MBBS, MD¹, Nimish Thakral, MD¹, Snigdha Nutalapati, MBBS, MD², Jerapas Thongpiya, MD^3
1University of Kentucky, Lexington, KY; ²University of Kentucky College of Medicine, Lexington, KY; ³Texas Tech University Health Sciences Center, Lubbock, TX

Introduction: Gastric cancer with lymphoid stroma (GCLS) is a rare type of gastric cancer characterized by abundant lymphocytic infiltration of the stroma. It is associated with Epstein-Barr virus. Currently there are no standardized guidelines for treatment. We present a case of GCLS that presented to our institution .

Case Description/Methods: A 50 year old male patient with no significant medical history presented to the hospital with fatigue and generalized weakness to the hospital . Of note , he had noticed black colored stools over the past few days . At admission , patient was noted to have hb of 5.2 . patient received PRBC transfusions with improvement in hb to > 8. His platelet count , Coagulation panel and LFTS were within normal limits. CT scan of abdomen with IV contrast showed wall thinning of distal stomach and edema of remaining gastric tissue concerning for ulcer. GI was consulted for EGD which was performed and showed Large non bleeding ulcer(Forrest grade 3 ) involving 2/3rds of pylorus circumference . Biopsy was concerning for chronic H. Pylori gastritis with focal intestinal metaplasia and patient was started on triple regimen with omeprazole 20 mg BID, amoxicillin and Clarithromycin . patient was admitted again with similar symptoms when a repeat EGD was performed which showed single large cratered friable , malignant appearing ulcer in pylorus with non bleeding visible vessel (forrest grade 2 A) that involves 80 % of circumference and extends through the pyloric channel . A cold foreceps biopsy was performed and pathology showed Gastric Cancer with Lymphoid stroma (EBV positive ) . Patient was referred to oncology for further treatment .

Discussion: Gastric cancer with lymphoid stroma (GCLS) is a rare type of gastric carcinoma which belongs to the group of Epstein-Barr virus (EBV)-associated gastric cancers and accounts for about 1%-7% of gastric carcinomas. Clinical manifestations are non-specific and diagnosis relies on pathological histological examination. There is no consensus on its management given its rarity . Potential surgical options include endoscopic gastric mucosal dissection in early stages and subtotal gastrectomy being required for advanced GCLS with lymph node metastasis. The role of Immunotherapy( Programmed cell death (PD)-1/PD-L1 immunotherapy) is potentially beneficial but there are no current established guidelines for the management of this rare malignancy .


Disclosures:


Kishore Karri, MBBS, MD¹, Nimish Thakral, MD¹, Snigdha Nutalapati, MBBS, MD², Jerapas Thongpiya, MD³. P3370 - A Rare Case of EBV-Associated Gastric Carcinoma With Lymphoid Stroma, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.