Clinicopathologic features of early gastric carcinoma with lymphoid stroma and feasibility of endoscopic submucosal dissection

Surg Endosc. 2017 Oct;31(10):4156-4164. doi: 10.1007/s00464-017-5470-8. Epub 2017 Apr 13.


Background: Gastric carcinoma with lymphoid stroma (GCLS) is a rare disease known to have unique features and a favorable prognosis. This study aimed to determine the clinicopathologic features of early GCLS (EGCLS) and define the feasibility of endoscopic submucosal dissection (ESD) for EGCLS.

Methods: We performed a retrospective analysis of 70 EGCLS patients treated via ESD or surgery and 1626 patients who underwent surgical resection for early non-GCLS (ENGCLS) between January 2007 and December 2014 at Pusan National University Hospital, Busan, Republic of Korea.

Results: The mean age of EGCLS patients was 58 years (range 36-77 years); a male predominance (3.7:1) was observed, and 81.4% showed Epstein-Barr virus positivity. Compared with ENGCLS, EGCLS was macroscopically more elevated (34.3 vs. 18.0%, P = 0.003) and located more proximally (upper third: 37.1 vs. 9.7%, P < 0.001). Tumor size was smaller (2.1 ± 1.1 vs. 3.1 ± 2.0 cm, P < 0.001), but submucosal invasion was more frequent (77.1 vs. 44.4%, P < 0.001) and deeper in the EGCLS group. Among the 59 EGCLS patients who were treated surgically, only two (3.4%) showed lymph node metastasis (LNM). Despite submucosal invasion, EGCLS showed a lower LNM rate (4.0 vs. 19.4%, P = 0.007) than ENGCLS, even in patients with SM3 EGCLS (5.3 vs. 24.5%, P = 0.007). There were no recurrences in the available ten patients who underwent ESD alone during a mean follow-up of 37.2 months.

Conclusions: In this study, we observed unique clinicopathologic features with a very low LNM rate in EGCLS. We consider ESD a potentially curative treatment strategy for EGCLS despite deep submucosal invasion, especially in patients with poor performance status and significant comorbidities.

Keywords: Early gastric cancer; Endoscopic submucosal dissection; Gastric carcinoma with lymphoid stroma.

MeSH terms

  • Adenocarcinoma / pathology*
  • Adenocarcinoma / surgery
  • Adenocarcinoma / virology
  • Adult
  • Aged
  • Aged, 80 and over
  • Connective Tissue / pathology*
  • Early Detection of Cancer
  • Endoscopic Mucosal Resection / methods
  • Epstein-Barr Virus Infections / epidemiology
  • Feasibility Studies
  • Female
  • Gastrectomy
  • Gastric Mucosa / pathology*
  • Gastric Mucosa / surgery
  • Humans
  • Lymph Node Excision
  • Lymph Nodes / pathology*
  • Lymphatic Metastasis
  • Lymphocytes / pathology*
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Republic of Korea
  • Retrospective Studies
  • Stomach Neoplasms / pathology*
  • Stomach Neoplasms / surgery
  • Stomach Neoplasms / virology
  • Young Adult