A Case of Gastric Lymphoepithelioma-like Carcinoma Presenting as Panperitonitis by Perforation of Stomach

Pyung Gohn Goh; Eui Sik Kim; Yun Jeung Kim; Soo Youn Lee; Hee Seok Moon; Seok Hyun Kim; Byung Seok Lee; Hyun Yong Jeong

doi:10.4166/kjg.2011.58.4.208

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Goh, Kim, Kim, Lee, Moon, Kim, Lee, and Jeong: A Case of Gastric Lymphoepithelioma-like Carcinoma Presenting as Panperitonitis by Perforation of Stomach

Case Report

Korean J Gastroenterol 2011;58(4):208-211.

Published online: 4 October 2011

DOI: https://doi.org/10.4166/kjg.2011.58.4.208

A Case of Gastric Lymphoepithelioma-like Carcinoma Presenting as Panperitonitis by Perforation of Stomach

Pyung Gohn Goh, Eui Sik Kim, Yun Jeung Kim, Soo Youn Lee, Hee Seok Moon, Seok Hyun Kim, Byung Seok Lee, Hyun Yong Jeong

Department of Internal Medicine, School of Medicine, Chungnam National University, Daejeon, Korea

Correspondence to: Hee Seok Moon, Department of Internal Medicine, School of Medicine, Chungnam National University, 33, Munhwa-ro, Jung-gu, Daejeon 301-721, Korea. Tel: +82-42-280-7143, Fax: +82-42-257-5753, E-mail: mhs1357@hanmail.net

Received 10 August 2010 Accepted 6 September 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Gastric lymphoepithelioma-like carcinoma is a rare carcinoma among gastric malignant tumor but has a good prognosis. The carcinoma has histologic feature characterized by small nest of cancer cells mixed with lymphoid stroma. We report a case with lymphoepithelioma-like carcinoma of stomach initially presenting as panperitonitis because of spontaneous tumor perforation. A 56-year-old man visited our emergency room because of epigastric pain. A preoperative abdominal CT scan showed a massive pneumoperitoneum in the upper abdomen, and the presence of gastric cancer in the lesser curvature of the stomach. An emergent laparotomy was performed followed by radical subtotal gastrectomy. Pathologic examination revealed that the tumor was a lymphoepithelioma-like gastric carcinoma.

Keywords: Gastric lymphoepithelioma-like carcinoma, Spontaneous tumor perforation

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Fig. 1.

Chest X-ray finding. It showed free air below the right diaphragm.

Fig. 2.

Abdominal CT finding. It showed massive pneumoperitoneum, especially in the upper abdomen. Cancer with occult perforation was suspected because of gastric wall thickening with small air bubble in the lesser curvature of the stomach.

Fig. 3.

Gross finding of subtotally resected stomach. There was a large ulceroinfiltrative lesion in the antrum along the lesser curvature. The size of tumor was 6.9×6.6 cm sized. At the central portion of the tumor a tiny hole was noted, suggesting perforated site (yellow arrow).

Fig. 4.

Pathologic findings. (A) Tumor cells infiltrated into the serosa (H&E, ×20). (B) Tumor cells consisted ‘pushing border' around the muscle layer. It was characteristic of lymphoepithelioma-like carcinoma (H&E, ×20). (C) Nests of tumor cells were mixed with numerous lymphocytes. A lot of lymphocytes infiltrated into the surrounding muscle layers (H&E, ×200).

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