[Lymphoepithelioma-like gastric carcinoma: unusual variant in postgastrectomy stump]

Gastric lymphoepithelioma--like carcinoma, undifferentiated with lymphoid or medullary stroma, constitutes a 3.8% of gastric carcinomas. Microscopically it is similar to other lymphoepitheliomas, it has an expansive growth and better prognosis than other histologic types. A possible relation to Epstein Barr virus is presumed. A 56 year old female, gastrectomized due to a cancer (Billroth II) 31 years before, showed an ulcer lesion close to the anastomosis at endoscopy. A biopsy was taken with positive result and gastrectomy was performed. The surgical specimen included gastric stump, jejunoanastomosis, omentum and lymph nodes. It had a 4.5 cm, protruded ulcerated lesion, located in anterior wall, 1.5 cm from stomy. It was fixed in buffered formalin, routinely processed and stained with Hematoxilin--Eosin. Immunohistochemistry techniques for CKAE1-AE3, EMA, CEA, CD45, CD20, CD3 and CD45Ro, and PCR for Epstein Barr virus were performed. Microscopically it was constituted by an expansive proliferation of polygonal cells with barely eosinophylic cytoplasm and vesicular nuclei, arranged in small clusters or isolated, positive for CKAE1-AE3, EMA and CEA, with dense mature lymphoid infiltrate, both follicular and diffuse, positive for CD45, CD45Ro, CD3 and CD20. PCR technique for Epstein Barr virus was positive. This has been the first case of this type in our department since 1989. In addition to the peculiar characteristics of this variety, whose differential diagnosis must be made with lymphomas, the origin from gastric stump, where this complication appears with variable rates, the risk being related to the type of surgery and the time elapsed are relevant.