Two early EBV-positive gastric cancers in one patient with H. pylori infection

What happened, in summary

A 60-year-old man with no symptoms was found to have Helicobacter pylori infection during a medical checkup. Endoscopy then revealed two nearby gastric lesions. Biopsies showed moderately differentiated tubular adenocarcinoma. Imaging found no enlarged lymph nodes or distant metastases, and both tumors were clinically Stage I.

He underwent distal gastrectomy with D2 lymph-node dissection. Pathology showed that both cancers were confined to the submucosal layer and that all 17 removed lymph nodes were free of metastasis. Pathology confirmed Stage I disease, and the surgical margins were negative.

Unexpectedly, both tumors tested positive for Epstein-Barr virus, with prominent lymphocyte infiltration around the cancers. His blood EBV DNA level after surgery was normal, and he had no signs of chronic active EBV infection. Because the cancers had been completely resected at an early stage, no adjuvant chemotherapy was given. H. pylori eradication therapy was also completed successfully.

He continued surveillance, including annual endoscopy of the remaining stomach. Three years after surgery, he was in good health with no recurrence or metastatic disease.