IDCases · 2026
Gastric cytomegalovirus disease mimicking locally advanced gastric adenocarcinoma in a patient with newly diagnosed AIDS: A case report and literature review.
Клинический случайСтатьяНазвание и аннотация: Перевод пока не подготовлен
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Nikmanesh Mehrdad, Tabarsi Payam, Sedaghat Meghdad, Pourabdollah Mihan, Mortaz Esmaeil, Mansouri Davood
Аннотация
INTRODUCTION: Gastric cytomegalovirus (CMV) disease is an uncommon manifestation of tissue-invasive CMV infection and, in rare instances, may mimic gastric malignancy. Recognition of this pseudomalignant presentation is important to prevent misdiagnosis and inappropriate oncologic management.
CASE PRESENTATION: A 65-year-old woman presented with abdominal pain, diarrhea, recurrent post-prandial vomiting, poor oral tolerance, and a 20-kg weight loss over one year. Upper gastrointestinal endoscopy showed a large ulcerated antral mass with raised borders, highly suspicious for gastric adenocarcinoma. Endoscopic ultrasound (EUS) demonstrated a hypoechoic prepyloric/pyloric lesion with mural thickening extending to the subserosa and regional lymphadenopathy, resembling locally advanced gastric malignancy. Diagnostic laparoscopy, ascitic fluid cytology, and omental biopsy showed no malignancy. Histopathological review of gastric biopsies revealed severe CMV cytopathic changes in endothelial, epithelial, and stromal cells, confirmed by CMV immunohistochemistry. Cytokeratin markers were negative in atypical stromal cells, supporting exclusion of poorly differentiated adenocarcinoma. Subsequent evaluation revealed newly diagnosed advanced HIV infection with profound CD4 lymphopenia (initial CD4 count, 24.5 cells/µL), CMV viremia (31,000 copies/mL), HIV-1 RNA viremia (192,129 copies/mL), and CMV retinitis. The patient was treated with intravenous ganciclovir 250 mg twice daily for approximately 32 days, followed by oral valganciclovir 900 mg twice daily, together with antiretroviral therapy and intravitreal ganciclovir 2 mg for left-eye CMV retinitis. Follow-up demonstrated clearance of CMV viremia, subsequent suppression of HIV viremia to undetectable levels, CD4 recovery to 120 cells/µL, complete endoscopic healing of the gastric ulcers, and no evidence of neoplasia on repeat biopsies.
CONCLUSION: Gastric CMV disease can closely mimic locally advanced gastric adenocarcinoma on endoscopy and EUS. In immunocompromised patients with malignant-appearing gastric lesions, repeat tissue sampling and CMV immunohistochemistry should be considered before committing to oncologic treatment, with cytokeratin staining performed when histologically indicated.
CASE PRESENTATION: A 65-year-old woman presented with abdominal pain, diarrhea, recurrent post-prandial vomiting, poor oral tolerance, and a 20-kg weight loss over one year. Upper gastrointestinal endoscopy showed a large ulcerated antral mass with raised borders, highly suspicious for gastric adenocarcinoma. Endoscopic ultrasound (EUS) demonstrated a hypoechoic prepyloric/pyloric lesion with mural thickening extending to the subserosa and regional lymphadenopathy, resembling locally advanced gastric malignancy. Diagnostic laparoscopy, ascitic fluid cytology, and omental biopsy showed no malignancy. Histopathological review of gastric biopsies revealed severe CMV cytopathic changes in endothelial, epithelial, and stromal cells, confirmed by CMV immunohistochemistry. Cytokeratin markers were negative in atypical stromal cells, supporting exclusion of poorly differentiated adenocarcinoma. Subsequent evaluation revealed newly diagnosed advanced HIV infection with profound CD4 lymphopenia (initial CD4 count, 24.5 cells/µL), CMV viremia (31,000 copies/mL), HIV-1 RNA viremia (192,129 copies/mL), and CMV retinitis. The patient was treated with intravenous ganciclovir 250 mg twice daily for approximately 32 days, followed by oral valganciclovir 900 mg twice daily, together with antiretroviral therapy and intravitreal ganciclovir 2 mg for left-eye CMV retinitis. Follow-up demonstrated clearance of CMV viremia, subsequent suppression of HIV viremia to undetectable levels, CD4 recovery to 120 cells/µL, complete endoscopic healing of the gastric ulcers, and no evidence of neoplasia on repeat biopsies.
CONCLUSION: Gastric CMV disease can closely mimic locally advanced gastric adenocarcinoma on endoscopy and EUS. In immunocompromised patients with malignant-appearing gastric lesions, repeat tissue sampling and CMV immunohistochemistry should be considered before committing to oncologic treatment, with cytokeratin staining performed when histologically indicated.