Gastric cancer and cytomegalovirus association: an incidental diagnosis of common variable immunodeficiency

Common variable immunodeficiency (CVID) is an immunodeficiency disease with an increased risk of malignancy, including gastric adenocarcinoma. We describe a case of a 41-year-old Caucasian man admitted in our department with a 3-month complaint of epigastric pain, asthenia, and weight loss. Esophagogastroduodenoscopy (EGDS) showed a bleeding ulcerative lesion in the greater gastric curve and biopsies revealed poorly differentiated adenocarcinoma cells. A sub-total gastrectomy was performed. Histology revealed a pT1b-pN0 gastric adenocarcinoma. Postoperative course was marked by prolonged fever, radiological and EGDS controls were negative. Immunohistochemically proven cytomegalovirus gastrointestinal disease was found. At multidisciplinary board a CVID diagnosis was given. At 22 months a new adenocarcinoma was diagnosed at 3 cm of the previous anastomosis. A total gastrectomy was performed. Histology revealed an gastric adenocarcinoma classified as rpT2-pN0. At 2 years of follow up patient is alive without recurrence. To conclude our case suggest us to perform a close follow up in patient with CVID.