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Resumen El carcinoma tipo-linfoepitelioma pulmonar es una variante rara de carcinoma de células no pequeñas de pulmón, representa aproximadamente 0.7% de todos los casos. Está usualmente asociado con la infección por el virus de Epstein-Barr y es más prevalente en el Sureste de Asia; sin embargo, es extremadamente raro en Améri ca Latina. Informamos el caso de un hombre de 65 años de edad con un carcinoma tipo-linfoepitelioma pulmo nar, que se presentó con tos, disnea y pérdida de peso. La TAC de tórax mostró nódulo mal definido localizado en el pulmón derecho. Se realizó biopsia transtorácica de la lesión, y el estudio microscópico reveló células gran des poligonales dispuestas en mantos, infiltrados por abundantes linfocitos y células plasmáticas, alrededor del intersticio. Las células neoplásicas fueron positivas para citoqueratina 5/6 y p63, y negativas para Napsina A y el factor de transcripción tiroideo 1 (TTF-1). La expre sión de PD-L1 fue positivo (aproximadamente 100%) por inmunohistoquímica; así como el núcleo de las células neoplásicas mediante hibridación in situ para el RNA codificado por el virus de Epstein-Barr (EBER-ISH). El paciente recibió seis ciclos de un esquema combinado de quimioterapia basado en platino (gencitabina/cisplatino) más durvalumab. Presentó progresión de la enfermedad y finalmente murió 9 meses después del diagnóstico.
Abstract Pulmonary lymphoepithelioma-like carcinoma is a rare type of non-small cell lung cancer, it accounts for approximately 0.7% of all cases. It is usually associated with Epstein-Barr virus infection and is more prevalent in Southeast Asia; however, it is extremely rare in Latin America. We present a 65-year-old man with a primary pulmonary lymphoepithelioma-like carcinoma, who presented with cough, dyspnoea and weight loss. Com puter tomographic scan of the thorax showed a nodule localized in the right lung. A transthoracic biopsy of the lung lesion was made and the microscopic obser vation revealed large polygonal cells that proliferated in a nest pattern with infiltration by lymphocytes and plasma cells around the interstitium. The tumour cells were positive for citokeratin 5/6 and p63, and negative for Napsin A and thyroid transcription factor 1 (TTF-1). PD-L1 expression was positive (approximately 100%) in the immunohistochemical study, and the nuclei of the tumour cells were positive for EBV-encoded small RNA in-situ hybridization (EBER-ISH). The patient underwent six cycles of platinum-based combination (gencitabine/ carboplatin) chemotherapy plus durvalumab. He pre sented progression of the disease and finally he died 9 months after diagnosis.
ABSTRACT
Primary pulmonary lymphoepithelioma-like carcinoma (PPLELC) is a distinct type of lung cancer with histological profiles similar to nasopharyngeal carcinoma. The development is associated with EBV and plasma EBV DNA has predictive value in the progression and prognosis of PPLELC. PPLELC is different from some other types of lung cancer in that it has a low mutation rate of the classical lung cancer driver genes and targeted therapy is ineffective for it. Chemotherapy combined with immunotherapy may be the best first-line treatment option for patients with advanced PPLELC.
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Urinary bladder neoplasm is the 10 most common cancer in the world, predominantly affecting males. Nowadays incidence of urinary bladder carcinoma in female has increased. It is a uncommon type carcinoma of urinary bladder. It resembles to non-keratinizing carcinoma of nasopharynx. This study report a case of 65 years old male presented with painless gross hematuria for 3 weeks. Patient was a known case of Meckel's diverticulum. Ultrasonography and cystoscopy showed a mass on lateral wall of urinary bladder measuring 3x3 cm . A radical cystectomy of the urinary bladder tumor was done. He was diagnosed as case of lymphoepithelioma like carcinoma of urinary bladder along with benign prostate hyperplasia and Meckel's diverticulum was made with stage 2. According to the WHO classification criteria, Lymphoepithelioma like carcinoma is a subtype of undifferentiated carcinomas. Immunohistochemical stains are helpful to differentiate Lymphoepithelioma from primary lymphoma of the bladder. Differentiation of LELCB from urothelial carcinoma is important, since it has better prognosis compared to pure urothelial carcinoma. It is important to diagnose this neoplasm for therapeutic as well as prognostic purpose.
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Lymphoepithelioma-like carcinoma or lymphoepithelial carcinoma (LEC) of the maxillary sinus is an extremely rare malignancy. It is a rare type of undifferentiated carcinoma, consisting of atypical epithelial cells surrounded by reactive lymphoplasmacytic infiltrate. The paper reports the case of a 76-year-old male patient, with complain of swelling on the hard palate and epistaxis. Biopsy from the hard palate mass showed features consistent with LEC, with contrast-enhanced computed tomography nasopharynx and neck showing soft-tissue lesion in the right maxillary sinus. The patient is currently under treatment with external beam radiotherapy.
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Resumen El carcinoma similar al linfoepitelioma (LELC) del cuello uterino es una variante infrecuente del carcinoma de células escamosas. Se presenta el caso de una mujer con un tumor exofítico en el cuello uterino de consistencia aumentada, sangrado al tacto y parametrios libres de tumor clasificándose como etapa clínica IBI; el estudio histopatológico reportó LELC con recurrencia a distancia al año de seguimiento. Debido a su buen pronóstico existen pocos casos reportados de recurrencia posterior al tratamiento inicial.
Abstract Lymphoepithelioma-like carcinoma (LELC) of the cervix is an uncommon variant of squamous cell carcinoma. We present the case of a woman with an exophytic tumor on the cervix of increased consistency, bleeding to the touch and tumor-free parametriums classified as clinical stage IBI; the histopathological study reported LELC with distant recurrence at one year of follow-up. Due to its good prognosis, there are few reported cases of recurrence after initial treatment.
Subject(s)
Humans , Female , Carcinoma, Squamous Cell , Cervix Uteri , Women , NeoplasmsABSTRACT
Lymphoepithelioma is a rare clinical entity, first was described in nasopharynx, and have been reported in another organs. Lymphoepithelioma-like carcinoma (LEC) of the breast is an undifferentiated carcinoma. Approximately 32 cases have been described, and differential diagnoses include primary breast lymphoma and medullary carcinoma. We present a 57-year-old woman, diagnosed with LEC of the breast, treated with mastectomy, followed by adjuvant chemotherapy, radiotherapy, and hormone therapy, with a disease-free interval of 2 years. There is scarce evidence related to the best treatment choice in this histological type.
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@#Primary pulmonary lymphoepithelioma-like carcinoma (PPLELC) is a rare type of lung cancer with special characteristics of epidemiology, clinical diagnosis, treatment and prognosis. It has close relationship with Epstein-Barr virus (EBV) infection and has prominent regional feature. Most patients are young and non-smoking. There is no specificity of clinical manifestation. Most patients are asymptomatic at the time of diagnosis. As for treatment, the standard treatment for early stage disease is complete resection. Platinum-based doublet chemotherapy has been applied in locally advanced disease as the first line therapy. Due to its rarity, the treatment of advanced PPLELC is still lack of evidence of large sample randomized controlled trial. Whether target therapy or immunotherapy is effective is worth further study. This article reviews the research progress of PPLELC, to give a particular sight for clinicians and provides a better understanding of this rare tumor for researchers.
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Objective: To investigate CT findings of pulmonary lymphoepithelioma-like carcinoma (LELC). Methods CT findings of 244 patients with pathologically proved pulmonary LELC were analyzed retrospectively. All patients underwent nonenhancement CT scan, 226 of them also underwent contrast-enhanced CT scan. Results: Totally 132 (132/244, 54.10%) central tumors and 112 (112/244, 45.90%) peripheral tumors were identified. The maximum diameter of lesion was ranged from 1.2 cm to 13.1 cm, with average (5.42±2.64)cm. The lesions were characterized with 49 (49/244, 20.08%) nodules and 195 (195/244, 79.92%) masses. Totally 169 (169/244, 69.26%) tumors were found with well-defined borders, 183 (183/244, 75.00%) showed lobulations, and 104 (104/244, 42.62%) showed spiculation. The tumor located closely with the mediastinum in 184 cases (184/244, 75.41%), while pleural change of tail sign was observed in 111 cases (111/244, 45.49%). The tumor showed homogeneous density on nonenhancement CT in 158 cases (158/244, 64.75%), moderate enhancement in 160 cases (160/223, 71.75%), gradually enhancement in 145 cases (145/193, 75.13%), while 108 cases (108/193, 55.96%) showed abnormal small vessels and 81 cases (81/193, 41.97%) showed vascular encasements. Bronchial encasement and/or stenosis was found in 185 cases (185/244, 75.82%). Ground-glass opacity around the lesion was detected in 124 cases (124/244, 50.82%), when interstitial thickening was noticed in 81 cases (81/244, 33.20%) and obstructive pneumonia or pulmonary atelectasis was found in 132 cases (132/244, 54.10%). Hilar and/or mediastinal lymph node enlargement was found in 167 cases (167/244, 68.44%). Conclusion: Most pulmonary LELC occurres in right middle lobe and bilateral lower lobe of lung, and appeares as well-defined and slight lobulated tumor with enlarged lymph nodes. Vascular encasements, closely associated with mediastinum, pleural change of tail sign, ground-glass opacity and interstitial thickening are comparative characteristics of pulmonary LELC.
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Objective To investigate CT,clinical and pathological features of primary pulmonary lymphoepithelioma-like carcinoma (LELC). Methods The clinical,CT and pathological data of 22 patients with pulmonary LELC confirmed by pathology were analyzed retrospectively, including 8 males and 1 4 females whose ages were from 1 8 to 88 years old.Results Among 22 cases,1 2 patients were found by physical examination,2 patients had cough and sputum,7 patients had cough hemoptysis and 1 patient was found by re-examination after breast cancer surgery.On CT,all cases manifested single mass in the lung,and the longer diameters ranged from 1.5 cm to 1 1 cm,in which there were central type tumors in 8 cases and peripheral type tumors in 14 cases.Nineteen masses showed homogeneous density in non-enhanced scan,and the cavity,irregular calcification and small patchy necrosis were seen in each 1 case.After contrast-media injected,masses were mild-moderately or evidently enhanced in 7 cases and 1 5 cases respectively.Eighteen cases had well defined border and unclear border in 4 cases.Vascular encasement were found in 6 central type tumors,8 tumors squeezed peripheral vascular and 8 cases had clear demarcation between tumors and vascular.Nineteen tumors were surgically removed,in which 7 cases appeared metastasis of lymph node.Histopathology showed that the tumor cells had large volumes,unclear boundaries,large nuclei,growing in syncytial nest-like patches.There were abundant lymphocyte and plasma cell infiltration in tumor’s mesenchyma.EBER were done in 1 6 cases and the results were all positive.Conclusion CT feature of pulmonary LELC manifestes that the masses are mostly single,large size, homogeneous density,clearly boundary,shallow lobulated and significantly enhancement.Vascular encasement is the feature of central pulmonary LELC,and peripheral LELC is more likely to occur in the sub-pleural region.Final diagnosis should be combined with clinical and pathological diagnosis.
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Abstract: Lymphoepithelioma-like hepatocellular carcinoma (LEL-HCC) is a rare primary hepatic neoplasm with female predominance and relatively good prognosis. We report a 73-year-old female with chronic hepatitis B who developed metastatic lesions 5 years after underwent resection for LEL-HCC. The metastatic lesions showed a spectrum of morphologic findings, which could be mistaken for other entities such as lymphoma, particularly in lesions with single-cell infiltrative pattern and abundant tumor-infiltrating lymphocytes. Immunohistochemical study to confirm the origin of the neoplastic cells is important to make the diagnosis. We also highlighted the clinicopathologic correlation and potential therapeutic implication of programmed death ligand-1 expression in LEL-HCC.
Subject(s)
Humans , Female , Aged , Biomarkers, Tumor/analysis , Carcinoma, Hepatocellular/chemistry , B7-H1 Antigen/analysis , Liver Neoplasms/chemistry , Biopsy , Immunohistochemistry , Predictive Value of Tests , Carcinoma, Hepatocellular/secondary , Carcinoma, Hepatocellular/therapy , Carcinoma, Hepatocellular/virology , Hepatitis B, Chronic/complications , Liver Neoplasms/pathology , Liver Neoplasms/therapy , Liver Neoplasms/virology , Lymphatic MetastasisABSTRACT
Purpose To study the clinicopathological characteristics,treatments and prognosis of primary pulmonary lymphoepithelioma-like carcinoma (LELC).Methods Twenty cases of LELC were collected and the clinicopathological characteristics,immunohistochemical expression,survival data and clinical treatments were analyzed,with review of the literatures.Resuits Histopathologically,it was characterized by the syncytial pattern of growing with large vesicular nuclei,conspicuous nucleoli,and a marked lymphocytic infiltrate in the stroma that was similar to undifferentiated nasopharyngeal carcinoma.The immunohistochemical staining of CKpan showed positive expression in all cases (100％).Also the positive expression of in situ hybridization of Epstein-Bar virus-encoded RNA (EBER) were in all cases (100％) while the positive cases of CK5/6,p63 and p40 were 19,18,and 16 respectively.But gene mutations such as EGFR,K-RAS were negative.All the LELC patients in this cohort were survived until the deadline of follow-up.Comprehensive treatments were done such as surgical resection,radiotherapy and chemotherapy.Conclusion Primary pulmonary LELC is a rare disease that histomorphological analysis and immunohistochemistry are the main methods of diagnosis for it.It must be excluded the metastasis carcinoma from other locations.While both EGFR mutation and anaplastic lymphoma kinase (ALK)mutation could be commonly detected in non-small cell lung cancer,but seldom in LELC of lung.The high expression of PD1/PD-L1 may provide a rationale for immunotherapy in this subtype of lung cancer.Currently,experimental therapy is still taken in the pulmonary LELC.
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A 69-year-old male smoker was referred to ¹⁸F-f luorodeoxyglucose (FDG) pos i t r on emi s sion tomography-computed tomography (PET/CT) with the indication of a suspicious solitary pulmonary nodule. FDG PET/CT determined a 2.5 × 2-cm soft-tissue lesion (SUVmax, 16.2) with spiculated margins in the hilum of the right lung. A 1-cm diameter lymphadenopathy on the right hilum with an SUVmax of 3.2 was also determined. Transbronchial biopsy of the right hilar lymphadenopathy did not reveal any malignant features in histopathologic examination, and it was determined to be reactive. The patient underwent a right upper lobe segmentectomy, and the histopathologic evaluation revealed that the tumor was a primary lymphoepithelioma-like carcinoma (LELC) of the lung with negative Epstein-Barr virus (EBV) on in situ hybridization studies. In this case report, we mainly focus on the FDG avidity of this very rare kind of tumor comparatively with previous reports and possible explanations of discordancy in FDG avidity in relation to histopathologic characteristics.
Subject(s)
Aged , Humans , Male , Biopsy , Herpesvirus 4, Human , In Situ Hybridization , Lung , Lung Neoplasms , Lymphatic Diseases , Mastectomy, Segmental , Positron Emission Tomography Computed Tomography , Solitary Pulmonary NoduleABSTRACT
Lymphoepithelioma-like carcinoma (LELC) of the uterine cervix is exceedingly uncommon. We herein report a rare case of cervical LELC. A 45-year-old woman was admitted to gynecology department with vaginal bleeding for one month. Liquid-based cytology revealed atypical endometrial cells, not otherwise specified on her cervix. On a hysteroscopy, an endocervical mass was identified and the pathologic result was consistent with poorly differentiated squamous cell carcinoma. Magnetic resonance imaging and positron emission tomography with 2-deoxy-2-[fluorine-18] fluoro-D-glucose integrated with computed tomography revealed a 3.1-cm endocervical mass without distant metastasis or enlarged lymph nodes. The International Federation of Gynecology and Obstetrics stage was IB1. A radical hysterectomy and bilateral pelvic lymph node dissection were performed. The pathologic diagnosis was a poorly differentiated carcinoma, showing features of LELC. She has been followed for 8 months without adjuvant treatment since the surgery, during which time there has been no evidence of tumor recurrence or metastasis.
Subject(s)
Female , Humans , Middle Aged , Carcinoma, Squamous Cell , Cervix Uteri , Diagnosis , Gynecology , Herpesvirus 4, Human , Hysterectomy , Hysteroscopy , Lymph Node Excision , Lymph Nodes , Magnetic Resonance Imaging , Neoplasm Metastasis , Obstetrics , Positron-Emission Tomography , Recurrence , Uterine Cervical Neoplasms , Uterine HemorrhageABSTRACT
Lymphoepithelioma-like carcinoma (LELC), an undifferentiated carcinoma with intense lymphoplasmacytic infiltrates, is commonly reported in the nasopharynx and occasionally in other organs. Pure type of LELC has previously been reported in the gallbladder. Mixed type could be reportable in comparison with other organs. Here we present a case of an 83-year-old man with mixed LELC and adenocarcinoma in the gallbladder. To the best of our knowledge, this is the first case of mixed LELC and adenocarcinoma in the gallbladder.
Subject(s)
Aged, 80 and over , Humans , Adenocarcinoma , Carcinoma , Gallbladder , NasopharynxABSTRACT
Lymphoepithelioma-like carcinoma (LELC) of the liver is uncommon, only 20 cases have been reported in the English-language literature so far, and the majority has been identified as cholangiocarcinomas, only four cases were hepatocellular LELC. Here we described a rare case of lymphoepitheliomalike hepatocellular carcinoma (HCC). A 42-year-old Chinese female who was incidentally found to have a liver-occupying lesion during a routine medical examination. Ultrasonography revealed a 47 mm × 33 mm × 36 mm hypoechoic mass in the left lobe. Computed tomography and magnetic resonance imaging displayed a nodular lesions in the left liver lobe. The patient underwent a left-side hepatectomy. Histopathological examination of the resected specimen revealed an undifferentiated carcinoma with a dense lymphocytic infiltrate, predominantly composed of CD3(+) T cells, morphologically similar to nasopharyngeal carcinoma. Immunohistochemically, the tumor cells were positive for CK, EMA, Glypican-3 and hepatocyte, but negative for alpha-fetoprotein, CK19, CK7 and CK20. Epstein–Barr virus (EBV) in situ hybridization was negative. The final histopathological diagnosis was lymphoepithelioma-like HCC without EBV infection.
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Objective To assess the diagnostic value of 18 F?FDG PET/CT imaging for primary pul?monary lymphoepithelioma?like carcinoma (LELC). Methods A total of 19 patients (10 males, 9 fe?males;average age 56.4 years) with suspected primary pulmonary LELC undergone whole?body 18F?FDG PET/CT and chest contrast CT scan were enrolled in this retrospective study. The SUVmax and uptake pat?terns of FDG, the histological types and the clinical stages were recorded. Image characteristics of contrast CT and FDG PET/CT were observed, and the diagnostic efficiency was calculated. Two?sample t test and one?way analysis of variance were used to analyze the results. Results The diagnostic sensitivity and spe?cificity of LELC were 12/13 and 4/6 for FDG PET/CT. The SUVmax of LELC lesions was significantly differ?ent from that of other lung malignant tumors or lung benign lesions (F=3.67, P<0?05). The lesion had longer diameter, lower CT density, higher SUVmax in stage Ⅳ patients, compared with that in stageⅠ-Ⅲpatients ( F=7.01, P<0.05) . The significant difference of SUVmax was found between lesions with ring up?take and lesions with other uptake types (3.94±0.67 vs 2.86±0.35; t=4.07, P<0?05). The SUVmax was higher in Schmincke tumors when compared with that in tumors of Regaud subtype ( 3. 61 ± 0. 71 vs 2. 76 ± 0?29; t=2.99, P<0.05) . Conclusion 18 F?FDG PET/CT could be an accurate method in differential diag?noses of primary pulmonary LELC.
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Due to differences in prognosis and management, it is important to subclassify esophageal carcinoma. Esophageal lymphoepithelioma-like carcinoma (LELC) is extremely rare, with only a few cases reported to date. Review of the literature revealed case reports describing lesions with similar histology. We present a 69-year-old man with a giant pedunculated-polypoid lesion of the esophagus shrinking the lumen. Endoscopic excision of the tumor was performed and final histopathological diagnosis was confirmed to be LELC. In contrast to a previous case with a more aggressive course and a recurrent lesion, our patient died of his disease within 8 months of diagnosis. Here we discuss the endoscopic and radiologic findings of the case and a review of the literature.
Subject(s)
Aged , Humans , Diagnosis , Esophagus , PrognosisABSTRACT
Purpose To investigate the clinicopathologic features and immunophenotype as well as its association with EBV infection of lymphoepithelioma-like gastric carcinoma (LLGC). Methods The clinical pathological data were reviewed, morphological changes were observed and immunohistochemical staining was done in 6 cases of LLGC. The expression of EBV-encoded small RNA ( EBER) in the 6 cases of LLGC were carried out by in situ hybridization. Results All of the six patients were male, the age was arranged 47 to 68 years, with mean of 55 years. All of the six cases, the lesions were located in gastric body. Microscopically, the undifferentiated carcinoma cells were arranged in cords and nests, scattering in the lymphoid-rich stroma, occasionally poor development tubular struc-tures were seen in the near surface of mucosa. Lymphoid follicles could be seen with lack of fibrous tissues reaction in the tumor stro-ma. Immunohistochemical staining and in situ hybridization showed the tumor cells were diffusely positive for CKpan, CK19, CEA and EBER, but negative to CK7, CK20, CK5/6 and LMP1; interstitial lymphocytes expressed CD3 or CD20, while lost expression of EBER. Follow-up for 6-57 months, all of the 6 patients were survived without tumor. Conclusions The LLGC is a rare and unique subtype of gastric carcinoma with good prognosis, which is often associated with EBV infection.
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Lymphoepithelioma-like gastric carcinoma (LELGC) is a rare neoplasm of the stomach with an incidence of 1-4% of all gastric cancers. It is characterized by the presence of a lymphoid stroma with cells arranged primarily in micro alveolar, thin trabecular, and primitive tubular patterns or isolated cells. It is one of the histological patterns observed in patients with Epstein — Barr virus (EBV)-associated gastric carcinoma (EBVaGC). In situ hybridization was usually used to confirm the presence of EBV. There are two types of EBVaGC, LELGC, and ordinary type. Approximately, 15-25% of EBVaGC exhibit the LELGC pattern. Here, we described two cases of LELGC and the related literatures were reviewed as well. The two cases were submucosal mass from a 59- or 63-year-old man. We found LELGC has special clinicopathologic features and protein expression profile. This should promote us to make a true diagnosis.