Imaging and pathological analysis of primary pulmonary lymphoepithelioma-like carcinoma / 中华放射学杂志

ABSTRACT

Objective To discuss the imaging findings and pathological features of primary pulmonary lymphoepithelioma-like carcinoma (LELC). Methods Imaging and pathological data of 13 patients (9 male and 4 female, age from 17 to 72 years, median age 52 years) with pathology-proven primary pulmonary LELC from January 2010 to March 2015 were retrospectively analyzed. Thirteen patients underwent X-ray examination, two of them underwent non-enhanced CT scan, eight underwent non-enhanced and enhanced CT scans, one underwent non-enhanced MR scan. All imaging data including location, number, shape, size and density of lesions were analyzed by two experienced chest radiologists respectively and reached an agreement after consultations. Surgery was performed in 11 cases and aspiration biopsy in 2 cases. HE staining was performed in all cases and immunohistochemistry staining in 6 cases. Results All thirteen primary pulmonary LELC were unilateral. Nine peripheral tumors and four central tumors were identified. Lobulations (n=11), spiculas (n=7), vessel convergences (n=3), vascular encasements (n=2), pleural indentations (n=4) and punctuate calcification sign (n=1) were seen in the CT images. Thirteen tumors had diameters ranging from 1.3—11.0 cm, average diameter of (4.4 ± 2.7) cm, and all showed homogeneous density in non-enhanced CT. CT value ranged from 22—48 HU, average value of(34± 10)HU, and during arterial phase it ranged from 33—70 HU, average value of(53 ± 13)HU;and during venous phase it ranged from 43—86 HU, average value of(66±14)HU;the tumor had long T1 and long T2 signal in non-enhanced MR scan, and signals were homogeneous. Pathologically, the tumor was from pleomorphic epithelial with large cells, syncytia in the infiltration of lymphocytes or accompanied with collagenzation. Large nucleus showed vacuole-shape. Immunochemistry CK(+), P63(+), CK5/6(+), CK14(-) supported the diagnosis of LELC. Conclusions There are certain imaging characteristics for primary pulmonary LELC. Histopathological and immunohistochemistry examination could provide the definitive diagnose.