Primary lymphoepithelioma-like carcinoma of the lung: a case report and literature review_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

SONG Lin ¹ ,  HAN Fengfeng ¹ , CUI Zhilei ¹ , GUAN Wenbin ² , GUO Xuejun ¹

1. Department of Respiratory Medicine, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, P. R. China;
2. Department of Pathology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, P. R. China;

Corresponding author：

HAN Fengfeng, Email: fengfh86@sina.com

Keywords：

Lymphoepithelioma-like carcinoma of the lung; Clinicopathology; Epstein-Barr virus; Prognosis

DOI：

10.7507/1671-6205.201610028

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the clinicopathologic features, diagnosis, treatment and prognosis of the primary lymphoepithelioma-like carcinoma (PLELC) of the lung. Methods Clinical and pathological data of one patient with PLELC of the lung were reviewed. PLELC of the lung was analyzed through review of literatures. Results A mass in the upper lobe of the left lung and atelectasis were detected by CT in a 36 year old nonsmoker male. He presented with cough, expectoration, fever and shortness of breath for one month. Neoplasm in left main bronchus was observed through bronchoscopy. Histological study showed cohesive clusters of comprising syncytial-appearing cells with vesicular nuclei and tumor infiltrating lymphocytes. Immunohistochemistry showed positive expression of Epstein-Barr virus (EBV) encoded small nuclear RNA. Nasal CT scan was negative for suspicious nasopharyngeal mucosal lesion or tumor. Then he was diagnosed as PLELC. The patient received docetaxel+nedaplatin regimens for 6 cycles with stable disease, but one month later after the end of chemotherapy, he was readmitted to hospital for dyspnea. CT scans showed progression of the lesion with massive pericardial effusion and pleural effusion. The patient could not tolerate chemotherapy, then received supportive treatment and died soon. Totally 18 Chinese articles and 25 foreign articles were screened out. Literature review suggested that patients with PLELC of the lung usually occurred in young nonsmokers and without gender difference. PLELC of the lung was closely associated with EBV infection. Its clinical manifestations were not specific, so that histopathological and immunohistochemical analyses were the main method of diagnosis. PLELC of the lung may respond to chemotherapy and radiotherapy. Surgery-based multimodality treatment was recommended. Patients with early or resectable disease had better prognosis, but patients with unresectable disease had poor prognosis. Conclusions PLELC of the lung may be closely associated with EBV infection. Histopathological and immunohistochemical analysis is the main method of diagnosis. Surgery-based multimodality treatment should be recommended because of its high response to chemotherapy and radiotherapy. Patients with early or resectable disease have better prognosis.

Citation： SONG Lin, HAN Fengfeng, CUI Zhilei, GUAN Wenbin, GUO Xuejun. Primary lymphoepithelioma-like carcinoma of the lung: a case report and literature review. Chinese Journal of Respiratory and Critical Care Medicine, 2017, 16(6): 575-580. doi: 10.7507/1671-6205.201610028 Copy

1.	Aoki R, Mitsui H, Harada K, et al. A case of lymphoepithelioma-like carcinoma of the skin associated with Epstein-Barr virus infection. J Am Acad Dermatol, 2010, 62(4): 681-684.
2.	Bégin LR, Eskandari J, Joncas J, et al. Epstein-Barr virus related lymphoepithelioma-like carcinoma of lung. J Surg Oncol, 1987, 36(4): 280-283.
3.	韩安家, 熊敏, 顾荣荣, 等. 肺淋巴上皮瘤样癌临床病理特点和预后. 中华病理学杂志, 2001, 30(5): 328-331.
4.	张冬坤, 苏晓东, 龙浩, 等. 原发性肺淋巴上皮瘤样癌的临床分析. 中华肿瘤杂志, 2008, 30(1): 72-74.
5.	夏金晶, 姜丽岩, 张杰, 等. 原发性肺淋巴上皮瘤样癌 21 例手术患者临床分析. 中国肺癌杂志, 2009, 12(11): 1169-1173.
6.	蒋牧良, 龙莉玲, 秦雯, 等. 原发性肺淋巴上皮瘤样癌影像表现与病理分析. 中华放射学杂志, 2016, 50(2): 91-94.
7.	Han AJ, Xiong M, Zong YS. Association of Epstein-Barr virus with lymphoepithelioma-like carcinoma of the lung in southern China. Am J Clin Pathol, 2000, 114(2): 220-226.
8.	Han AJ, Xiong M, Gu YY, et al. Lymphoepithelioma-like carcinoma of the lung with a better prognosis. A clinicopathologic study of 32 cases. Am J Clin Pathol, 2001, 115(6): 841-850.
9.	Ho JC, Wong MP, Lam WK. Lymphoepithelioma-like carcinoma of the lung. Respirology, 2006, 11(5): 539-545.
10.	Ooi GC, Ho JC, Khong PL, et al. Computed tomography characteristics of advanced primary pulmonary lymphoepithelioma-like carcinoma. Eur Radiol, 2003, 13(3): 522-526.
11.	Hoxworth JM, Hanks DK, Araoz PA, et al. Lymphoepithelioma-like carcinoma of the lung: radiologic features of an uncommon primary pulmonary neoplasm. Am J Roentgenol, 2006, 186(5): 1294-1299.
12.	Ma H, Wu Y, Lin Y, et al. Computed tomography characteristics of primary pulmonary lymphoepithelioma-like carcinoma in 41 patients. Eur J Radiol, 2013, 82(8): 1343-1346.
13.	Chan AT, Teo PM, Lam KC, et al. Multimodality treatment of primary lymphoepithelioma-like carcinoma of the lung. Cancer, 1998;83(5): 925-929.
14.	Huang CJ, Feng AC, Fang YF, et al. Multimodality treatment and long-term follow-up of the primary pulmonary lymphoepithelioma-like carcinoma. Clin Lung Cancer, 2012, 13(5): 359-362.
15.	Wang L, Lin Y, Cai Q, et al. Detection of rearrangement of anaplastic lymphoma kinase (ALK) and mutation of epidermal growth factor receptor (EGFR) in primary pulmonary lymphoepithelioma-like carcinoma. J Thorac Dis, 2015, 7(9): 1556-1562.
16.	Liu Q, Ma G, Yang H, et al. Lack of epidermal growth factor receptor gene mutations in exons 19 and 21 in primary lymphoepithelioma-like carcinoma of the lung. Thorac Cancer, 2014, 5(1): 63-67.
17.	Liang Y, Wang L, Zhu Y, et al. Primary pulmonary lymphoepithelioma-like carcinoma: fifty-two patients with long-term follow-up. Cancer, 2012, 118(19): 4748-4758.
18.	Castro CY, Ostrowski ML, Barrios R, et al. Relationship between Epstein-Barr virus and lymphoepithelioma-like carcinoma of the lung: a clinicopathologic study of 6 cases and review of the literature. Hum Pathol, 2001, 32(8): 863-872.
19.	Travis WD, Brambilla E, Nicholson AG, et al. The 2015 World Health Organization Classification of Lung Tumors: impact of genetic, clinical and radiologic advances since the 2004 Classification. J Thorac Oncol, 2015, 10(9): 1243-1260.
20.	Kasai K, Kon S, Sato N, et al. Case report of lymphoepithelioma-like carcinoma of the lung--lymphoid population consisting of cytotoxic T cells in resting state. Pathol Res Pract, 1999, 195(11): 773-779.
21.	陈愉生, 苗彦, 李鸿茹, 等. 原发性肺淋巴上皮瘤样癌一例. 中华结核和呼吸杂志, 2013, 36(1): 61-63.
22.	Liang YS, Shen C, Che GW, et al. Primary pulmonary lymphoepithelioma-like carcinoma initially diagnosed as squamous metaplasia: a case report and literature review. Oncol Lett, 2015, 9(4): 1767-1771.
23.	Wong JF, Teo MC. Case report: lymphoepithelial-like carcinoma of the lung--a chronic disease?. World J Surg Oncol, 2012, 10: 91.
24.	Fang W, Hong S, Chen N, et al. PD-L1 is remarkably over-expressed in EBV-associated pulmonary lymphoepithelioma-like carcinoma and related to poor disease-free survival. Oncotarget, 2015, 6(32): 33019-33032.
25.	Jiang L, Wang L, Li PF, et al. Positive expression of programmed death ligand-1 correlates with superior outcomes and might be a therapeutic target in primary pulmonary lymphoepithelioma-like carcinoma. Onco Targets Ther, 2015, 8: 1451-1457.
26.	He J, Shen J, Pan H, et al. Pulmonary lymphoepithelioma-like carcinoma: a surveillance, epidemiology, and end results database analysis. J Thorac Dis, 2015, 7(12): 2330-2338.
27.	Ngan RK, Yip TT, Cheng WW, et al. Clinical role of circulating Epstein-Barr virus DNA as a tumor marker in lymphoepithelioma-like carcinoma of the lung. Ann N Y Acad Sci, 2004, 1022: 263-370.

1. Aoki R, Mitsui H, Harada K, et al. A case of lymphoepithelioma-like carcinoma of the skin associated with Epstein-Barr virus infection. J Am Acad Dermatol, 2010, 62(4): 681-684.
2. Bégin LR, Eskandari J, Joncas J, et al. Epstein-Barr virus related lymphoepithelioma-like carcinoma of lung. J Surg Oncol, 1987, 36(4): 280-283.
3. 韩安家, 熊敏, 顾荣荣, 等. 肺淋巴上皮瘤样癌临床病理特点和预后. 中华病理学杂志, 2001, 30(5): 328-331.
4. 张冬坤, 苏晓东, 龙浩, 等. 原发性肺淋巴上皮瘤样癌的临床分析. 中华肿瘤杂志, 2008, 30(1): 72-74.
5. 夏金晶, 姜丽岩, 张杰, 等. 原发性肺淋巴上皮瘤样癌 21 例手术患者临床分析. 中国肺癌杂志, 2009, 12(11): 1169-1173.
6. 蒋牧良, 龙莉玲, 秦雯, 等. 原发性肺淋巴上皮瘤样癌影像表现与病理分析. 中华放射学杂志, 2016, 50(2): 91-94.
7. Han AJ, Xiong M, Zong YS. Association of Epstein-Barr virus with lymphoepithelioma-like carcinoma of the lung in southern China. Am J Clin Pathol, 2000, 114(2): 220-226.
8. Han AJ, Xiong M, Gu YY, et al. Lymphoepithelioma-like carcinoma of the lung with a better prognosis. A clinicopathologic study of 32 cases. Am J Clin Pathol, 2001, 115(6): 841-850.
9. Ho JC, Wong MP, Lam WK. Lymphoepithelioma-like carcinoma of the lung. Respirology, 2006, 11(5): 539-545.
10. Ooi GC, Ho JC, Khong PL, et al. Computed tomography characteristics of advanced primary pulmonary lymphoepithelioma-like carcinoma. Eur Radiol, 2003, 13(3): 522-526.
11. Hoxworth JM, Hanks DK, Araoz PA, et al. Lymphoepithelioma-like carcinoma of the lung: radiologic features of an uncommon primary pulmonary neoplasm. Am J Roentgenol, 2006, 186(5): 1294-1299.
12. Ma H, Wu Y, Lin Y, et al. Computed tomography characteristics of primary pulmonary lymphoepithelioma-like carcinoma in 41 patients. Eur J Radiol, 2013, 82(8): 1343-1346.
13. Chan AT, Teo PM, Lam KC, et al. Multimodality treatment of primary lymphoepithelioma-like carcinoma of the lung. Cancer, 1998;83(5): 925-929.
14. Huang CJ, Feng AC, Fang YF, et al. Multimodality treatment and long-term follow-up of the primary pulmonary lymphoepithelioma-like carcinoma. Clin Lung Cancer, 2012, 13(5): 359-362.
15. Wang L, Lin Y, Cai Q, et al. Detection of rearrangement of anaplastic lymphoma kinase (ALK) and mutation of epidermal growth factor receptor (EGFR) in primary pulmonary lymphoepithelioma-like carcinoma. J Thorac Dis, 2015, 7(9): 1556-1562.
16. Liu Q, Ma G, Yang H, et al. Lack of epidermal growth factor receptor gene mutations in exons 19 and 21 in primary lymphoepithelioma-like carcinoma of the lung. Thorac Cancer, 2014, 5(1): 63-67.
17. Liang Y, Wang L, Zhu Y, et al. Primary pulmonary lymphoepithelioma-like carcinoma: fifty-two patients with long-term follow-up. Cancer, 2012, 118(19): 4748-4758.
18. Castro CY, Ostrowski ML, Barrios R, et al. Relationship between Epstein-Barr virus and lymphoepithelioma-like carcinoma of the lung: a clinicopathologic study of 6 cases and review of the literature. Hum Pathol, 2001, 32(8): 863-872.
19. Travis WD, Brambilla E, Nicholson AG, et al. The 2015 World Health Organization Classification of Lung Tumors: impact of genetic, clinical and radiologic advances since the 2004 Classification. J Thorac Oncol, 2015, 10(9): 1243-1260.
20. Kasai K, Kon S, Sato N, et al. Case report of lymphoepithelioma-like carcinoma of the lung--lymphoid population consisting of cytotoxic T cells in resting state. Pathol Res Pract, 1999, 195(11): 773-779.
21. 陈愉生, 苗彦, 李鸿茹, 等. 原发性肺淋巴上皮瘤样癌一例. 中华结核和呼吸杂志, 2013, 36(1): 61-63.
22. Liang YS, Shen C, Che GW, et al. Primary pulmonary lymphoepithelioma-like carcinoma initially diagnosed as squamous metaplasia: a case report and literature review. Oncol Lett, 2015, 9(4): 1767-1771.
23. Wong JF, Teo MC. Case report: lymphoepithelial-like carcinoma of the lung--a chronic disease?. World J Surg Oncol, 2012, 10: 91.
24. Fang W, Hong S, Chen N, et al. PD-L1 is remarkably over-expressed in EBV-associated pulmonary lymphoepithelioma-like carcinoma and related to poor disease-free survival. Oncotarget, 2015, 6(32): 33019-33032.
25. Jiang L, Wang L, Li PF, et al. Positive expression of programmed death ligand-1 correlates with superior outcomes and might be a therapeutic target in primary pulmonary lymphoepithelioma-like carcinoma. Onco Targets Ther, 2015, 8: 1451-1457.
26. He J, Shen J, Pan H, et al. Pulmonary lymphoepithelioma-like carcinoma: a surveillance, epidemiology, and end results database analysis. J Thorac Dis, 2015, 7(12): 2330-2338.
27. Ngan RK, Yip TT, Cheng WW, et al. Clinical role of circulating Epstein-Barr virus DNA as a tumor marker in lymphoepithelioma-like carcinoma of the lung. Ann N Y Acad Sci, 2004, 1022: 263-370.

Chinese Journal of Respiratory and Critical Care Medicine

Primary lymphoepithelioma-like carcinoma of the lung: a case report and literature review

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content