Lymphoepithelioma-like carcinoma of lung – a case report

Abstract

We report a case in 49-year-old Asian female who presented with a radio-dense mass in the posterobasal segment of right lower lobe, located in a subpleural location. Sectioning showed a well defined, firm, circumscribed, nodular tumour 30 × 30 × 25 mm in a subpleural location leading to puckering of the overlying pleura. Three subcarinal lymph nodes were also submitted. Histopathology showed the nodule was a poorly differentiated carcinoma, forming a syncytium of tumour cells with vesicular nuclei. Accompanying the tumour was heavy lymphoid infiltrate, infiltrating within and surrounding the tumour mass. Tumour cells were postive for AE1/AE3, p63 and EBV ISH. Keratin 7 and 20 were negative. One of three lymph nodes contained metastatic carcinoma. Lymphoepithelioma-like carcinoma of the lung occurs as an EBV-associated neoplasm. The virus may be demonstrated by expression of latent membrane protein-1 and EBV-deoxyribonucleic acid in tumour cells by immunohistochemistry, and in situ hybridisation for EBV-encoded small nuclear ribonucleic acid. It needs to be distinguished histologically from large cell lymphoma, germ cell tumour, poorly differentiated squamous cell carcinoma and mucoepidermoid carcinoma. A thorough evaluation of other primary sites such as the nasopharynx should be done to exclude a metastatic tumour. The behaviour of lymhoepithelioma-like carcinoma is highly variable, ranging from apparently curable (by excision) to highly aggressive with extensive disease at presentation.