Lymphoepithelial carcinoma versus large cell undifferentiated carcinoma of the major salivary glands

Lymphoepithelial Carcinoma of the Sublingual Gland: A Case Report

Lymphoepithelial carcinoma (LEC) of the salivary gland is a rare squamous cell carcinoma. LEC commonly presents in the parotid and submandibular glands and rarely in the sublingual gland. While salivary gland LEC has a predilection for Inuit-Yupik and Chinese populations, few cases have been reported in the Hispanic population and none for sublingual glands in the English language literature. Here, we present the seventh case report in the English language literature for sublingual LEC and the first case observed in a Hispanic patient.

The role of postoperative radiotherapy (PORT) in lymphoepithelial carcinoma of the salivary gland (LECSG) and the effect of postoperative EBV DNA on prognosis

BACKGROUND

Whether postoperative radiotherapy (PORT) could improve survival and the role of EBV DNA remains unclear for patients with lymphoepithelial carcinoma of the salivary glands (LECSG).

PATIENTS AND METHODS

360 patients were included. Independent prognostic factors were selected using a Cox proportional hazards model and incorporated into risk stratification.

RESULTS

The number of positive lymph nodes (PLNs) ≥ 3 and tumor size ≥ 3 cm were independent factors for PFS in patients with neck dissection (ND). Patients were divided into three groups: high-risk, size ≥ 3 cm&PLNs ≥ 3; intermediate-risk, size < 3 cm&PLNs ≥ 3 or size ≥ 3 cm&PLNs < 3; low-risk, size < 3 cm&PLNs < 3. The 5-year PFS rate of the low-, intermediate- and high-risk patients receiving non-PORT and PORT was 87.9% vs 93.5% (p = 0.12), 41.2% vs 81.1% (p < 0.001), 18.0% vs 51.1% (p = 0.034). N stage was an independent factor for PFS in patients with non-neck dissection (NND) and patients were divided into two groups: low-risk, N0; and high-risk, N1/2. The 5-year PFS rate of the low-risk, and high-risk patients receiving non-PORT and PORT was 77.9% vs 94.3% (p = 0.0019), 21.4% vs 71.3% (p = 0.015). Compared with EBV DNA = 0, the 5-year PFS rate of patients with EBV DNA > 0 was 19.9% vs 91.3% (p < 0.001). In patients with EBV DNA = 0, the 5-year PFS rate of patients with or without PORT was 95.1% vs 92.3% (p = 0.082); while in patients with EBV DNA > 0, the 5-year PFS rate was 37% vs 9.2% (p = 0.0056).

CONCLUSIONS

In patients with ND, PLNs < 3&size < 3 cm patients did not benefit from PORT. Detectable EBV DNA after surgery was a negative prognostic factor.

Could definitive radiotherapy be a treatment option for lymphoepithelial carcinoma of major salivary gland: Comparison of clinical outcomes of upfront surgery and upfront chemoradiotherapy

OBJECTIVES

The optimal treatment and associated clinical outcomes for lymphoepithelial carcinoma of the major salivary gland (LECSG) are currently unclear. As such, the purpose of this study was to assess the survival rates of LECSG patients who received either upfront surgery or upfront chemoradiotherapy (CRT).

MATERIALS AND METHODS

In this retrospective study, we analyzed cases of LECSG patients treated at our center from January 2010 to April 2021. The cumulative incidences of overall survival rate (OS) and locoregional failure-free survival rate (LRFFS) were evaluated using the Kaplan-Meier method. In order to balance potential risk factors between the treatment groups, we conducted propensity score matching (PSM) at a 1:1 ratio.

RESULTS

The study enrolled a total of 107 patients, among whom 24 received surgery alone, 56 underwent surgery combined with postoperative radiotherapy, and 27 underwent definitive radiotherapy. The 5-year LRFFS rate and 5-year OS rate for the entire cohort were 86.6% and 84.4%, respectively. Following PSM, the 5-year LRFFS and OS rates for the upfront CRT cases were comparable to those of upfront surgery, both before and after matching. However, the upfront surgery group showed a tendency toward more de novo facial nerve injury and post-treatment facial nerve injury.

CONCLUSION

The results of this study suggest that upfront CRT is as effective as upfront surgery in terms of locoregional control and overall survival for LECSG patients. Therefore, upfront CRT could be considered a viable treatment option, potentially avoiding the risks associated with surgical intervention.

Lymphoepithelial carcinoma of the head and neck: a SEER analysis of prognostic factors for survival

OBJECTIVE

To explore the epidemiological characteristics of patients with lymphoepithelial carcinoma (LEC) of the head and neck and the prognostic factors.

METHODS

We conducted a retrospective cohort study of cases of head and neck LEC retrieved from the Surveillance, Epidemiology and End Results database. Kaplan-Meier survival analysis and the log-rank test were employed to assess overall survival (OS) and cancer-specific survival (CSS). Univariate and multivariate analyses were used to construct Cox regression models. We established nomograms to predict OS and CSS among patients with nasopharyngeal LEC, who were divided into high- and low-risk groups based on the OS nomograms to compare the effects of treatment using the restricted mean survival time (RMST).

RESULTS

The 5-year OS and CSS rates of the cohort were 70.8% and 74.8%, respectively. Advanced age, unmarried status, black race, distant metastasis, and the absence of surgical treatment were significantly associated with decreased survival rates. RMST did not differ between the combined treatment (radiotherapy and chemotherapy) and radiotherapy monotherapy groups, but chemotherapy alone displayed poor efficacy.

CONCLUSIONS

Head and neck LEC is associated with a favorable prognosis. Radiotherapy plays a significant role in managing patients with nasopharyngeal LEC, which is influenced by multiple prognostic factors.

Lymphoepithelial Subtype of Oral Squamous Cell Carcinoma: Report of an EBV-Negative Case and Literature Review

Lymphoepithelial carcinoma (LEC) of the oral mucosa is a rare histopathologic subtype of squamous cell carcinoma (SCC), which shares morphologic similarities with nasopharyngeal carcinoma (NPC), non-keratinizing undifferentiated subtype. The admixture of neoplastic epithelial tumor cells and a dense lymphoplasmacytic infiltrate makes microscopic diagnosis challenging. LEC etiopathogenesis has been variably associated with Epstein–Barr virus (EBV) infection, depending on the specific anatomic location and racial predilection, with a higher incidence in endemic populations. Although described in several subsites of the head and neck region, including the major salivary glands, the oral mucosa is considered an infrequent location for LEC development, deriving either from minor salivary glands (MSGs) or the surface epithelium. Herein, we report a rare case of an EBV-negative LEC arising from the oral surface epithelium, presenting as gingival swelling, and review the pertinent English-language literature, which revealed only 26 previously reported oral LECs. Our case is only the fourth oral LEC originating from the surface epithelium and the first one to affect the gingiva.

Lymphoepithelial carcinoma of the parotid gland: Clinicopathological analysis of 146 cases from a single institute

BACKGROUND

Parotid lymphoepithelial carcinoma (LEC) is a rare malignant tumor. The purpose of this study was to investigate the clinicopathological features of parotid LEC.

METHODS

All patients clinicopathological information diagnosed parotid LEC from 2005 to 2017 were analyzed.

RESULTS

A total of 146 cases of parotid LECs were identified. Of these, 126 (86.3%) were primary and 20 (13.7%) were secondary LECs. Patients with secondary LEC tended to have tumors with earlier TNM staging than those with primary (p = 0.031). The tumor cells in 87 (94.6%, 87/92) cases tested positive for Epstein-Barr virus (EBV). Cervical node metastases were present at diagnosis in 46 (31.5%) cases. Overall survival at 5 and 10 years was 97.0% and 90.8%, respectively. Older age was an adverse prognostic indicator for overall survival (p < 0.001).

CONCLUSIONS

Parotid LEC is associated with EBV and an increased rate of cervical node metastases. However, most patients, especially younger ones, have a good prognosis.

Clinical features in salivary gland lymphoepithelial carcinoma in 10 patients: Case series and literature review

Objective

Lymphoepithelial carcinoma (LEC) accounts for 0.4% of malignant tumors of the salivary gland and 0.8% of parotid gland malignancies. Over the past 50 years, less than 300 cases have been reported in the literature. The purpose of this study was to investigate the characteristics of salivary gland LEC.

Methods

We retrospectively reviewed the medical records and analyzed clinical data obtained from 10 patients seen at our hospital between 2005 and 2020 with salivary gland LEC.

Results

All patients presented with a self‐palpable, non‐tender, hard swelling, or lump near the jaw or infra‐auricular region. Most cases (n = 8) were of solitary tumors, and enhancing patterns on computed tomography mainly were homogenous (n = 8). Interestingly, eight patients tested positive for the Epstein–Barr encoding region in in situ hybridization. Still, only three patients had detectable circulating Epstein–Barr virus (EBV) DNA, and one patient had detectable EBV IgA. All patients underwent complete tumor resection, followed by radiotherapy, and six also underwent chemotherapy. Nine patients became disease‐free within 5 years, and one died due to disease 4 years after surgery.

Conclusion

Although rare and considered to be a high‐risk malignancy, LECs have favorable treatment outcomes. Circulating EBV DNA is still not considered a marker for preoperative assessment or postoperative treatment response. The role of EBV DNA requires further investigation.

Level of Evidence: 4

Analysis of Trends in Mortality in Patients with Lymphoepithelial Carcinoma of the Head and Neck

Background

Squamous cell carcinoma is the most common subtype of malignancy found in patients with head and neck malignancy. There are other rare subtypes which are not adequately reported in medical literature. Lymphoepithelial carcinoma consists of lymphocytic infiltration in a background of undifferentiated carcinoma. They are most often seen in salivary glands but can also be found in other structures of the head and neck region. This analysis reports the nation-wide mortality of patients diagnosed with lymphoepithelial carcinoma of the head and neck.

Methods

Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) Database from the years 2000 to 2014. Incidence-based mortality for all stages was queried and results were grouped by gender and race (Caucasian/White, African American/Black, American Indian/Alaskan native and Asian/Pacific Islander). Paired T-test was used to determine statistically significance difference between various subgroups.

Results

Incidence-based mortality has been improving for African American/Black patients and has been worsening for Caucasian/White, American Indian/Alaskan native and Asian/Pacific Islander for the period of 2000 to 2014. The differences in mortality trends were statistically different (P < 0.05). The highest mortality rate per 1000 patients was seen in Asian/Pacific Islander population, followed by African American/Black, American Indian/Alaskan native and the least mortality was noted in Caucasian/White patients. When a similar analysis with linearized trend lines on gender was conducted, only African American/Black males and Asian/Pacific Islander females showed an improving trend in mortality. The sample size was a major limitation of this study (Caucasian/White - 134, African American/Black - 30, American Indian/Alaskan native - 5 and Asian/Pacific Islander - 87).

Conclusion

Lymphoepithelial carcinoma is a rare subtype of head and neck malignancies whose incidence-based mortality showed a worsening trend. This study showed significant race and gender disparity amongst patients with lymphoepithelial carcinoma. Due to its rarity, this subtype warrants further study, especially with regards to its etiology, clinical course and cure rates.

Undifferentiated and dedifferentiated head and neck carcinomas

Undifferentiated carcinomas arising at salivary gland and head and neck mucosal sites may originate either de novo or through a process of dedifferentiation of a differentiated carcinoma. While in the latter group the diagnosis is largely dependent on the identification of the differentiated component or recognition of a specific genotype, the classification of undifferentiated carcinomas that lack a differentiated component is mainly based on the identification of specific genetic drivers, like for example the NUTM1 fusions in NUT carcinoma. A further category is represented by virus associated carcinomas (mainly HPV and EBV), that frequently displays an undifferentiated morphology. Overall, these tumors often represent a diagnostic challenge, especially in small biopsies. This review summarizes and discuss the diagnostic approach to the main head and neck carcinoma types that frequently or occasionally display an undifferentiated appearance, with a focus on salivary gland, oropharyngeal, nasopharyngeal and sinonasal subsites.

Lymphoepithelial carcinoma of larynx and hypopharynx: a systematic review and pooled analysis

PURPOSE

To define the oncologic outcomes and the prognostic factors of laryngeal and hypopharyngeal lymphoepithelial carcinoma (LEC).

METHODS

A systematic review and individual patient data analysis were performed according to the PRISMA guidelines. A total of 41 patients (males: 37; mean age: 63.1, standard deviation: 10.0) were included.

RESULTS

The median follow-up time was 36.0 months (interquartile range, IQR: 11.5-73.5), while the median overall survival (OS) time was 96 months (IQR: 39.0-120.0). Estimated disease-specific survival (DSS) rates (95% Confidence Interval, CI; number still at risk) at 1, 3, and 5 years were 94.4% (79.5-98.6; 31), 82.7% (62.7-92.5; 21), and 78.1% (56.8-89.7; 13), respectively. Estimated disease-free survival (DFS) rates (95% CI; number still at risk) at 1, 3, and 5 years were 92.1% (77.4-97.4; 31), 74.9% (55.6-86.8; 21), and 66.6% (46.1-80.8; 13), respectively. Patients undergoing primary surgery had a reduced chance of death from cancer than patients receiving primary radiotherapy (5-year DSS 85.6 vs. 56.2%; p = 0.04), while EBV positivity tend to be a negative prognostic factor (5-year DSS 100 vs. 66.7%; p = 0.05).

CONCLUSIONS

Laryngeal and hypopharyngeal LEC is a rare disease with favorable survival. Further prospective multicenter studies are needed to make a reliable statement on prognosis and outcome, stratifying patients for different therapy regimens and tumor stages.

Lymphoepithelial Carcinoma of Salivary Glands

Lymphoepithelial carcinoma of salivary glands (LECSG) is an uncommon neoplasm. This article summarizes the findings of 438 cases in a review of the literature. Concurrent lymphoepithelial lesions may suggest a primary tumor. The tumor shows a nonkeratinizing carcinoma intimately associated with a rich lymphohistiocytic infiltrate, destroying adjacent salivary gland tissue. Irrespective of race or ethnicity, the tumors usually express Epstein-Barr virus, with Epstein-Barr virus encoded small RNA (EBER) and/or latent membrane protein-1 (LMP-1), although a subset does not. There is an overall good prognosis of about 80% at 5 years.

Tumors of Atypical Carcinoma of the Parotid Gland and Papillary Thyroid Carcinoma: A Case Report

Lymphoepithelial carcinoma (LEC) is a variant of anaplastic carcinoma usually found in the nasopharynx. It is a rare, aggressive malignant tumor in the salivary glands, which is usually associated with Epstein-Barr virus (EBV), and often presents with facial nerve paralysis when in the parotid gland. This case report is unique in that our patient had EBV-negative LEC, with facial nerve involvement and a concurrent primary papillary thyroid carcinoma (PTC). We successfully managed this patient with surgery and adjuvant chemoradiotherapy. The patient has responded well to the treatment and she showed no evidence of disease at the 24-month follow-up.

Lymphoepithelial Carcinoma of Salivary Gland EBV-association in Endemic versus Non-Endemic Patients: A Report of 16 Cases

Lymphoepithelial carcinoma of salivary glands (LECSG) are rare neoplasms, reported in endemic populations (southeastern Chinese) with a strong Epstein-Barr virus (EBV) association. A retrospective series comparing EBV status within an ethnically diverse population (endemic vs. non-endemic patients) has not been reported. Sixteen LECSG were equally distributed between males (n = 8) and females (n = 8) with a median age of 54 years (range 18 to 85 years) at initial diagnosis. Ten patients were white, 4 Asian, and 2 black. The patients typically presented with swelling or mass for an average of 11.6 months. Tumors affected only major salivary glands: parotid (n = 13); submandibular (n = 3). Tumors were an average of 2.9 cm (range 1.5 to 5.8 cm). Nine of 16 (56%) patients had cervical lymph node metastases at presentation. No patients had nasopharyngeal or oropharyngeal tumors. Microscopically, the tumors were widely infiltrative, characterized by large polygonal to spindled cells arranged in a syncytial, lattice-like network in a background of lymphoplasmacytic cells. The neoplastic cells showed an open-vesicular nuclear chromatin to a more basaloid-morphology, the latter showing hyperchromatic nuclei and less cytoplasm, while nearly all of the cases had associated lymphoepithelial lesions/sialadenitis. By in situ hybridization, 8 of 16 cases had a strong, diffuse EBER expression (4 of 4 Asians; 4 of 12 non-Asians), while with immunohistochemistry all cases tested were pan-cytokeratin, CK5/6 and p63 reactive; none of the cases tested were p16 reactive. All patients were managed with wide or radical excision, 4 with concurrent chemoradiation, and 6 with radiation alone. Distant metastasis (lung, brain, and bone) developed in 2 patients. Overall follow-up (mean 3.8 years) revealed 12 patients alive and 2 dead, none with evidence of disease (mean 4.3 years); one white male alive with disease at 1.9 years, and one Asian female dead of disease at 4.2 years; both of these latter patients had Group IV stage disease. High stage (Group IV) patients had a shorter mean survival than lower stage patients: 3.1 versus 4.8 years, respectively. In conclusion, LECSG are uncommon primary neoplasms. Concurrent lymphoepithelial lesions may help suggest a primary tumor. The tumors, irrespective of race or ethnicity, may express EBER. There is an overall good survival, perhaps better for EBV-negative patients and for those with lower stage disease.

Primary Large-Cell Undifferentiated Carcinoma of the Ureter

OBJECTIVE

To report the first case in the literature of a primary large-cell undifferentiated carcinoma (LCUC) of the ureter with a very aggressive behavior and dismal prognosis.

CLINICAL PRESENTATION AND INTERVENTION

A 60-year-old woman with a history of intermittent macroscopic hematuria and mild to moderate right flank pain was admitted to the Department of Urology. Tissue biopsies and cytological samples were taken. Pathologic examination was consistent with LCUC.

CONCLUSION

LCUC of the ureter is an aggressive tumor with a high proliferation index. Patients might be diagnosed at an advanced stage. LCUC must be considered in the differential diagnosis of urinary tract pathologies.

Primary lymphoepithelial-like carcinoma of the parotid gland-case presentation

Background/Aim: Primary Lymphoepithelial carcinoma (PLEC) is a rare subtype of salivary gland cancers, which comprises only 0.4% of salivary malignant neoplasms and only a few cases have been presented previously. Case report: A patient with PLEC of the parotid gland, its management and the available literature are presented. A 53-year-old woman with initial lesion of a lump in the region of the right parotid received treatment with antibiotics which did not lead to improvement. MRI was performed that recorded the presence of a tumor in the right parotid gland and the patient subsequently underwent excision biopsy. The histopathological evaluation together with additional immunohistochemical positive staining of EMA+, EGFR+, p63+, CK 5/6+, AE1/AE3+ established the diagnosis of PLEC. A PET-CT scanning has shown nor primary mucosal source neither skin lesion to account for any possible metastatic disease, consequently a course of adjuvant post-operative radiotherapy to the region of the right parotid gland was performed. Conclusions: In the differential diagnosis of a parotid gland lump should be included the possibility of a rare salivary gland neoplasm such as PLEC. Surgical excision and radiotherapy have been proposed for the treatment of early and advanced neoplasm stages. Ages of the patient, stage of the neoplasm as well as type of therapy are significant and individual variables for the prediction of the prognosis.

Lymphoepithelial carcinoma of salivary glands: CT and MR imaging findings

OBJECTIVES

To depict the CT and MRI characteristics of salivary gland lymphoepithelial carcinoma (LEC) and provide more diagnostic information for this malignancy.

METHODS

103 salivary gland LEC subjects were retrospectively reviewed. The subjects include 35 males with a mean age of 40.8 years and 68 females with a mean age of 49.4 years. Of the 103 subjects, 86 had carcinomas in the parotid gland, 5 in the submandibular gland, 1 in the sublingual gland, 3 in the cheek and 8 in the palate. All subjects underwent routine CT and MRI (plain and contrast-enhanced scans) prior to surgical treatment and histopathological examination.

RESULTS

Based on the pathological outcomes, all the salivary gland LECs were classified into two types from CT and MRI scans: solitary LEC (56 cases, 54.4%) and multiple LEC (47 cases, 45.6%). The latter included solitary salivary gland LEC with extraglandular lymph-node metastases (12 cases), parotid gland LEC with ipsilateral intraglandular lymph-node metastases (11 cases), parotid gland LEC with ipsilateral intra- and extraglandular lymph-node metastases (23 cases) and bilateral parotid gland LEC (1 case). The salivary gland LEC was depicted on CT and MRI scans as a lobular mass in 64 of 104 (61.5%), homogeneous mass in 65 of 104 (62.5%) or enhanced neoplasm in 94 of 104 (90.4%).

CONCLUSIONS

Salivary gland LEC has a predilection for females in the fourth to fifth decade of life and the parotid gland. CT and MRI findings between solitary and multiple salivary LECs vary. A majority of multiple parotid gland LECs are characterized by metastasis of ipsilateral intraglandular lymph nodes, which may accompany with or without extraglandular lymph-node metastases.

NUT Midline Carcinoma of the Sublingual Gland: Clinical Presentation and Review

NUT midline carcinoma (NMC) is a rare and aggressive disease encountered in the midline of the head and neck or mediastinum. Due to its sparse incidence and subtle pathologic features, we aim to increase knowledge and awareness for this pathologic entity. We present an exemplary case of a young, healthy male presenting with oral cavity pain and cervical lymphadenopathy. This patient was initially diagnosed with an unspecified, highly aggressive sublingual gland malignancy and underwent locoregional resection with free flap reconstruction however suffered a rapid local recurrence and widely extensive metastasis within just 1 month. After rigorous analysis, final pathologic diagnosis revealed a poorly differentiated carcinoma with evidence of squamous differentiation that eventually, post-mortem tested positive for NMC. Only one prior case of sublingual gland NMC has been previously reported as we discuss the literature regarding all sublingual gland malignancies as well as the pathologic features and treatment options for NMC. We recommend consideration of testing for the NUT proto-oncogene at the time of biopsy in the clinical setting of a poorly differentiated midline carcinoma, especially with squamous differentiation, of the head or neck in order to identify patients for clinical trial enrollment and appropriately counsel on the poor clinical prognosis. Improving clinician awareness is critical to increase diagnostic accuracy and need to study prospective treatment outcomes as the first step toward improving management of this difficult disease.

Lymphoepithelial carcinoma of the salivary glands

RATIONALE

Lymphoepithelial carcinoma (LEC) is a rare malignancy with the histopathological feature of undifferentiated carcinoma and an intermixed reactive lymphoplasmacytic infiltration. Although clinically significant because of its malignant nature, it is difficult to make a differential diagnosis by preoperative imaging. Here, we report 3 cases of primary LEC arising in the major salivary glands, which showed unusual imaging features unlike other malignant tumors.

PATIENT CONCERNS

Our first case is a 44-year-old man with LEC in the right parotid gland, the second case is a 71-year-old woman with LEC in the right submandibular gland, and the third case is a 35-year-old woman with LEC in the right parotid gland. All of the patients presented with a palpable mass of variable duration.

DIAGNOSES

Computed tomography (CT) scans revealed a relatively well-defined, slightly hyperattenuated exophytic solid mass that had homogeneous well-enhanced regions. Ultrasonography (US) in the first 2 cases showed well-defined, hypoechoic solid masses with posterior enhancement. The CT findings seem to be benign tumors, but US features are compatible with highly cellular and hypervascular tumors.

INTERVENTIONS

The resection of the involved salivary gland with postoperative radiation therapy was performed.

OUTCOMES

There was no evidence of recurrence or metastasis after 5 years in all 3 patients.

LESSONS

Understanding these unusual imaging findings may be helpful in detecting LEC, and may also help clinicians provide adequate management to patients, such as surgery with adjuvant radiotherapy, because of its malignant entity.

Distribution of lymph node metastasis from lymphoepithelial-like carcinoma of the parotid

Purpose

To explore the distribution of node spread from lymphoepithelial-like carcinoma (LELC) of the parotid gland based on the 2013 updated guidelines for neck node levels.

Results

42 (58.3%) cases had metastatic nodes, all were localized at the ipsilateral neck. The detailed distribution was: level Ia 0, level Ib 6(14.3%), level II 34 (80.1%), level III 16 (38.1%), level IV 9 (21.4%), level V 7 (16.7%), level VI 0, level VII 0, level VIII 37 (88.1%), level IX 0, level Xa 2 (4.8%), and level Xb 0. Lymphadenopathy in level Ib, V and Xa was always accompanied with level II or level VIII nodal metastasis. No statistical significance was found in the incidence of nodal involvement between T1-2 and T3-4 tumors (57.4% versus 61.1%, p = 0.78).

Methods

We retrospectively reviewed the surgical and imaging documents of 72 cases of LELC from the parotid gland between January 2004 and November 2015. All patients received contrast enhanced computed tomography (CT) or magnetic resonance imaging (MRI). Parotid metastasis from nasopharyngeal cancer (NPC) was excluded. Nodal status and distribution was evaluated by both pathologic reports and imaging studies.

Conclusions

This is the first description of topography of cervical nodal metastases from LELC of the parotid gland. Incidence of nodal involvement is high. Nodes at ipsilateral level VIII and II were most frequently involved, followed by level III, IV, V and Ib. Nodes in level Ia, VI and level VII were rarely seen.

Primary lymphoepithelial carcinoma of the intraoral minor salivary gland: A case report

Lymphoepithelial carcinoma (LEC) of salivary gland origin is a rare malignant tumor with morphological characteristics identical to those of undifferentiated nasopharyngeal carcinoma. It has a marked racial predilection for Inuit and Southeast Asian populations. An association between LEC and Epstein-Barr virus (EBV) infection has previously been reported. LEC most frequently affects the parotid gland, followed by the submandibular glands. To the best of our knowledge, only three LECs arising from the minor salivary gland have been previously described in the English language literature. The current study reports a case of EBV-associated LEC of the minor salivary gland in the hard palate of a 38-year-old Chinese female, and reviews the clinicopathological characteristics of this uncommon tumor.

Lymphoepithelial carcinoma of the salivary gland: morphologic patterns and imaging features on CT and MRI

BACKGROUND AND PURPOSE

Lymphoepithelial carcinoma is a rare salivary gland lesion. We retrospectively reviewed CT and MR imaging features of salivary gland lymphoepithelial carcinoma to determine their imaging features and morphologic patterns.

MATERIALS AND METHODS

The clinical data, CT, and MR imaging findings of 28 patients with histologically proved lymphoepithelial carcinoma of the salivary gland were retrospectively reviewed. Morphologic patterns of the lesions were categorized into 3 types on the basis of margin and shape.

RESULTS

There were 17 men and 11 women with a mean age of 39.3 years; 96.4% of patients were positive for Epstein-Barr virus both on histologic staining and Epstein-Barr virus serology. Tumors were parotid in 18 patients, submandibular in 8 patients, sublingual in 1 patient, and palatal in 1 patient. Most tumors (57.1%) manifested as a partially or ill-defined mass with a lobulated or plaque-like shape. Homogeneous enhancement was found in 16 patients, while heterogeneous enhancement was found in 12, including 4 patients with intratumoral necrosis. Invasion into adjacent structures was found in 5 patients; 60.7% of patients exhibited abnormal lymph nodes, with nodal necrosis in 3 patients.

CONCLUSIONS

The characteristic lobulated or plaque-like shape, with a partially or ill-defined margin, of a salivary gland mass associated with ipsilateral lymphadenopathy may suggest a preoperative diagnosis of lymphoepithelial carcinoma.

Primary lymphoepithelioma-like carcinoma of salivary gland: sixty-nine cases with long-term follow-up

BACKGROUND

Lymphoepithelioma-like carcinoma (LELC) in the salivary glands is a rare but unique malignancy.

METHODS

Sixty-nine patients with salivary gland LELC with long-term follow-up were reviewed for this study.

RESULTS

There were 52 cases in the parotid gland and 17 cases in the submandibular gland. All patients underwent complete tumor excision, 41 underwent neck dissection, and 39 received postoperative radiotherapy. The 5-year, 10-year, and 15-year overall survival (OS) rates were 90%, 75%, and 54%, respectively. Patients with higher neutrophil/lymphocyte ratio (NLR ≥ 4.0) and advanced stage (stage III and IV) had significantly poorer OS. Patients who received postoperative radiotherapy had significantly better relapse-free survival (RFS). In multivariate analysis, stage, NLR, and neck dissection were associated independently with OS, whereas stage and postoperative radiotherapy were associated independently with RFS.

CONCLUSION

Salivary gland LELC is a rare malignancy with a better prognosis that partially attributes to surgery with neck dissection and postoperative radiotherapy. Preoperative NLR is an independent prognostic factor.

Large cell carcinoma of the lacrimal gland diagnosed by fine needle aspiration biopsy

A 67-year-old man presented with a 6-month history of a malignant appearing left lacrimal gland mass. Fine needle aspiration biopsy was performed in the office, diagnosing the mass as large cell carcinoma (LCCA) of the lacrimal gland. This represents the second reported case of LCCA of the lacrimal gland and details the potential for FNA biopsy to successfully yield the diagnosis. LCCA of the lacrimal gland is rare, but should be considered in cases of malignant lacrimal gland neoplasms.

Undifferentiated carcinoma of the oropharynx: a human papillomavirus-associated tumor with a favorable prognosis

Undifferentiated carcinoma (undifferentiated carcinoma, nasopharyngeal type, or lymphoepithelial carcinoma) is an uncommon and histologically distinct tumor in the oropharynx, which in Western countries, has been clearly shown not to harbor Epstein Barr virus (EBV). We sought to analyze these tumors for human papillomavirus (HPV) and to examine their clinical outcomes. All cases of oropharyngeal carcinoma diagnosed as 'undifferentiated' or 'lymphoepithelial' were retrieved from the department files at Barnes-Jewish Hospital. After consensus review by all three study pathologists, 16 were found to have diagnostic histological features and to lack distinguishing characteristics of other oropharyngeal cancers. Immunohistochemistry for p16 and p53 and in-situ hybridization for HPV and EBV encoded small RNA were performed. p16-positive but HPV in situ hybridization-negative cases were analyzed by polymerase chain reaction for high-risk HPV types. The results were correlated with pathological findings and clinical follow up. There were 16 patients. The average age was 59.2 years, 14 patients (88%) were smokers, and 13 (81%) had nodal metastases. In all, 14 cases (88%) were p16 positive and 15 (94%) were HPV positive by in situ hybridization and/or polymerase chain reaction. All cases were negative for EBV, and p53 was overexpressed in five (33%), four of which were HPV positive. Disease recurred in only three patients and two of these died with disease at 38 and 136 months, respectively. Three year overall, disease-free, and disease-specific survival rates were 54, 78, and 100%, respectively. In summary, in our patient population, the majority of oropharyngeal undifferentiated carcinomas harbor transcriptionally active HPV but not EBV. Almost all overexpress p16, and few have p53 overexpression. Disease-specific survival is comparable to published rates for other HPV-related oropharyngeal squamous cell carcinoma variants and is better than that of HPV-negative carcinomas.

Lymphoepithelial carcinoma: two case reports and a systematic review of oral and sinonasal cases

Lymphoepithelial carcinoma (LEC) is a rare malignancy. Histologically, it is an undifferentiated carcinoma with an intermixed reactive lymphoplasmacytic infiltrate. Herein, we report two cases of LEC in the head and neck region that presented to Oulu University Hospital. Our first case is a 30-year-old man with LEC in the left maxillary sinus. The second case is a 49-year-old man with LEC in the soft palate and uvula with regional lymph node metastases at diagnosis. In addition, a systematic review of the literature from 1980 to 2010 was performed with MEDLINE and cross-references were searched manually. Case reports and clinical series of oral, oropharyngeal, nasal, and paranasal sinus LECs were reviewed revealing a total of 110 cases. Most of the oral cases were found in the tonsils (n = 29), oropharynx (n = 19), and in oral mucosa (n = 18), while sinonasal cases (n = 40) were mainly in the paranasal sinuses and nasal cavity. From 37 case reports, including ours, the median age was 58 and 62 years for sinonasal and oral/oropharyngeal LECs, respectively. Oral and oropharyngeal LECs have a 70.0% tendency to metastasize and 16.6% spread locally. In contrast, none of the nasal and paranasal LECs metastasized, but 60% spread locally. Epstein-Barr virus (EBV) had been detected in 87.5% of all tested LEC cases. Treatment of LECs, during the last decade, has largely consisted of surgery, combined with radiotherapy or chemoradiation. Although local spread or nodal metastases are fairly common at the time of diagnosis, the mortality rate of adequately treated LEC patients is low.

Lymphoepithelial carcinoma of the parotid gland arising in an intraglandular lymph node: report of a rare case mimicking metastasis

We present a case (female patient aged 40 years) with a primary Epstein-Barr virus-associated lymphoepithelial carcinoma of the parotid gland that was confined to an intraparotid lymph node. This appearance of the tumor simulated a metastasis that was excluded by exhaustive radiologic and clinicopathologic investigations.

Primary undifferentiated large cell carcinoma of the lacrimal gland

PURPOSE

To report a unique case of primary undifferentiated large cell carcinoma (LCCA) of the lacrimal gland, a tumor not previously described in the ophthalmic literature.

DESIGN

Single interventional case report.

PARTICIPANTS

A patient affected by undifferentiated LCCA of the lacrimal gland.

METHODS

A 65-year-old white man with a 3-month history of a painful mass in the left lacrimal gland fossa underwent an incisional biopsy that revealed a "high-grade" epithelial malignancy. Systemic workup revealed enlargement of the regional lymph nodes, and subsequently the patient underwent extended exenteration with clear histologic margins and radical neck lymphadenectomy followed by adjunctive radiotherapy. Fifteen months postoperatively, the patient is alive and well without evidence of local recurrence or metastatic disease.

MAIN OUTCOME MEASURES

Treatment result, evidence of local recurrences or distant metastasis, and follow-up.

RESULTS

Histologic examination revealed a poorly circumscribed tumor composed of large cells invading orbital fat, lateral rectus muscle, and peripheral nerves. The surrounding orbital bone was infiltrated, but the surgical margins were clear. The cell population was composed of large cells (>30 μm) with eosinophilic cytoplasm and ovoid and irregular nuclei containing a prominent nucleoli and coarse chromatin. The cell borders were well defined. Mitosis figures were abundant, and Ki-67 was positive in more than 60% of the cells. The cells were arranged in cords and trabeculae or irregular sheets of discohesive cells. The immunophenotype analysis showed positivity for cytokeratin but negative cytokeratin 20 stains, which is considered a distinctive feature of LCCA.

CONCLUSIONS

Undifferentiated LCCAs are rare tumors of the major salivary glands, especially the parotid gland. Primary undifferentiated LCCA of the lacrimal gland has never been reported in the literature. Differential diagnosis must include a primary source in another organ. Given the aggressive nature of the tumor, radical surgery followed by radiotherapy is recommended, but evidence-based indications regarding the preferred line of treatment are lacking and the prognosis remains guarded.

FINANCIAL DISCLOSURE(S)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Salivary gland and nasopharyngeal cancers in individuals with acquired immunodeficiency syndrome in United States

Individuals with acquired immunodeficiency syndrome (AIDS) manifest an increased risk of cancer, particularly cancers caused by oncogenic viruses. Because some salivary gland and nasopharyngeal cancers are associated with Epstein Barr virus, the impact of AIDS on these cancers needs further evaluation. We used linked U.S. AIDS and cancer registry data (N = 519,934 people with AIDS) to derive standardized incidence ratios (SIRs) comparing risk of salivary gland and nasopharyngeal cancers to the general population. For salivary gland cancers (N = 43 cases), individuals with AIDS had strongly elevated risks for lymphoepithelial carcinoma (SIR 39, 95% CI 16-81) and squamous cell carcinoma (SIR 4.9, 95% CI 2.5-8.6). Among nasopharyngeal cancers (N = 39 cases), risks were elevated for both keratinizing and nonkeratinizing carcinomas (SIR 2.4, 95% CI 1.5-3.7 and SIR 2.4, 95% CI 1.2-4.4, respectively). The elevated risks of salivary gland and nasopharyngeal cancers among people with AIDS suggest that immunosuppression and oncogenic viral infections are etiologically important.

Salivary gland neoplasms in oral and maxillofacial regions: a 23-year retrospective study of 6982 cases in an eastern Chinese population

There is little information in the English-language literature about the epidemiology of salivary gland neoplasms in the eastern Chinese population. A large retrospective study (6982 primary salivary tumors during 23 years) was carried out to investigate the clinicopathological features (tumor location, patient sex and age) of these tumors in this population. 3593 tumors were in males and 3389 in females. Pleomorphic adenoma (69%) was the most common tumor and 20% were located in minor glands. 92% of Warthin's tumors occurred in males. Malignant tumors were predominantly adenoid cystic carcinoma (30%) and mucoepidermoid carcinoma (30%). Incidences of lymphoepithelial carcinomas (5%) and polymorphous low-grade adenocarcinoma (1%) of malignant tumors were identified. 28% of tumors originated from minor glands. Most findings were similar to those in the literature, with some variations. The salivary tumors slightly predominated in males. Relatively higher incidences of minor gland tumors and specifically of pleomorphic adenoma in minor glands were noted. Adenoid cystic carcinoma and mucoepidermoid carcinoma constituted the most common malignancies. There was a high incidence of lymphoepithelial carcinomas but a low incidence of polymorphous low-grade adenocarcinoma. The historical significant male predominance of Warthin's tumor was confirmed.

Primary lymphoepithelial carcinoma of the parotid gland in a North African woman

Lymphoepithelial carcinoma of the salivary glands is a rare neoplasm that is characterized by a non-neoplastic lymphocytic infiltration associated with an epithelial proliferation. It involves mainly the parotid gland. Racial and geographical factors contribute to the pathogenesis of this tumor. We report a case of a 70-year old woman from a non-endemic area who presented with several months history of swelling in the parotid region. Magnetic resonance imaging showed a parotid mass suggestive of a pleomorphic adenoma. The diagnosis of lymphoepithelial carcinoma of the parotid gland was performed on the surgical specimen. A primitive nasopharyngeal carcinoma was ruled out by random biopsies of the nasopharynx mucosa. The Epstein-Barr virus (EBV) was absent in neoplastic cells. We insist that, even in non-endemic areas and when clinical and radiological characteristics are not suggestive of malignancy, intra-operative frozen section analysis should be used in order to ensure the appropriate treatment.

Epstein-barr virus-associated lymphoepithelioma-like carcinoma of mandible

We describe the first case of an lymphoepithelioma-like carcinoma (LEC) of the mandible with a view to discuss probable histogenesis from salivary gland inclusions in the mandible, effective therapy, the unusual pattern of nodal metastases, and association with the Epstein-Barr virus. An 11-year-old boy presented with a lytic lesion in the left mandible and bilateral neck node enlargement. Histologically, the biopsied metastatic neck nodes showed sinusoids distended with histiocytes and single large atypical cells that mimicked Hodgkin lymphoma. The mandibular tumor on biopsy showed morphology similar to an undifferentiated carcinoma or LEC of nasopharynx with nuclear Epstein-Barr virus-associated in situ hybridization signals. The patient received ifosfamide, cisplatin, and etoposide chemotherapy followed by a hemimandibulectomy, which did not reveal any residual tumor. Postoperative radiotherapy was completed, and 3 years later the patient is alive and free of disease.

Epithelioid Cell Clusters With an Extensive Lymphoid Background

Context.—Fine-needle aspiration of salivary gland lesions can be particularly challenging for pathologists. There are numerous neoplasms that occur in this area and several cytologic variations of each specific lesion.

Objective.—To present and discuss a practical pattern recognition approach to fine-needle aspiration diagnosis, which includes categorizing lesions that share a certain overall cytologic architectural pattern, followed by identifying unique cellular characteristics that are specific to a certain lesion. An extensive discussion of one cytologic common pattern of salivary gland lesions, “epithelioid cell clusters with an extensive lymphoid background,” is presented. The pathologic entities that fall under this architectural pattern group are discussed, with an emphasis on neoplasms.

Data Sources.—Published literature and personal experience.

Conclusions.—A practical cytologic architectural pattern method can aid the pathologist in rendering a correct diagnosis when evaluating salivary gland lesions. One common pattern in salivary gland cytopathology is epithelioid cell clusters with an extensive lymphoid background. This pattern is often associated with Warthin tumor; however, other benign and malignant entities fall under this diagnostic group. Unique cytologic features separate these lesions into their respective diagnostic category.

Epstein-Barr virus in oral diseases

Epstein-Barr virus (EBV), a B-lymphotropic gamma-herpesvirus, causes infectious mononucleosis and oral hairy leukoplakia, and is associated with various types of lymphoid and epithelial malignancies. Saliva is the main vehicle for EBV transmission from individual to individual. Recent studies have also implicated EBV in the pathogenesis of advanced types of periodontal disease. EBV DNA is detected in 60-80% of aggressive periodontitis lesions and in 15-20% of gingivitis lesions or normal periodontal sites. The periodontal presence of EBV is associated with an elevated occurrence of periodontopathic anaerobic bacteria. Moreover, EBV active infection occurs in approximately 70% of symptomatic and large-size periapical lesions. EBV and cytomegalovirus often co-exist in marginal and apical periodontitis. Periodontal therapy can markedly suppress the EBV load in periodontal pockets as well as in saliva, which has the potential to reduce the risk of viral transmission between close individuals. EBV proteins up-regulate cytokines and growth factors, which seem to play a central role in the proliferative response of tongue epithelial cells in oral hairy leukoplakia and in the cell-transformation process of EBV-associated malignancies. Further research is needed to identify the full range of EBV-related diseases in the human oral cavity.

Large-cell undifferentiated carcinoma of the submandibular gland

Large-cell undifferentiated carcinoma (LCUC) arising in the submandibular gland is so rare that there have been only a few reported cases. We encountered a 65-year-old Japanese male, whose left submandibular gland was enlarged due to LCUC. Exenteration of the left submandibular gland together with selective neck dissection was performed, followed by postoperative radiotherapy. Current literature concerning the histopathological and clinical features of this neoplasm was reviewed.