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Argyris PP, Lukenda C, Racila EV, Midtling J, Ahmad M, Gopalakrishnan R, Freedman P, Koutlas IG. Intraoral salivary lymphoepithelial carcinoma: clinicopathologic and immunophenotypic characterization of 3 cases indicates elevated programmed death-ligand 1 expression. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:623-631. [PMID: 37770328 DOI: 10.1016/j.oooo.2023.07.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 06/01/2023] [Accepted: 07/26/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVE Intraoral salivary lymphoepithelial carcinoma (ISLEC) is a rare malignancy with programmed death-ligand 1 (PD-L1) expression levels that have been greatly understudied. We examined the clinicopathologic and immunophenotypic characteristics, including PD-L1 levels, of 3 cases of ISLEC. STUDY DESIGN We searched the archives of 2 oral and maxillofacial pathology laboratories for specimens diagnosed as ISLEC between 1985 and 2022. We collected patient demographic and clinical data. Immunostaining for AE1/AE3, CK7, CD3, CD20, p16, p53, Ki67, and PD-L1 (SP263), as well as Epstein-Barr virus-encoded small RNAs (EBER) in situ hybridization (ISH) were performed. RESULTS All 3 cases affected males aged 42 to 84 years (median = 61y) and involved the floor of the mouth, soft palate/uvula, and tongue. The lesions showed diffuse infiltration by non-keratinizing sheets and islands of undifferentiated carcinoma cells with associated dense lymphoplasmacytic inflammation. Immunohistochemically, all tumors showed AE1/AE3 positivity, selective p53 staining, and negativity for CK7 and p16. Ki67 highlighted 20%-80% of lesional cells. The inflammatory infiltrate comprised a mixed population of T and B lymphocytes. EBER ISH was positive in one case. All ISLECs displayed membranous, focal-to-diffuse, PD-L1 staining with tumor proportion score > 95% in two and 40-50% in the third case. CONCLUSIONS The clinicopathologic and immunophenotypic characteristics of the cases we examined highlight the rarity of ISLEC and indicate overall high PD-L1 levels in this type of malignancy, rendering patients with ISLEC potential candidates for targeted α-PD-1/PD-L1 immunotherapy.
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Affiliation(s)
- Prokopios P Argyris
- Division of Oral and Maxillofacial Pathology, School of Dentistry, University of Minnesota, Minneapolis, MN, USA; Ohio State University College of Dentistry, Division of Oral and Maxillofacial Pathology, Columbus, OH, USA.
| | - Carter Lukenda
- School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - Emilian V Racila
- Department of Laboratory Medicine and Pathology, Medical School, University of Minnesota, Minneapolis, MN, USA
| | | | - Mansur Ahmad
- Division of Oral Medicine, Diagnosis and Radiology, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - Rajaram Gopalakrishnan
- Division of Oral and Maxillofacial Pathology, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - Paul Freedman
- Section of Oral Pathology, New York-Presbyterian Queens Hospital, Flushing, NY, USA
| | - Ioannis G Koutlas
- Division of Oral and Maxillofacial Pathology, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
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Kubota A, Bandoh N, Goto T, Matsumoto KI, Yamaguchi-Ishochi T, Kato Y, Nishihara H, Takei H. Epstein‑Barr virus‑associated lymphoepithelial carcinoma arising in the parotid gland: A case report and literature review. Mol Clin Oncol 2023; 18:24. [PMID: 36844465 PMCID: PMC9944707 DOI: 10.3892/mco.2023.2620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 01/30/2023] [Indexed: 02/12/2023] Open
Abstract
A 60-year-old woman presented with a 3-year history of a slow-growing, painless mass in their left parotid gland. Ultrasonography revealed a well-circumscribed, lobulated, hypoechoic mass measuring 19x12x10 mm in the left parotid gland. Computed tomography revealed a well-circumscribed, solid mass with homogeneous enhancement. Fluorodeoxyglucose-positron emission tomography revealed uptake by the tumor but no uptake in other organs, including the nasopharynx. The patient underwent superficial parotidectomy with adequate safety margins and selective neck dissection followed by radiotherapy. No facial paralysis or recurrence of the tumor had been observed as of 20 months post-operation. Histologically, the tumor was composed of sheets of syncytial cancer cells with prominent nucleoli in a dense lymphoplasmacytic background. Epstein-Barr virus (EBV)-encoded RNA in situ hybridization was diffusely positive in the tumor cells. These findings indicated that the tumor was an EBV-associated lymphoepithelial carcinoma. Metastasis, especially from the nasopharynx, was excluded endoscopically and radiologically. Targeted next-generation sequencing of 160 cancer-related genes using the surgical specimen revealed no mutations, including known significant mutations detected in EBV-associated nasopharyngeal carcinoma.
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Affiliation(s)
- Akinobu Kubota
- Department of Otolaryngology-Head and Neck Surgery, Hokuto Hospital, Obihiro, Hokkaido 080-0833, Japan,Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical University, Asahikawa, Hokkaido 078-8510, Japan
| | - Nobuyuki Bandoh
- Department of Otolaryngology-Head and Neck Surgery, Hokuto Hospital, Obihiro, Hokkaido 080-0833, Japan,Correspondence to: Dr Nobuyuki Bandoh, Department of Otolaryngology-Head and Neck Surgery, Hokuto Hospital, 7-5 Inadacho Kisen, Obihiro, Hokkaido 080-0833, Japan
| | - Takashi Goto
- Department of Otolaryngology-Head and Neck Surgery, Hokuto Hospital, Obihiro, Hokkaido 080-0833, Japan
| | - Ken-Ichi Matsumoto
- Department of Radiation Therapy, Hokuto Hospital, Obihiro, Hokkaido 080-0833, Japan
| | | | - Yasutaka Kato
- Department of Pathology and Genetics, Hokuto Hospital, Obihiro, Hokkaido 080-0833, Japan
| | - Hiroshi Nishihara
- Keio Cancer Center, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Hidehiro Takei
- Department of Pathology and Translational Pathobiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103, USA
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Abstract
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.
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Shimizu S, Miyazaki A, Nakamori K, Nakai H, Ogi K, Hasegawa T, Hiratsuka H. Immunophenotypic analysis of tumor infiltrating lymphocytes in Epstein-Barr virus-negative lymphoepithelial carcinoma of the oral cavity: Report of a case. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2017. [DOI: 10.1016/j.ajoms.2017.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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A clinical analysis of 37 cases with lymphoepithelial carcinoma of the major salivary gland treated by surgical resection and postoperative radiotherapy: a single institution study. Med Oncol 2014; 31:957. [DOI: 10.1007/s12032-014-0957-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 03/31/2014] [Indexed: 11/30/2022]
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Znati K, Zaki Z, Badioui I, Chbani L, Harmouch T, Amarti A. [Very rare parotidian tumor]. Ann Pathol 2013; 33:370-2. [PMID: 24238255 DOI: 10.1016/j.annpat.2013.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 09/16/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Kaoutar Znati
- Laboratoire d'anatomie pathologique, hôpital des spécialités, CHU Hassan II, Fès, Maroc.
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A spectrum of basaloid morphology in a subset of EBV-associated "lymphoepithelial carcinomas" of major salivary glands. Head Neck Pathol 2012; 6:445-50. [PMID: 22926973 PMCID: PMC3500900 DOI: 10.1007/s12105-012-0394-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 08/14/2012] [Indexed: 12/27/2022]
Abstract
Nasopharyngeal carcinomas of the undifferentiated or lymphoepithelial type are most commonly seen in South East Asians. Identical tumors have also been described at a variety of other sites including lung, skin and salivary gland and have been referred to by a number of names including lymphoepithelial carcinoma (LEC). LECs of major salivary gland are extremely rare. They are particularly common amongst the Inuit populations of the arctic region including Greenland (Denmark), Canada and Alaska, as well as South East Asians. Within the Inuit group, this tumor represents the majority of all salivary gland carcinomas. Amongst primary LEC of major salivary gland, most cases reported in the literature have represented typical nasopharynx-like tumors. Variants of Epstein-Barr Virus (EBV) associated LEC have not been described previously, to the best of our knowledge. In this report, we describe 4 EBV-associated major salivary gland LECs with prominent basaloid morphology, which represent 22 % of a cohort of 18 salivary LECs from an Inuit population in Greenland. The features described in these cases raise a differential diagnosis of other basaloid tumors, particularly in light of the salivary gland location. A basaloid variant of LEC in major salivary gland should be recognized, especially in highly prone populations, to avoid misdiagnosis of other more common salivary tumors.
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Rytkönen AE, Hirvikoski PP, Salo TA. Lymphoepithelial carcinoma: two case reports and a systematic review of oral and sinonasal cases. Head Neck Pathol 2011; 5:327-34. [PMID: 21698444 PMCID: PMC3210216 DOI: 10.1007/s12105-011-0278-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Accepted: 06/13/2011] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Aleksi E. Rytkönen
- Department of Diagnostics and Oral Medicine, Institute of Dentistry, Oulu University Hospital, University of Oulu, PO Box 5281, 90014 Oulu, Finland
| | - Pasi P. Hirvikoski
- Department of Pathology, Oulu University Hospital, Oulu, Finland
- Länsi-Pohja Central Hospital, Kemi, Finland
| | - Tuula A. Salo
- Department of Diagnostics and Oral Medicine, Institute of Dentistry, Oulu University Hospital, University of Oulu, PO Box 5281, 90014 Oulu, Finland
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Purgina B, Pantanowitz L, Seethala RR. A Review of Carcinomas Arising in the Head and Neck Region in HIV-Positive Patients. PATHOLOGY RESEARCH INTERNATIONAL 2011; 2011:469150. [PMID: 21660273 PMCID: PMC3108450 DOI: 10.4061/2011/469150] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Accepted: 02/14/2011] [Indexed: 12/30/2022]
Abstract
The majority of malignancies arising in the head and neck among patients with AIDS are Kaposi sarcoma and non-Hodgkin lymphoma. Patients with HIV/AIDS are also at increased risk of developing several carcinomas of the head and neck. This paper focuses on these less common, albeit important, carcinomas. An English language literature search identified numerous population-based studies evaluating carcinomas in the head and neck of HIV-positive patients. Published results indicate that patients with HIV/AIDS are at an increased risk of developing mucosal squamous cell carcinoma, nasopharyngeal carcinoma, lymphoepithelial carcinoma of the salivary gland, and Merkel cell carcinoma in this anatomic region. Data also suggest that HIV-positive patients with these cancers present at a younger age, with more aggressive disease and worse prognosis compared to HIV-negative patients. Treatment involves surgical resection with or without radiation therapy and chemotherapy for locally advanced and metastatic disease. AIDS patients, however, are more likely to suffer radiation treatment complications. Highly active antiretroviral therapy (HAART) has not altered the incidence of these malignancies.
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Affiliation(s)
- Bibianna Purgina
- Department of Pathology, Presbyterian-Shadyside University Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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Grimaldo-Carjevschi M, López-Labady J, Villarroel-Dorrego M. Squamous cell carcinoma on the palate in a patient with systemic lupus erythematosus: case report and review of literature. Lupus 2010; 20:519-22. [DOI: 10.1177/0961203310383068] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Squamous cell carcinoma is a rare consequence of lupus erythematosus and it is generally associated with skin lesions rather than with oral mucosa. This paper reports a patient diagnosed with systemic lupus erythematosus who developed a squamous cell carcinoma on the palate as an outcome of a persistent ulcer, a frequent lesion in patients with this disease and, in fact, clinical criterion for its diagnosis. A 38-year-old female patient diagnosed with systemic lupus erythematosus 12 years previously, who attended the dental school for routine dental control. The patient was being treated with prednisone 10 mg per day and cyclophosphamide 750 mg per month until 10 months prior to her diagnostic biopsy. She had, however, been previously treated with chloroquine. Oral lesions started 6 months before consultation as symptomatic multiple ulcers on the palate. After topical treatment with steroids for 1 month, the lesions regressed except for the central lesion, from which an incisional biopsy was taken and a well differentiated squamous cell carcinoma was diagnosed. The oncological phase consisted of partial palatectomy. To date, 3 years after surgery, the patient is free from malignant lesions. Lupus erythematosus is considered a potentially malignant disorder, although the cause for neoplasic transformation in these patients is still not clear, but cyclophosphamide consumption may be implicated; the case emphasizes the importance of periodical oral evaluation of such patients. Repeated biopsies should be performed if there is failure to respond to conventional therapy.
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Affiliation(s)
| | | | - M Villarroel-Dorrego
- Institute of Dental Research, Central University of Venezuela, Caracas, Venezuela
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Shebl FM, Bhatia K, Engels EA. Salivary gland and nasopharyngeal cancers in individuals with acquired immunodeficiency syndrome in United States. Int J Cancer 2010; 126:2503-8. [PMID: 19810095 DOI: 10.1002/ijc.24930] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
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.
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13
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Schneider M, Rizzardi C. Lymphoepithelial carcinoma of the parotid glands and its relationship with benign lymphoepithelial lesions. Arch Pathol Lab Med 2008; 132:278-82. [PMID: 18251590 DOI: 10.5858/2008-132-278-lcotpg] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2007] [Indexed: 11/06/2022]
Abstract
The salivary glands, despite their relatively simple morphology, give rise to more than 30 histologically distinct benign and malignant tumors. Salivary gland neoplasms comprise less than 2% of all tumors in humans and 3% of all head and neck tumors. They arise in the parotid gland in 80% of cases, and approximately 80% are benign and 20% are malignant. Among them are lymphoepithelial lesions, rare lesions of the salivary glands and especially of the parotid gland that are characterized by lymphocytic infiltration associated with an epithelial proliferation. They are divided into benign, which is considered as a tumorlike condition, and malignant, which is a rare carcinoma of the salivary glands. This article provides a review of the current knowledge on lymphoepithelial carcinoma with a look at its association with benign lesions and on the importance of making the correct diagnosis for the appropriate treatment.
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Affiliation(s)
- Manuela Schneider
- Sezione Complessa Anatomia Patologica, Dipartimento di Patologia e Medicina Legale, Ospedale di Cattinara, Strada di Fiume 447, Trieste, Italy I-34149.
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