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

Lymphoepithelial carcinoma of the parotid gland

Primary lymphoepithelial carcinoma of the salivary glands is an exceptional oncological condition that predominantly emerges within the parotid gland. A significant prevalence of lymphoepithelial carcinoma has been reported in the Inuit population, along with an associated positive serology for Epstein-Barr virus in these endemic regions. In this paper, we present a case of primary lymphoepithelial carcinoma of the parotid gland in a 68-year-old female patient with a history of diabetes and hypertension residing in a non-endemic area. Histology plays a critical role in the definitive diagnosis, and confirming the primary origin of lymphoepithelial carcinoma after ruling out metastasis from undifferentiated nasopharyngeal carcinoma. The mainstay of treatment is a combination of surgical resection and adjuvant radiotherapy. Inoperable forms are typically managed with chemoradiotherapy.

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.

Is radical radiotherapy with/without surgery an effective treatment in the lymphoepithelial carcinoma of the salivary gland？

BACKGROUND

There is limited information of radical radiotherapy (RT) on lymphoepithelial carcinoma of salivary gland (LECSG) regarding to the rarity of the disease. We conducted this retrospective study that evaluated the feasibility and efficacy of radical RT with/without surgery in LECSG.

METHODS

We retrospectively reviewed patients that were pathologically diagnosed of LECSG and had definite or suspicious residual disease. The prescribed dose given to P-GTV and/or P-GTV-LN was 66 to 70.4 Gy. The clinical target volume (CTV) involved ipsilateral salivary gland and corresponding lymph node drainage area.

RESULTS

A total of 56 patients were included. With a median follow-up of 60 months (range: 8 to 151 months), the 1-, 5-, and 10-year progression-free survival (PFS) rates were 94.6%, 84.7% and 84.7%; locoregional progression-free survival (LRPFS) rates were 98.2%, 87.4% and 87.4%; distance metastasis-free survival (DMFS) rates were 94.6%, 86.7% and 86.7%; and overall survival (OS) rates were 98.2%, 92.4% and 89.0%, respectively. A total of 7 patients without surgery were included. All patients were alive and only one patient experienced failure of distant metastasis four months after RT. The results of univariate analysis showed that compared with N stage, the number of positive lymph nodes (2 positive lymph nodes) was better prognostic predictor especially in PFS. There were no treatment-related deaths and most toxicities of RT were mild.

CONCLUSIONS

Radical RT with/without surgery in LECSG for definite or suspicious residual disease is feasibility and efficacy. Most toxicities of RT were mild due to the target volume involved ipsilateral area.

Clinical characteristics, prognostic factors, and treatment modalities for head and neck lymphoepithelioma-like carcinoma: A real-world study from southern China

BACKGROUND

We aimed to elucidate the clinical characteristics, prognostic factors and optimal treatment modalities of head and neck lymphoepithelioma-like carcinoma (HNLELC).

METHODS

Consecutive patients newly-diagnosed with non-metastatic HNLELC between December 2001 and March 2021 treated with curative intent were retrospectively reviewed.

RESULTS

A total of 288 patients were included, of whom 87 (30.2%) underwent radical surgery alone, 43 (14.9%) underwent definitive radiotherapy with or without concurrent chemotherapy, and 158 (54.9%) underwent surgery followed by postoperative radiotherapy (SRT). Epstein-Barr virus-encoded small RNA (EBER) was positive in 94.8% (239/252) of patients. Cervical node infiltration was seen in 52.8% (152/288) of patients. No significant difference was found in nodal metastasis rate between T1-2 and T3-4 classifications (49.5% vs. 56.5%, p = 0.308). The 3-year overall survival (OS), disease-free survival, locoregional relapse-free survival, and distant metastasis-free survival rates were 89.4%, 78.7%, 89.2%, and 87.7%, respectively. Compared to SRT, surgery alone associated with significant reduced 3-year local (92.8% vs. 96.5%, p = 0.012) and regional relapse-free survival rates (89.3% vs. 96.8%, p = 0.002). Definitive radiotherapy and SRT demonstrated comparable results in all 3-year survival outcomes (all p＞0.05). Multivariate analysis found EBER status was an independent favorable prognostic factor for OS (HR = 0.356, 95% CI: 0.144-0.882, p = 0.026).

CONCLUSION

HNLELC was observed to associate with EBV infection and cervical nodal infiltration. Definitive radiotherapy achieved similar survival outcomes compared to SRT, and may serve as a good substitute for patients unfit or unwilling to undergo surgery.

Epstein-Barr Virus-Associated Lymphoepithelial Carcinoma Arising in a Salivary Sebaceous Lymphadenoma

BACKGROUND

Lymphadenomas are rare benign tumors of the major salivary glands that are further classified as sebaceous and non-sebaceous. No association with viruses has been reported so far. Little is known about the mechanisms that allow lymphadenomas to undergo malignant transformation. Among these rare instances, there has never been a malignant transformation to Epstein-Barr virus (EBV)-associated lymphoepithelial carcinoma.

METHODS

Clinical data of the reported case were retrieved from the patient's electronic medical record. Hematoxylin & eosin-stained slides, immunohistochemical tests, and in situ hybridization performed for routine diagnostic purposes were reviewed.

RESULTS

We report a salivary gland sebaceous lymphadenoma in which the luminal components were mostly replaced by malignant epithelial cells with markedly atypical nuclear features. Presence of EBV was demonstrated in all components by EBER. The morphological and immunohistochemical findings were consistent with a lymphoepithelial carcinoma arising from a sebaceous lymphadenoma.

CONCLUSION

We report the first case of an Epstein-Barr virus-associated lymphoepithelial carcinoma arising from a sebaceous lymphadenoma.

Primary Lymphoepithelial Carcinoma of the Submandibular Gland in A Young Patient: A Case Report

Lymphoepithelial carcinoma (LEC) is a rare entity of malignancy. It has been associated with Epstein-Barr virus (EBV), and in regions where it is endemic, such as Southeast Asia, EBV is typically associated with nasopharyngeal carcinoma. The incidence of such malignancies in the young population is unusual. Here we report a 17-year-old with a 5-year history of a painless right submandibular mass presenting with a sudden increase in size for one month before surgery. Neck examination revealed a firm right submandibular gland measuring five by five cm, with an irregular surface, non-tender with normal overlying skin. We performed a fine needle aspiration cytology (FNAC), and he underwent computed tomography (CT) scan of the neck. He underwent a right submandibulectomy. Lymph nodes from levels I and II were also removed. The final histopathology was reported as LEC. Following this tissue diagnosis, another follow-up surgery, a modified radical neck dissection, was carried out for locoregional clearance. Postoperatively, he completed chemoradiotherapy treatment and is now on regular follow-up.

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.

Clinical outcomes of non‐nasopharyngeal lymphoepithelial carcinoma treated with a combined modality approach: A single‐institution study

BACKGROUND

This study presents a summary of the clinical characteristics of non-nasopharyngeal lymphoepithelial carcinoma (NNPLEC), effects of combined modality treatment and prognostic value of plasma Epstein-Barr virus (EBV) deoxyribonucleic acid (DNA) load, with the aim of providing a reference framework for optimizing treatment practices and outcomes.

METHODS

Patients with NNPLEC treated by our center between January 2000 and December 2020 were retrospectively reviewed.

RESULTS

In total, 728 patients were included. The lung was identified as the most common primary tumor site (64.0%), followed by the salivary gland (19.2%). A total of 539 (74.0%) patients underwent surgery, 459 (63.0%) received chemotherapy, and 361 (49.6%) were subjected to radiotherapy. The median follow-up time was 45 months (range, 6-212 months) and 5-year overall survival (OS) was 79.1%. Increased plasma EBV-DNA load of >513.5 copies/mL was predictive of disease progression, with a specificity of 98.1% and a sensitivity of 98.9%. In multivariate Cox analysis, N stage, surgery, and radiotherapy were independent prognostic factors for both OS and PFS. Radiotherapy significantly improves OS in comparison with no radiotherapy group for salivary LEC, while surgery significantly improves OS for pulmonary LEC.

CONCLUSION

Based on our analysis, surgery and radiotherapy are associated with better OS and PFS for NNPLEC. Radiotherapy could be recommended for salivary LEC, while surgery remains the primary treatment strategy for pulmonary LEC patients. An increased plasma EBV-DNA load of >513.5 copies/mL is strongly predictive of disease progression, supporting the importance of regular evaluation of plasma EBV-DNA as part of the diagnostic routine.

Epstein-Barr Virus (EBV) Epithelial Associated Malignancies: Exploring Pathologies and Current Treatments

Epstein-Barr virus (EBV) is one of eight known herpesviruses with the potential to infect humans. Globally, it is estimated that between 90-95% of the population has been infected with EBV. EBV is an oncogenic virus that has been strongly linked to various epithelial malignancies such as nasopharyngeal and gastric cancer. Recent evidence suggests a link between EBV and breast cancer. Additionally, there are other, rarer cancers with weaker evidence linking them to EBV. In this review, we discuss the currently known epithelial malignancies associated with EBV. Additionally, we discuss and establish which treatments and therapies are most recommended for each cancer associated with EBV.

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.

Is postoperative radiotherapy an essential treatment for nonmetastatic lymphoepithelial carcinoma of the salivary gland?

BACKGROUND

Lymphoepithelial carcinoma of salivary gland (LECSG) is a rare malignant tumor. Whether postoperative radiotherapy (PORT) can improve locoregional control and which patients can benefit from PORT are unknown. This study aimed to evaluate the role of PORT and provide individualized suggestions for postoperative therapy in patients with LECSG.

PATIENTS AND METHODS

We retrospectively reviewed patients with nonmetastatic LECSG who underwent surgery with or without PORT. Recursive partitioning analysis (RPA) was performed to categorize the patients and predict progression-free survival (PFS).

RESULTS

A total of 223 patients were included, 34 (15.2%) received surgery alone, whereas the remaining 189 (84.8%) underwent PORT in the initial treatment. Although patients in the PORT group were with advanced T stage and N stage, the PORT group had an advantage over the non-PORT group on 1-year, 5-year and 10-year PFS and locoregional control (LRC). PORT was an independent prognostic factor for PFS and LRC. Furthermore, compared with T stage and N stage, the size of the primary tumor and the number of positive lymph nodes were better prognostic predictors. The RPA model was generated according to the endpoint of PFS and categorized patients into 3 prognostic groups: low-risk (maximum diameter of primary lesion (≤3cm) and number of positive lymph nodes (≤2)), intermediate-risk (maximum diameter of primary lesion (>3cm) and number of positive lymph nodes (≤2)), and high-risk (number of positive lymph nodes (>2)), with corresponding 5-year PFS rates of 90.0%, 75.0%, and 51.0%, respectively. Significant improvement in PFS was observed in the PORT group among intermediate-risk (P=0.000) and high-risk patients (P=0.000).

CONCLUSIONS

PORT was shown to be a positive prognostic factor for PFS and LRC of LECSG. PORT was an essential treatment especially for patients with >3cm maximum diameter of primary lesion and/or >2 positive lymph nodes.

Mutational and immunologic Landscape in malignant Salivary Gland Tumors harbor the potential for novel therapeutic strategies

Salivary gland carcinomas (SGC) are rare (3-6 % of all head and neck cancers) and show biological heterogeneity depending on the respective histological subtype. While complete surgical resection is the standard treatment for localized disease, chemotherapy or radiation therapy are frequently insufficient for the treatment of unresectable or metastasized SGC. Therefore, new therapeutic approaches such as molecularly targeted therapy or the application of immune checkpoint inhibition enhance the treatment repertoire. Accordingly, comprehensive analyses of the genomic landscape and the tumor-microenvironment (TME) are of crucial importance in order to optimize and individualize SGC treatment. This manuscript combines the current scientific knowledge of the composition of the mutational landscape and the TME in SGCs harboring the potential for novel (immune-) targeted therapeutic strategies.

Nomograms-based prediction of overall and cancer-specific survivals for patients diagnosed with major salivary gland carcinoma

Background

Major salivary glands carcinoma (MSGC) is a relatively rare cancer with diverse histological types and biological behavior. The treatment planning and prognosis prediction are challenging for clinicians. The aim of the current study was to establish a reliable and effective nomogram to predict the overall survival (OS) and cancer-specific survival (CSS) for MSGC patients.

Methods

Patients pathologically diagnosed with MSGC were recruited from Surveillance, Epidemiology, and End Results (SEER) database and randomly divided into training and validation groups (7:3 ratio). Univariate, multivariate Cox proportional hazard models, and least absolute shrinkage and selection operator (LASSO) regression were adopted for the selection of risk factors. Nomograms were developed using R software. The model performance was evaluated by drawing receiver operating characteristic (ROC), overtime C-index curves, and calibration curves. Harrell C-index, areas under the curves (AUC), and Brier score were also calculated. The decision curve analysis (DCA) was conducted to measure the net clinical benefit.

Results

A total of 11,362 patients were identified and divided into training (n=7,953) and validation (n=3,409) dataset. Sex, age, race, marital status, site, differentiation grade, American Joint Committee on Cancer (AJCC) stage, T/N/M stage, tumor size, surgery, and histological type were incorporated into the Cox hazard model for OS prediction after variable selection, while all predictors, except for marital status and site, were selected for CSS prediction. For 5-year prediction, the AUC of the nomogram for OS and CSS was 83.5 and 82.7 in the training and validation dataset, respectively. The C-index was 0.787 for OS and 0.798 for CSS in the validation group. The Brier score was 0.0153 and 0.0130 for OS and CSS, respectively. The calibration curves showed that the nomogram had well prediction accuracy. From the perspective of DCA, a nomogram was superior to the AJCC stage and TNM stage in net benefit. In general, the performance of the nomogram was consistently better compared to the AJCC stage and TNM stage across all settings.

Conclusions

The performance of the novel nomogram for predicting OS and CSS of MSGC patients was further verified, revealing that it could be used as a valuable tool in assisting clinical decision-making.

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.

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 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.

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.