Lymphoepithelioma-like carcinoma of the lung: an unusual case and literature review. Case Rep Pulmonol. 2013;2013:143405. [PMID: 24288644 PMCID: PMC3833058 DOI: 10.1155/2013/143405]

Lymphoepithelioma-like cholangiocarcinoma not associated with Epstein-Barr virus or hepatitis virus: case report and literature review of 100 reported cases

Lymphoepithelioma-like cholangiocarcinoma (LEL-CC) is a type of lymphoepithelioma-like carcinoma (LELC) and a rare variant of primary liver tumor. Although it is uncommon and only 100 cases have been reported thus far, the number of reports has increased in recent years. LEL-CC reportedly occurs more frequently in Asian women; Epstein-Barr virus (EBV) and hepatitis viruses are both strongly associated with tumor development. Here, we describe a 76-year-old woman who exhibited LEL-CC not associated with EBV or hepatitis virus. She was referred to our department with a 3.0-cm × 2.8-cm tumor in the left lobe of the liver. Based on computed tomography and magnetic resonance imaging findings, the tumor was preoperatively diagnosed as hepatocellular carcinoma. Thus, we performed extended left hepatectomy with caudal lobectomy. Histopathological examinations revealed columnar tumor cells with atypical nuclei that proliferated in a cord-like or glandular tubular pattern with dense lymphocytic infiltration. Immunohistochemical analysis showed negative HepPar-1 and arginase findings, indicating non-hepatocyte origin; however, the biliary-type cytokeratins CK7 and CK19 were detected. Based on these findings, the tumor was identified as LEL-CC. EBV-encoded RNA in situ hybridization findings were negative; the patient's clinical characteristics were not suggestive of hepatitis virus infection. In conclusion, we suggest that clinicians consider LEL-CC as a differential diagnosis for liver tumors in Asian women, including patients without EBV or hepatitis virus.

Pathogenic Role of Epstein-Barr Virus in Lung Cancers

Human oncogenic viruses account for at least 12% of total cancer cases worldwide. Epstein–Barr virus (EBV) is the first identified human oncogenic virus and it alone causes ~200,000 cancer cases and ~1.8% of total cancer-related death annually. Over the past 40 years, increasing lines of evidence have supported a causal link between EBV infection and a subgroup of lung cancers (LCs). In this article, we review the current understanding of the EBV-LC association and the etiological role of EBV in lung carcinogenesis. We also discuss the clinical impact of the knowledge gained from previous research, challenges, and future directions in this field. Given the high clinical relevance of EBV-LC association, there is an urgent need for further investigation on this topic.

Lung Cancer in Pregnancy: An Unusual Case of Complete Response to Chemotherapy

The diagnosis of lung cancer in pregnancy is rare. Most cases are quite advanced and have dismal outcomes despite treatment. We present the case of a 26-year-old woman who was diagnosed with Stage IIIA (T3N2M0) squamous-cell carcinoma of the lung with lymphoepithelioma-like features at the 18(th) week of pregnancy. A chest CT revealed a large right hilar mass with obliteration of the right main bronchus and resulting collapse of the right lung with mediastinal shift to the right. A transbronchial biopsy of the mass and a subcarinal lymph node confirmed poorly differentiated squamous cell carcinoma with lymphoepithelioma-like features. Brain MRI, PET, and CT scans were negative for distant metastasis. The patient received four cycles of neoadjuvant cisplatin and docetaxel with a complete radiographic response. She delivered a healthy baby girl at 35 weeks gestation. Post-partum, she received radiation to the right hilum and mediastinum as consolidation. The patient continues to remain free of disease more than 16 months after initial diagnosis. To our knowledge, this is the only reported case of lung cancer in pregnancy where there is a complete response to chemotherapy. The histology is also distinct from other reported cases. In addition, this case exemplifies the relative safety and efficacy of chemotherapy during the later stages of pregnancy. As long as a patient is beyond the first trimester of pregnancy, platinum-based doublet chemotherapy may be considered as a feasible treatment option.

Lessons from rare tumors: Hepatic lymphoepithelioma-like carcinomas

In this review we focus on lymphoepithelioma-like hepatocellular carcinomas (LEL-HCC) and lymphoepithelioma-like cholangiocarcinomas (LEL-ICC). Despite their rarity, these tumors are of general interest because of their epidemiological and clinical features, and because they represent a distinct model of interaction between the immune system and neoplastic cells. Approximately half of LEL-HCC arise in the context of chronic hepatitis C virus (HCV) infection and have been described both in Eastern and Western patients. By contrast, LEL-ICC is associated in almost all cases with Epstein-Barr virus (EBV) infection and exhibits the same epidemiological features of EBV related malignancies. Compared with classical hepatocellular carcinoma and intrahepatic cholangiocarcinoma of corresponding stage, both LEL-HCC and LEL-ICC are characterized by lower rates of recurrence after surgery and better overall survival. How this behavior is related to distinct genetic alterations and tumor microenvironment is unclear. The pathophysiological mechanisms of lymphoid infiltrations seem to be different among the two groups of tumors. In fact, LEL-HCC frequently arises in the context of inflammatory changes driven by HCV infection, and has been recognized as a variant of classical hepatocellular carcinoma. At variance, lymphocyte recruitment of LEL-ICC is similar to that described in nasopharyngeal carcinoma and gastric LEL, and possibly depends on the expression pattern of latent EBV infection.