Primary Esophageal Lymphoepithelioma

Primary lymphoepithelioma-like carcinoma of the esophagus with metastatic lymph node and gastric cancer

Upper gastrointestinal lymphoepithelioma-like carcinoma (LELC) is a rare disease-especially esophageal LELC (ELELC). Here, we report a surgically treated case of ELELC with gastric carcinoma. The patient was a 68-year-old asymptomatic Japanese man. Endoscopy revealed a submucosal-like protruding tumor located in the anterior wall of the esophagus 31-33 cm from the upper incisors and a slightly ulcerative lesion at the antrum of stomach. Histopathological diagnosis from biopsy of the esophageal lesion revealed a poorly differentiated squamous cell carcinoma; the stomach lesion was found to be well-differentiated tubular adenocarcinoma. CT showed a swollen lymph node along the left recurrent nerve. On the basis of a diagnosis of esophageal and gastric cancer, we performed esophagectomy with three-field lymph node dissection and partial gastrectomy. Histopathology of the resected esophageal tumor revealed solid nests of cancer cells, with substantial infiltration of lymphoid cells into the stroma. There were poorly differentiated cancer cells with large nuclei in the lymph node. In situ hybridization for Epstein-Barr virus showed no nuclear signal in the tumor cells. Immunohistochemistry gave a diagnosis of ELELC.

Rare tumors of esophageal squamous mucosa

In spite of increasing incidence of esophageal adenocarcinoma in the last few decades, esophageal squamous cell carcinoma (SCC) still remains the dominant subtype of esophageal cancer worldwide. Apart from conventional SCC, some rare unconventional tumors of esophageal squamous mucosa are also well known. This study provides an introduction to these and presents a brief review of the literature, including the diagnostic and prognostic importance of each variant.

Lymphoepithelioma-like carcinoma of the vulva: a case report

This report describes a lymphoepithelioma-like carcinoma of the vulva in a 64-year-old woman. The tumor showed distinct morphologic features including syncytial sheets of malignant epithelioid cells and a dense lymphoplasmacytoid infiltrate. In situ hybridization and immunohistochemistry for Epstein-Barr virus were negative. The tumor was treated by surgical excision. No evidence of recurrence has been detected 3 years after treatment. To our knowledge this is the second reported case of lymphoepithelioma-like carcinoma of the vulva.

Lymphoepithelioma-like carcinoma of the esophagus: report of a case with non-progressive behavior

Lymphoepithelioma-like carcinoma (LELC) of the esophagus is extremely rare and the prognosis has been described to be favorable. Herein, the case is reported of esophageal LELC showing non-progressive course for 1 year. The patient was a 70-year-old Japanese man with a submucosal tumor in the lower esophagus. The tumor was endoscopically regarded as a benign leiomyoma. One year after the first endoscopic examination, the size of the lesion remained unchanged despite no treatment. Histologically, the tumor showed undifferentiated carcinoma associated with dense lymphocytic and plasma cell infiltration. Lymphoid follicles surrounded the tumor cell nests. Immunohistochemically, Ki-67 labeling index of the tumor cells were 76.0%, and there were few single-strand DNA-positive apoptotic cells. In situ hybridization using a digoxigen-labeled Epstein-Barr virus (EBV)-encoded small RNA (EBER)-1 riboprobe failed to detect the presence of EBV infection. Physicians should be aware that esophageal LELC endoscopically mimics benign submucosal tumor. This case may demonstrate that esophageal LELC is a slow-growing tumor and it is related to immune reaction.

Epstein-Barr Virus-associated Primary Lymphoepitheliomalike Carcinoma of the Esophagus

Primary lymphoepitheliomalike carcinomas (LELC) of the esophagus are uncommon, with only 29 previously reported cases in the literature. Primary LELC of the esophagus is associated with Epstein-Barr virus (EBV). We herein report a 52-year-old man who presented with dysphagia and weight loss and was found to have a polypoid mass in the middle esophagus. Pathologic examination showed LELC. EBV infection was demonstrated by immunohistochemical detection of EBNA-1 in neoplastic cells and polymerase chain reaction amplification for EBNA-3C, BamHI-F, and W1/I1 regions but not by in situ hybridization by EBER-1 transcripts. EBV genotyping analysis demonstrated infection by a novel type "i"/XhoI loss recombinant strain. Although it is accepted that polymorphisms at BamHI-W1/I1 region cosegregate with polymorphisms at XhoI restriction site, this novel recombinant EBV has been identified in healthy donors and in nasal NK/T-cell lymphoma. To our knowledge, this is the first report that describes this recombinant type "i"/XhoI loss EBV strain in a primary LELC of the esophagus.

Epstein-Barr virus-associated lymphoepithelioma-like carcinoma of the esophagus

Epstein-Barr virus (EBV)-associated lymphoepithelioma-like carcinoma (LELC) rarely occurs in the esophagus. We report a case of such tumor arising in the esophagus of a 64-year-old Taiwanese woman. No tumors were detected outside the esophagus including nasopharynx by thorough clinical studies. She underwent subtotal esophagectomy. Light microscopy disclosed a poorly differentiated carcinoma morphologically reminiscent of nasopharyngeal undifferentiated carcinoma (lymphoepithelioma). Immunohistochemical stain for latent membrane protein-1 showed positivity on the tumor cells. The infiltrating lymphocytes were chiefly composed of CD8-positive cytotoxic T cells. EBV DNA was demonstrated by both nested polymerase chain reaction (PCR) in the main tumor and metastatic lymph node, and localization in the tumor cells by in situ PCR in situ hybridization (ISH). However, the result of EBV-encoded small RNA-1 ISH was negative. Our case suggests that LELC of the esophagus may be associated with EBV in the endemic area. Due to its distinct histological features, the association with EBV, and possible prognostic implication, LELC of the esophagus should be precisely diagnosed and discerned from the usual poorly differentiated carcinoma.

Lymphoepithelioma-like carcinoma of rectum: possible relation with EBV

Lymphoepithelioma-like carcinoma (LEC) of the colon is very rare. Here we report a case of LEC originating in the rectum that was closely associated with Epstein-Barr virus (EBV) infection. The histologic and immunohistologic features, namely, poorly differentiated adenocarcinoma with lymphoid stroma, showed this tumor to be an LEC. The EBV genome was detected by PCR using DNA obtained from tumor tissue sections. Immunohistochemically, EBV-determined nuclear antigen 2 was detected in the tumor cells, and in situ hybridization using EBV-encoded small RNAs probe showed positive labeling in some tumor cells together with a few stromal lymphoid cells. There are some reports of LEC cases that originated in the colon; however, a relation with EBV was not demonstrated. We report here a case of LEC of the rectum demonstrating a possible relation with EBV.