Difficult Preoperative Diagnosis of Lymphoepithelioma-Like Carcinoma of the Esophagus

A Case of Superficial Esophageal Neuroendocrine Carcinoma with Marked Morphological Changes in a Short Period

A de novo whitish subepithelial lesion (SEL) with irregular vascular hyperplasia was detected in the lower thoracic esophagus during endoscopic surveillance. Special types of esophageal cancer were suspected; however, endoscopic biopsy specimens were inadequate for a diagnosis. Ten days later, endoscopic ultrasound showed a 7-mm homogeneously hypoechoic round mass in the submucosa, and a biopsy confirmed a histological diagnosis of esophageal neuroendocrine carcinoma (eNEC). Based on the clinical diagnosis of cT2N0M0, subtotal esophagectomy followed by adjuvant chemotherapy was performed immediately after endoscopic reexamination revealing a 20-mm reddish SMT. We herein report the marked changes in endoscopic findings of eNEC within 1.5 months.

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.

Updates on World Health Organization classification and staging of esophageal tumors: implications for future clinical practice

The Fifth edition of the World Health Organization classification of digestive system and American Joint Committee on Cancer staging manual contain substantial refinements of information for esophageal tumors. The epithelial tumors of esophagus are classified as benign, dysplasia, and malignant groups. Dysplasia is divided into Barrett dysplasia and squamous dysplasia and graded into either low-grade or high-grade. Malignant esophageal tumors are often adenocarcinoma or squamous cell carcinoma. The main update in cancer staging in esophageal tumors is the subdivision of the prognostic staging into 3 groups; squamous cell carcinoma, adenocarcinoma, and carcinoma after adjuvant therapy. HER-2 amplification is recognized as a molecular target for therapy of esophagogastric adenocarcinoma. The other esophageal tumors are adenoid cystic carcinoma, mucoepidermoid/adenosquamous carcinoma, undifferentiated carcinoma and neuroendocrine neoplasms. Overall, the incorporation of new data and definitions on histopathology, prognostic factors, and genetics are important for personalized management of patients with esophageal tumors.

Superficial esophageal lymphoepithelioma-like carcinoma treated with endoscopic submucosal dissection: a case report

Lymphoepithelioma-like carcinoma (LELC) of esophagus is an extremely rare tumor only a few cases were successfully treated with endoscopic submucosal dissection (ESD). We herein report one case of superficial esophageal LELC with adjacent squamous intraepithelial neoplasia successfully treated by ESD, and the status of Epstein-Barr virus (EBV) infection and microsatellite instability (MSI) were detected simultaneously. A 71-year-old woman presented with complaints of substernal discomfort. Under endoscopy, a dome-shaped bulge of 1.2 cm × 0.8 cm was located at the mucosal lamina propria in the left lateral wall of the middle esophagus, and the mucosa covering the bulge was smooth and normal-appearing. A brownish lesion was found adjacent to the bulge. Microscopically, the tumor was well demarcated, and nests of syncytial epithelioid cells were identified in the lamina propria of the mucosa, with a large number of inflammatory cells. The squamous epithelium covering the surface of the infiltrating tumor and the second brownish lesion demonstrated low grade squamous intraepithelial neoplasia. Tumor tissue showed CK5/6, p63, and p40 positive staining, was EBV negative, and had microsatellite stability. After treatment with ESD, this patient received no further treatment, and had no recurrence or metastasis at 25-month follow-up.

Hidden Carcinoma: Pitfalls in the Diagnosis of Lymphoepithelioma-Like Cholangiocarcinoma

Lymphoepithelioma-like intrahepatic cholangiocarcinoma is a rare variant of cholangiocarcinoma that is associated with the Epstein-Barr virus. The intimate relationship between the malignant epithelial cells and the numerous lymphoid cells can make the diagnosis challenging on limited tissue samples. We present 2 cases in which the presence of a dense hematolymphoid infiltrate served to mask the diagnosis of carcinoma on initial frozen section and biopsy review, respectively. We bring awareness to this potential diagnostic pitfall and offer morphologic and immunohistochemical clues that may aid in recognition of this unusual and sometimes perplexing carcinoma.