Sasaki A, Kato T, Ujiie H, Cho Y, Sato M, Kaji M. Primary pulmonary lymphoepithelioma-like carcinoma with positive expression of Epstein-Barr virus and PD-L1: A case report.
Int J Surg Case Rep 2021;
79:431-435. [PMID:
33529823 PMCID:
PMC7851415 DOI:
10.1016/j.ijscr.2021.01.066]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/17/2021] [Accepted: 01/17/2021] [Indexed: 01/26/2023] Open
Abstract
Pulmonary lymphoepithelioma-like carcinoma (LELC) is extremely rare in Japan.
None of the studies regarding LELC in Japan described an association with PD-L1.
This is the first case of LELC in Japan with both expression of EBER-ISH and PD-L1.
An investigation of PD-L1 would be useful considering the PD-1/PD-L1 blockade.
Thus, PD-L1 expression should be examined in patients with pulmonary LELC.
Introduction and importance
Pulmonary lymphoepithelioma-like carcinoma (LELC) is a rare type of non-small cell lung cancer (NSCLC) that is classified as a subtype of unclassified carcinoma by the WHO. LELC is usually associated with Epstein-Barr virus (EBV) infection. LELC has often been observed in Southeast Asia; however, it is extremely rare in Japan.
Case presentation
A 60-year-old Japanese woman presented with an abnormal shadow in the left lung on chest radiography. Chest computed tomography showed a nodule located between the lingular and basal anteromedial segments. A blood test suggested an existing EBV infection, and LELC was suspected preoperatively in the transbronchial lung biopsy. She underwent a lingular and basal bi-segmentectomy. The EBV-encoded small ribonucleic acid in-situ hybridization (EBER-ISH) was positive, and she was diagnosed with LELC. Moreover, programmed death-ligand 1 (PD-L1) expression was moderately positive. No recurrence was observed for 30 months.
Clinical discussion
Although LELC has been reported as a low-grade malignancy with a good prognosis, the frequency of PD-L1 expression in LELC seems to be higher than that in other NSCLCs. Moreover, it has been reported that LELC patients with high PD-L1 expression are likely to have early recurrence/metastasis and poor prognosis.
Conclusion
An investigation of PD-L1 expression for LELC would be useful considering the benefit of PD-1/PD-L1 blockade in patients with pulmonary LELC with high PD-L1 expression. The present case is the first report of LELC with positive expression of EBER-ISH and PD-L1 in Japan.
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