A Case Report of Tongue Lymphoepithelial Carcinoma with a Histological Diagnostic Dilemma

Abstract

Most head and neck lymphoepithelial carcinomas (LECs) arise in the nasopharynx and harbor Epstein–Barr virus (EBV). LEC is also a rare subtype of the oral squamous cell carcinoma (SCC). Morphologically, LEC is defined as resembling non-keratinizing nasopharyngeal carcinoma, undifferentiated subtype. The histological features and pathogenesis of oral LEC are not established. We describe a case of tongue LEC with histopathological diagnostic difficulties. A 72-year-old Japanese female presented with a whitish change on her left-side tongue. The diagnosis was atypical epithelium; neoplastic change could not be ruled out by a biopsy. Although the lesion was monitored at our hospital per her request, invasive carcinoma was detected 11 months later. Microscopically, conventional SCC was observed with the characteristic features as LEC confined to the deep part of the lesion. We briefly discuss this unusual histological finding and make a novel proposal for distinguishing oral LEC from LECs in other regions based on these histological findings.

Lymphoepithelial Subtype of Oral Squamous Cell Carcinoma: Report of an EBV-Negative Case and Literature Review

“…The review of the pertinent literature yielded 27 cases (including our case), all of which were case reports or case series [ 5 , 11 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ]. The available data are presented in Table 1 and summarized in Table 2 .…”

“…It is worth mentioning that, in the remaining cases, no reliable conclusions regarding the tissue of origin could be drawn, as the relationship of tumor cells with the surface epithelium or subjacent MSG was not clearly described. Therefore, our case is only the fourth oral LEC with a demonstrated origin from the surface mucosa and the first reported one to affect the gingiva; the other three cases originating from the surface epithelium were located in the lateral border of the tongue (two cases) [ 40 , 41 ] and the lower lip (one case) [ 11 ]. The remaining oral LEC cases (of MSG or unspecified origin) showed a predilection for the palate, followed by the lips (mostly the lower) and the buccal mucosa; interestingly, two cases showed intrabony involvement (one in the maxilla and one in the mandible) [ 30 , 36 ], raising the possibility of an origin from odontogenic epithelial rests or entrapped MSG in the jaws (similar to other salivary gland neoplasms developing in the jaws) [ 42 ].…”