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

Abstract

Lymphoepithelial carcinoma (LEC) of the oral mucosa is a rare histopathologic subtype of squamous cell carcinoma (SCC), which shares morphologic similarities with nasopharyngeal carcinoma (NPC), non-keratinizing undifferentiated subtype. The admixture of neoplastic epithelial tumor cells and a dense lymphoplasmacytic infiltrate makes microscopic diagnosis challenging. LEC etiopathogenesis has been variably associated with Epstein–Barr virus (EBV) infection, depending on the specific anatomic location and racial predilection, with a higher incidence in endemic populations. Although described in several subsites of the head and neck region, including the major salivary glands, the oral mucosa is considered an infrequent location for LEC development, deriving either from minor salivary glands (MSGs) or the surface epithelium. Herein, we report a rare case of an EBV-negative LEC arising from the oral surface epithelium, presenting as gingival swelling, and review the pertinent English-language literature, which revealed only 26 previously reported oral LECs. Our case is only the fourth oral LEC originating from the surface epithelium and the first one to affect the gingiva.

Sinonasal Lymphoepithelial Carcinoma With Aggressive Orbital Invasion

“…Over the years, numerous terms have been used to describe LEC in extrapharyngeal sites, such as lymphoepithelioma, lymphoepithelioma-like carcinoma, lymphoepithelial-like carcinoma, undifferentiated carcinoma of nasopharyngeal type, and undifferentiated carcinoma with lymphoid stroma. Recently, it was accepted as a distinct entity separate from nasopharyngeal carcinoma (NPC) by topography and clinical outcome but histopathologically similar [ 7 ]. A study conducted in China shows the ratio of LEC to NPC to be 1:564 [ 8 ].…”

“…Around 90% of LEC cases are strongly associated with EBV. EBER ISH is the methodology of choice, which yields high sensitivity of detection for EBV [ 7 ]. In our patient, it tested negative for EBV.…”

Classificatory updates in verrucous and cuniculatum carcinomas: Insights from the 5th edition of WHO-IARC head and neck tumor classification

“…In contrast to the other subtypes, it may carry a more favorable prognosis[ 8 ]. The Lymphoepithelial Carcinoma variant showcases a pronounced lymphoid stroma and is comparatively rare within the oral cavity[ 9 ].…”