Lymphoepithelioma-like carcinoma of the breast. Report of a case with the first electron microscopic study and review of the literature

Abstract

Lymphoepithelioma-like carcinoma (LELC) is a tumor which occurs outside the nasopharynx and has morphological features identical to nasopharyngeal lymphoepithelioma. LELC of the breast (LELC-B) is uncommon, and its resemblance to medullary carcinoma of the breast (MC-B) obscures distinction between these two tumors. We report a case of LELC-B occurring in a 47-year-old woman. The tumor consisted of multinodules without circumscription. The tumor cells mainly exhibited loose clusters being permeated by numerous lymphocytes. The tumor cell clusters showed inconspicuous margins, which were far from syncytial patterns. The epithelial nature of the tumor cells was demonstrated by positivity for epithelial membrane antigen, AE1/AE3 and CAM5.2. Furthermore, glandular differentiation of the tumor cells was confirmed using electron microscopy for the first time. Epstein-Barr virus (EBV) was not detected using either in situ hybridization or polymerase chain reaction. These findings, together with former reports of LELC-B, suggest that the distinction between LELC-B and MC-B depends on whether circumscription and syncytial growth patterns exist. The other findings, including absence of EBV and immunohistochemical aspects of the tumor cells, are not considered different thus far. Although the prognosis of LELC-B is thought to be favorable, which is also similar to MC-B, distant metastasis was detected in the present case. To confirm the clinicopathological entity of these two tumors, it is important to recognize the difference between LELC-B and MC-B.

Lymphoepithelioma-like carcinoma of the breast: not Epstein-Barr virus–, but human papilloma virus–positive

“…Lymphoepithelioma-like carcinoma (LELC) of the breast is rare; 13 cases have been reported in the English medical literature so far [1][2][3][4][5][6][7][8][9]. Lymphoepithelioma-like carcinoma is a distinct type of poorly differentiated breast carcinoma with well-defined histologic features [2], distinguishing it from medullary or other poorly differentiated breast carcinomas.…”

Lymphoepithelioma-Like Carcinoma of the Breast: A Diagnostic and Therapeutic Challenge

“…The presence of lymph node metastases in 4 of the 14 women who underwent an axillary lymph node dissection (28.6%) lends support to continued use of that procedure or of a sentinel lymph node biopsy. Internal mammary lymph nodes appear at risk of spread, given a notable parasternal recurrence in the case reported by Kurose et al 8 and attributed to a nodal recurrence. Breastconserving surgery and mastectomy both appear to be appropriate for primary therapy.…”

“…Chemotherapy was used in 2 of the reported cases. In the case reported by Peştereli et al 10 , it was used in an adjuvant fashion, and in the case of Kurose et al 8 , it was delivered after recurrence. Unfortunately, the Kurose group described only chemotherapy with cef being given.…”

“…The cells may be arranged singly (Schminke's pattern) or in syncytial masses, nests, or cords (Regaud's pattern). Since Kumar and Kumar's first reported case in the breast 3 , another 15 cases of breast lelc have appeared in the English medical literature [4][5][6][7][8][9][10][11][12] .…”

Lymphoepithelioma-Like Carcinoma of the Breast: Cytological and Histological Features and Review of the Literature

“…Occasional microtubular formations were present in SLN frozen sections and FNA cytology (FNAC) aspirate from the primary tumour. Glandular differentiation of the tumour cells was confirmed in LELC of the breast for the first time by Kurose et al [25], using electron microscopy.…”