Primary pulmonary lymphoepithelioma-like carcinoma: a rare type of lung cancer with a favorable outcome in comparison to squamous carcinoma

Abstract

BackgroundPrimary pulmonary lymphoepithelioma-like carcinoma (LELC) is a rare tumor and often misdiagnosed as squamous carcinoma. In the current study, clinical characteristics and outcome of primary pulmonary LELC were systematically compared with pulmonary squamous carcinoma.MethodsForty-two cases of primary pulmonary LELC and 134 squamous carcinomas were enrolled retrospectively. Characteristic and prognosis difference between the two groups was compared, and the independent prognostic factor for pulmonary LELC was identified as well.ResultsIn comparison to squamous carcinoma, pulmonary LELC was more common in women with a younger median age and less smokers. LELC seemed to be smaller in diameter on computed tomography (CT) scans than squamous carcinoma, with scarce spiculation and vascular convergence signs. Epstein-Bar virus-encoded RNA (EBER) by in-situ hybridization was detected in 33 LELC cases, among whom 27 ones were positive in serum EBV-DNA examination. LELC patients presented a much longer median progression-free survival (PFS) than squamous carcinoma. Positive serum EBV-DNA, distant lymph node invasion, advanced clinical stage and receiving radiotherapy were correlated with the shorter PFS in LELC patients. However, only positive serum EBV-DNA was the independent PFS predictor.ConclusionPulmonary LELC looks like distinct from squamous carcinoma. Middle-aged women and nonsmokers are comparatively predominated. CT features of pulmonary LELC are relatively less-malignant. Correspondently, the progression of pulmonary LELC is seemingly favorable than squamous carcinoma and the positive serum EBV-DNA appears to be the predictor of PFS.

The clinicopathological features and prognosis of primary pulmonary lymphoepithelioma-like carcinoma: A systematic review and meta-analysis

“…Patients staged with 18F-FDG PET would have an improvement of 5-year OS from 49.7% to 85.4% (P = 0.012) [51]. In addition, positive serum EBV-DNA was reported to be the independent predictor of PFS [35]. In our meta-analysis, male patients were prone to have a superior DFS.…”

“…with other histologic NSCLC [35,36]. By comparison with SCC [35], the results showed that the diameter of LELC was smaller and computed tomography (CT) scans presented scarce vascular convergence signs and spiculation.…”

“…In our meta-analysis, male patients were prone to have a superior DFS. This may result from the relatively low proportion of male in the included studies [10,12,19,32], and female were considered to be predominated in PPLELC [35,36].…”

Primary pulmonary lymphoepithelioma-like carcinoma accompanied by hypertrophic pulmonary osteoarthropathy in a non-epidemic region: a case report and literature review

“…Recently, it was reported that plasma EBV DNA could be used as a tumor marker for pulmonary LELC and to predict the therapeutic effect and prognosis of this type of tumor. 9 Unfortunately, we contacted the patient, but the patient refused to return to the hospital.…”

Computed tomography-based differentiation of primary pulmonary lymphoepithelioma-like carcinoma and small-cell lung cancer

“…Primary pulmonary lymphoepithelioma-like carcinoma (LELC) is a rare subtype of non-small-cell lung cancer (NSCLC), accounting for 0.17% of all lung cancer cases in a study with 24 596 cases, 1 and 0.4% of NSLC 2 in a study with 9851 cases, based on the two largest Chinese studies. Begin et al first reported LELC and noted its association with Epstein–Barr virus (EBV) in 1987.…”