Lung
Other carcinomas
Lymphoepithelioma-like


Topic Completed: 1 January 2018

Minor changes: 4 September 2020

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PubMed Search: Lymphoepithelioma-like carcinoma[TI] lung

Roseann Wu, M.D., M.P.H.
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Cite this page: Wu R. Lymphoepithelioma-like. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/lungtumorLEL.html. Accessed September 29th, 2020.
Definition / general
Essential features
  • Pulmonary lymphoepithelioma-like carcinoma (LELC) is an epithelial malignancy characterized by large, syncytial cells with vesicular nuclei and prominent nucleoli, with a prominent lymphocytic infiltrate
  • LELC has a strong association with Epstein-Barr virus (EBV) and is more common in Asian populations
  • LELC shows similar morphologic features to nasopharyngeal carcinoma and may be mistaken for lymphoma due to prominent inflammatory infiltrate
Terminology
  • Lymphoepithelioma-like carcinoma (LELC) primary to lung first described in 1987 by Bégin et al. (J Surg Oncol 1987;36:280)
  • Previously considered subtype of large cell undifferentiated carcinoma
  • By 2015 WHO, now classified under epithelial tumor, "other and unclassified carcinomas" (J Thorac Oncol 2015;10:1243)
ICD coding
  • Use code specific for location of tumor
  • C34.90 Malignant neoplasm of unspecified part of unspecified bronchus or lung
Epidemiology
Sites
  • Intrapulmonary, either peripheral or central
Pathophysiology
Etiology
Clinical features
  • Nonspecific: cough, dyspnea, chest pain, weight loss
Diagnosis
  • Exclude metastatic nasopharyngeal carcinoma and other non small cell carcinomas
  • Presence of prominent inflammatory infiltrate helpful
  • Ancillary studies for EBV infection
Laboratory
  • EBV serology often reveals prior infection, with higher titers associated with larger tumor size and higher stage (Am J Surg Pathol 2002;26:715)
Radiology description
  • Similar to imaging characteristics of other primary lung cancers
  • Solitary, peripheral pulmonary nodule with direct contact with pleura (J Thorac Imaging 2014;29:246)
  • FDG PET / CT with strong FDG uptake
Radiology images

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Prognostic factors
  • Good prognosis: early tumor stage, normal serum lactate dehydrogenase level, normal serum albumin level, no lymph node metastasis
  • Those who underwent complete resection had better overall survival (Cancer 2012;118:4748)
  • Tumor recurrence and necrosis (5% or more of tumor) associated with poor prognosis (Am J Clin Pathol 2001;115:841)
Case reports
Treatment
  • Complete surgical resection for early stage disease, with adjuvant chemotherapy and radiotherapy in advanced cases (J Thorac Dis 2017;9:123)
Gross description
  • Variable size, can be > 10 cm
  • Well circumscribed, lobulated, solid nodule
  • Necrosis common
Gross images

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Excised mass

Excised mass

Microscopic (histologic) description
  • Anastamosing islands, nests, cords or diffuse sheets of tumor cells
  • Syncytial growth of monomorphous, polygonal epithelial cells with large vesicular nuclei, prominent eosinophilic nucleoli, accompanied by marked CD8+ lymphocytic infiltration
  • Admixed lymphocytes, plasma cells, histiocytes, occasional neutrophils or eosinophils
  • Predominantly pushing borders, permeative interface with adjacent lung
  • Intratumoral amyloid deposition in a few cases (Am J Surg Pathol 2002;26:715)
Microscopic (histologic) images

Contributed by Roseann Wu, M.D., M.P.H.
Syncytial growth of monomorphous, polygonal epithelial cells Syncytial growth of monomorphous, polygonal epithelial cells

Syncytial growth of monomorphous, polygonal epithelial cells

EBER+

EBER+



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Cytology description
  • Large clusters of neoplastic cells with scant cytoplasm, large hyperchromatic nuclei, irregular nuclear contours, prominent nucleoli, brisk mitotic figures and prominent intratumoral lymphoid infiltration (Diagn Cytopathol 2012;40:820)
  • Stripped, naked tumor nuclei
  • Interspersed lymphocytes, some with crush artifact
Positive stains
Negative stains
Molecular / cytogenetics description
Differential diagnosis
Board review style question #1
Lymphoepithelioma-like carcinoma of the lung has been linked to which pathogen, particularly in Asian populations?

  1. Epstein-Barr virus (EBV)
  2. Human immunodeficiency virus (HIV)
  3. Human papillomavirus (HPV)
  4. Human T lymphotropic virus (HTLV)
  5. Respiratory syncytial virus (RSV)
Board review answer #1
A. Epstein-Barr virus (EBV)
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