Lung tumor
Other carcinoma
Lymphoepithelioma-like carcinoma

Author: Roseann Wu, M.D. (see Authors page)

Revised: 15 January 2018, last major update January 2018

Copyright: (c) 2003-2018, PathologyOutlines.com, Inc.

PubMed Search: Lymphoepithelioma-like carcinoma[TI] lung
Cite this page: Wu, R. Lymphoepithelioma-like carcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/lungtumorLEL.html. Accessed February 25th, 2018.
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-10 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

Images hosted on other servers:

Various images

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

Images hosted on other servers:

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

Images hosted on PathOut server:

Images contributed by Dr. Roseann Wu:

Syncytial growth of monomorphous, polygonal epithelial cells

EBER+



Images hosted on other servers:

Various images


Various images

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 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)