Introduction. Primary pulmonary lymphoepithelial carcinoma is a poorly differentiated squamous cell carcinoma admixed with variable amounts of lymphoplasmacytic infiltrate, frequently associated with EBV. It is a rare cancer and have a better prognosis than other non-small cell lung cancer. The tumor can mimic metastatic non-keratinizing SCC of the naso-pharynx, poorly differentiated non-small cell carcinoma and NUT carcinoma arising in the lung, and non-Hodgkin
lymphomas.
Materials and methods. A 75-year-old man presented with peripheral mass of left lower lobe, maximal diameter was 5.1 cm, involving lingula and medial pleura, with mediastinal, and retroperitoneal lymphadenopathy revealed by computer tomography. Fine needle aspiration-EBUS was performed from hilar and interlobar lymph nodes. Papanicolaou smears
and cell blocks were prepared. Additional CT-guided cor-needle biopsy and FNA were performed from lung lesion later.
Results. A few large malignant epithelial cells, consistent with non-small lung cancer, were found on a background
of lymphocytes in fine-needle aspiration from lymph nodes. Immunostain results: Pan-CK (AE1/AE3), p63 and Ki67
were positive in malignant cells, leukocyte common antigen (CD45) was positive in lymphocytes (negative in tumor cells), and negative markers were TTF1, chromogranin and synaptophysin. Cytological diagnosis was metastatic non-small lung cancer, favor squamous cell carcinoma. Biopsy and aspiration from left lung showed syncytial groups of large malignant epithelial cells with scant cytoplasm and prominent nucleoli on a background of prominent inflammatory infiltrate,
consistent with lymphoepithelial carcinoma.
Conclusion. It is impossible to correctly diagnose metastasis of lymphoepithelial carcinoma in lymph node by FNA only without FNA or biopsy of primary lesion, because cytological features and immunostains are identical to non-keratinizing squamous cell carcinoma.
V. G. Kravtsov – M.D., Ph.D., M.I.A.C, Director of Cytopathology Unit, Department of Pathology, Meir Medical Center, Kefar-Sava, IsraelE-mail: This email address is being protected from spambots. You need JavaScript enabled to view it..
1. WHO Classification of Tumours Editorial Board. Thoracic tumours [Internet]. Lyon (France): International Agency for Research on Cancer; 2021 [cited 2021 06 06]. (WHO classification of tumours series, 5th ed.; vol. 5). Available from: https://tumourclassification.iarc.who.int/ chapters/35
2. Han AJ, Xiong M, Gu YY, et al. Lymphoepithelioma-like carcinoma of the lung with a better prognosis. A clinicopathologic study of 32 cases. Am J Clin Pathol. 2001;115:841–850.
3. Iezzoni JC, Gaffey MJ, Weiss LM. The role of Epstein-Barr virus in lymphoepithelioma-like carcinomas. Am J Clin Pathol. 1995;103:308–315.
4. Chee Kiang Tay, Yang Chong Chua, Angela Takano, et al. Primary pulmonary lymphoepithelioma-like carcinoma in Singapore. Ann Thorac Med. 2018 Jan-Mar; 13(1): 30–35.
5. Hayashi T, Haba R, Tanizawa J, et al. Cytopa-thologic features and differential diagnostic considerations of primary lymphoepitheliomalike carcinoma of the lung. Diagn Cytopathol. 2012;40(9):820–825.
6. Anand A, Zayac A, Curtiss C, et al. Pulmonary lymphoepithelioma-like carcinoma disguised as squamous cell carcinoma. J Thorac Oncol. 2018;13(5):e75–e76.
7. Qin Y, Gao G, Xie X, et al. Clinical features and prognosis of pulmonary lymphoepithelioma-like carcinoma: summary of eighty-five cases. Clin Lung Cancer. 2019;20(3):e329–e337.
8. Da-yun PENG, Qiu-lin LIAO, Xiao-dong CHEN, et al. Clinicopathologic study of lung primary lymphoepithelial-like carcinoma: an analysis of 18 cases. Chin J Clin Res. 2017;30(4):467–470.
9. Yeh YC, Kao HL, Lee KL, et al. Epstein-Barr Virus-associated pulmonary carcinoma proposing an alternative term and expanding the histologic spectrum of lymphoepithelioma-like carcinoma of the lung. Am J Surg Pathol. 2019;43(2):211–219.
10. Fan Y., Li C., Qin J., et al. Primary pulmonary lymphoepithelioma-like carcinoma. Med Oncol. 2020;37(20). https://doi.org/10.1007/s12032-020-1344-3.
11. Jiang WY, Wang R, Pan XF, et al. Clinico-pathological features and prognosis of primary pulmonary lymphoepithelioma-like carcinoma. J Thorac Dis. 2016;8(9): 2610–6.
12. Chen B, Chen X, Zhou P, et al. Primary pulmonary lymphoepithelioma-like carcinoma: a rare type of lung cancer with a favorable outcome in comparison to squamous carcinoma. Respir Res. 2019;20(1):262.
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