Lung Cancer: Student/Resident Case Report Poster - Lung Cancer II |

Primary Pulmonary Lymphoepithelioma-Like Carcinoma FREE TO VIEW

Awais Javed, MD; Bimaje Akpa, MD; Richard Fremont, MD
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Meharry Medical College, Nashville, TN

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):760A. doi:10.1016/j.chest.2016.08.855
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SESSION TITLE: Student/Resident Case Report Poster - Lung Cancer II

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Primary Pulmonary Lymphoepithelioma-like carcinoma (LELC) is a distinct form of Non small cell lung cancer (NSCLC)3 pathologically similar to undifferentiated nasopharyngeal carcinoma1. It is associated with Epstein-Barr virus (EBV)2. In this report we describe a case of a young female who presented with respiratory symptoms and RUL cavitary lesion intially supected for TB later proven to be LELC now undergoing chemo-radiation.

CASE PRESENTATION: 32 year-old non-smoker female from Nepal with TB exposure previously was initially treated at Health Department with 10 days of antibiotics for suspected community acquired pneumonia. She had 3 weeks of cough, shortness of breath, pleuritic chest pain, hemoptysis, weight loss and fatigue but denied night sweats or fever and had a negative PPD in 2010. CXR showed a RUL cavitary lesion. When no improvement was seen; IGRA, sputum AFB smears and cultures were taken and she was referred for TB induction therapy in isolation. Later IGRA and sputum AFB x 3 were reported negative. CT chest revealed a cavitary lesion with right mediastinal adenopathy. Patient was placed on airborne isolation and started on RIPE therapy. After 2 weeks patient reported no significant improvement. AFB cultures and Urine histoplasma antigen came out to be negative. Repeat CT chest showed bilateral mediastinal adenopathy with cavitary lesion. Bronchoscopic biopsy revealed malignancy but was indeterminate due to lack of sample size. MRI brain was negative and PET scan showed FDG avidity in right lung lesion and mediastinal nodes. A CT guided core biopsy of the RUL lesion initially indicated a Primary Synovial Sarcoma however FISH for SYT-SXT translocation was negative. EBV testing done was positive and re-review indicated LELC. Chemo-radiation was started with clinical improvement and she remains in treatment.

DISCUSSION: LELC is an uncommon form classified under NSCLC3 associated with EBV2. Seen mostly in young non-smoker Asians it has a striking resemblance to undifferentiated nasopharyngeal carcinoma1 with a significantly better prognosis in contrast to other primary lung cancers. Complete resection is done for early stage disease and multimodality treatment is standard for advanced stages.

CONCLUSIONS: LELC histologically similar to nasopharyngeal carcinoma assoicated with EBV is a rare malignancy. Due to low incidence current treatment is controversial with optimal treatment protocol yet to be determined.

Reference #1: Iezzoni JC, Gaffey MJ, Weiss LM. The role of Epstein-Barr virus in lymphoepithelioma-like carcinomas. Am J Clin Pathol. 1995;103: 308-315.

Reference #2: Begin LR, Eskandari J, Joncas J, et al. Epstein-Barr virus related lymphoepithelioma-like carcinoma of lung. J Surg Oncol. 1987;36: 280-283

Reference #3: Travis WD, Colby TV, Corrin B, et al. Histological typing of lung and pleural tumours. 3rd ed. Berlin, Germany: Springer-Verlag; 1999. World Health Organization International Histological Classification of Tumours.

DISCLOSURE: The following authors have nothing to disclose: Awais Javed, Bimaje Akpa, Richard Fremont

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