淋巴上皮瘤样癌临床病理特征及PD-L1表达分析

［摘要］　目的　探讨淋巴上皮瘤样癌(LELC)临床病理特征和程序性死亡配体1(PD-L1)的表达情况。方法　收集2010年1月至2021年5月暨南大学附属第一医院临床病理科确诊的15例LELC的临床资料。采用免疫组织化学染色法检测PD-L1及广谱细胞角蛋白（pan-CK）、P40、白细胞共同抗原(LCA)、突触素(Syn)和Ki-67。采用原位杂交法检测肿瘤组织中Epstein-Barr(EB)病毒编码的小RNA（EBER）。结果　15例LELC患者中,男4例,女11例,年龄28～81岁,中位年龄59岁。病变部位见于肺部10例,涎腺3例,肾盂1例,鼻腔1例。光学显微镜下,癌细胞呈巢状、弥漫片状或条索状排列;细胞圆形、多角形或不规则,胞质红染,界不清,未分化或低分化状;细胞核深染或呈空泡状,可见明显的核仁及核分裂像;间质伴丰富的淋巴细胞、浆细胞浸润。免疫组织化学染色结果显示pan-CK、P40均为阳性,间质淋巴细胞LCA阳性;14例样本Ki-67增殖指数≥40%。10例样本显示PD-L1膜阳性表达。14例样本EBER均为阳性。结论　LELC是较为罕见的恶性肿瘤,多见于肺部,大部分病变与EB病毒感染相关。大多数病例中肿瘤细胞高表达PD-L1,提示免疫治疗可能获益。     

腹腔来源淋巴上皮瘤样癌一例

1 病例介绍 患者,女,23岁.2019年1月体检B超示肝脏占位,诉乏力,至广西壮族自治区人民医院就诊.肝脏CT示:肝门区、胰头、胰体周围、胃底区、右侧心膈角多发结节及肿块影,包绕血管;肝左内叶多发占位.查体:卡氏评分90分,心、肺、腹腔检查无异常.     

淋巴上皮瘤样肝细胞癌1例报告

<正>淋巴上皮瘤样癌（lymphoepithelioma-like carcinoma, LELC）是一种罕见的由未分化的上皮癌细胞组成,伴有明显淋巴细胞浸润的肿瘤,首先报道发生于鼻咽部^[1],随后唾液腺、肺、乳腺、前列腺、膀胱、子宫等部位也有相关的报道。而原发于肝脏中的LELC极为罕见,根据免疫组化结果可进一步将其分为淋巴上皮瘤样肝细胞癌（lymphoepithelioma-like hepatocelluar carcinoma,LEL-HCC）和淋巴上皮瘤样胆管细胞癌（lymphoepithelioma-like cholangiocarcinoma, LEL-CC）。     

肝脏淋巴上皮瘤样癌临床病理观察并文献复习

淋巴上皮瘤样癌（1ymphoepjthelioma—like carcinoma,LELC）是一种分化差的癌,其典型的组织形态为多形性肿瘤细胞伴有大量成熟的小淋巴细胞浸润,与鼻咽部发生的未分化癌相似。发生在肝脏的LELC罕见,现结合本院诊治的1例LELC患者的临床、影像学和病理检查结果并复习相关文献报道如下,以探讨其诊断、鉴别诊断要点,加深认识。     

胃淋巴上皮瘤样癌表现为SMTs的病例分析及解读

内镜微创技术的不断进步与发展,使得更多黏膜下肿物（SMTs）逐渐被发现、诊断及治疗。胃肠道SMTs最常见的是平滑肌瘤、间质瘤、脂肪瘤、类癌,其他如异位胰腺、神经鞘瘤、错构瘤及血管球瘤等则较为少见。2016年5月本中心诊断并治疗1例以SMTs的形式表现且病理诊断为胃淋巴上皮瘤样癌（Lymphoepithelioma-like gastriccarcinoma,LELC）的患者,该病最早由Watanabe等[[[] Watanabe H,Enjojim,Imai T.Gastric carcinoma with lymphoid stroma.Its morphologic characteristics and prognostic correlations[J].Cancer,1976,38(1):232-243.]]于1976年报道,目前国内外报道例数极少,缺乏综合临床资料,术前诊断较困难。本文结合相关文献分析及病理学、免疫学特点,报道如下。     

膀胱淋巴上皮瘤样癌1例报告

膀胱淋巴上皮瘤样癌(lymphoepithelioma-like car-cinoma of urinary bladder,LELCB)是尿路上皮癌的一种组织学变异类型,1991年由Zukerberg等[1]提出.LELCB非常罕见,发生率约占膀胱癌的0.4％～1.3％[2].2018年3月26日南京医科大学第一附属...     

原发性食管淋巴上皮瘤样癌1例并文献复习

目的 原发性食管淋巴上皮瘤样癌罕见,本文旨在探讨该病的组织病理学特点,以及其与EB病毒的关系,以增强对本病的认识.方法 回顾性分析1例原发性食管淋巴上皮瘤样癌的临床资料,并复习相关文献进行讨论.结果 该病无特异临床表现,术前难以确诊,对该例患者行食管癌根治手术,其组织病理学分析显示未分化癌伴淋巴基质.结论 该病组织病理学特点显示为伴有淋巴基质的低分化或未分化癌,治疗以根治性手术为主.其具独特的组织病理学特征,但仍有必要通过一定的标准与其它恶性肿瘤相区别.尽管病理学上表现为高度恶性,但相比普通类型的食管癌患者,食管淋巴上皮瘤样癌预后较好.     

原发性胃淋巴上皮瘤样癌的临床影像分析

目的 探讨原发性胃淋巴上皮瘤样癌(LELC)的临床病理特点、CT影像特征,以提高对该病的认识。方法 回顾性分析2016年2月至2021年6月郑州大学第一附属医院收治20例经手术病理证实的胃LELC患者的临床、病理及CT影像资料。男性16例、女性4例;年龄31～76岁,中位年龄58岁。全部患者均接受CT平扫及增强检查,由2名经验丰富的腹部放射科医师对影像资料进行观察分析,包括病灶的部位、形态、生长方式、长径与厚径的比值、密度、黏膜表面有无溃疡,病灶增强方式及强化程度等。所有标本均行HE染色及免疫组织化学染色诊断。结果 胃LELC位于胃体9例,贲门-胃底8例,胃窦3例,病灶长径为1.5～8.3 cm,平均(4.1±1.9)cm,病灶厚径为1.0～7.0 cm,平均(3.2±1.6)cm,厚度与长径的比值为0.33～1.00(0.79±0.17);9例表现为胃壁局限性肿块,4例表现为胃壁向心性增厚,4例表现为黏膜下肿块,3例表现为胃壁弥漫性肿块;13例病灶表面出现溃疡,仅1例病灶内见坏死;平扫CT值为31～57(42.53±7.54)HU,动脉期CT值为59～118(87.00±18.64)...     

腮腺淋巴上皮瘤样癌的MRI表现

目的：探讨腮腺淋巴上皮瘤样癌（ lymphoepitheloma-like carcinoma,LELC）的MRI表现,旨在提高对该病的认识。方法回顾性分析经病理证实的8例腮腺LELC的MRI表现。结果8例腮腺LELC均为左侧实性肿块,单发3例,多发5例。深、浅叶均有者4例,浅叶者3例,跨深浅叶者1例。平扫T1 WI呈等或稍高信号4例,等信号4例;T2 WI呈高信号6例,稍高信号2例;增强后均呈现早期明显强化。完整及不完整包膜并存者4例,不完整分隔者2例,完整包膜者2例,包膜均呈长T1、等T2信号,增强后逐渐延迟强化。边界大部分清晰局部模糊者2例,清晰3例,模糊不清3例。有邻近皮下脂肪、皮肤侵犯6例,无2例。邻近区域有淋巴结转移者6例,无2例。结论 MRI能反映腮腺LELC的影像特点,具有一定特征性。     

原发性肺淋巴上皮瘤样癌18例临床特征分析

目的分析原发性肺淋巴上皮瘤样癌(PPLELC)的临床特点、治疗及预后。方法回顾性分析2014年1月至2021年7月在南京医科大学第一附属医院经病理确诊的18例PPLELC患者的临床资料, 其中男10例, 女8例, 年龄48～74(56.4±6.3)岁, 对其临床症状、实验室检查结果、影像学特征、治疗和转归进行综合分析。结果 18例患者中2例有吸烟史。多数患者无明显临床症状, 部分表现为咳嗽(4/18)、胸闷(2/18)或胸痛(1/18)。血肿瘤标志物CEA多正常, 部分患者NSE(7/16)或CYFRA21-1(4/16)升高。18例患者TNM分期以Ⅰ期(12/18)为主, 病灶皆为单发, 多位于右肺(10/18), 周围型(13/16)常见, 可伴有分叶(9/16)或空洞(2/16)。6例患者行PET/CT检查, SUV最大值为(8.15±3.08), MTV值为(6.85±4.95)cm3。10例患者行驱动基因检测, 其中6例行间变性淋巴瘤激酶(ALK)检测, 仅1例(1/6)ALK突变阳性。手术切除或手术联合化疗、免疫治疗是其主要治疗方式。至随访截止时间, 18例患者平均生存时间...     

Primary lymphoepithelioma-like carcinoma of lung

A 57-year-old Caucasian woman presented with nonproductive cough. Computed tomography revealed a peripheral solid mass in the upper lobe of the left lung. She underwent thoracotomy and upper lobectomy. Histology of the excised tumor demonstrated lymphoepithelioma-like carcinoma of the lung, with no associated Epstein-Barr virus activity. Being a rare entity and mostly seen in Asians, very few cases have been described previously.     

Clinical observation of pulmonary lymphoepithelioma-like carcinoma

BackgroundLymphoepithelioma-like carcinoma (LELC) of the lung is a rare type of non-small cell lung cancer (NSCLC), and researches of it are still not enough.MethodsIn this study, we retrospectively analyzed 36 patients with LELC diagnosed in the Fifth Affiliated Hospital of Sun Yat-sen University and Zhaoqing First People’s Hospital from January 2014 to June 2021, to investigate the clinical manifestations, tumor markers, treatment, and prognosis of LELC. Clinical data including age, gender, smoking history, family history of cancers, Epstein-Barr virus (EBV) encoding RNA (EBER) status, gene mutations, programmed death-ligand 1 (PD-L1) expression, treatment, and prognosis.ResultsThere was a total of 36 participants in this study, 16 males and 20 females, the median age was 57 years (37–76 years). A total of 22 cases (61.1%) were advanced (stage III and IV), and EBER was 94.4% positive. Most patients were treated with surgery, platinum chemotherapy, or radiotherapy. At the time of 31 June 2021, 33 participants had survived, and the longest survival time was 72 months. Lung LELC was more common in old participants (≥59 years) and was not associated with smoking history. Expression of PD-L1 was positive in the majority (27 cases, 75%) and participants with positive PD-L1 expression tended to have longer progression-free survival (PFS) and overall survival (OS) time than those with negative PD-L1 expression.ConclusionsPulmonary LELC usually occurs in non-smoking patients and is associated with EBV infection. Common treatments for tumors include multimodal therapy. The expression of PD-1 may be related to the prognosis of LELC, but more studies are needed to support further optimization of the treatment of LELC.     

Primary lymphoepithelioma-like carcinoma of the lung

Lymphoepithelioma-like carcinoma (LELC), best known to occur in the nasopharynx, can arise in a variety of sites, such as the salivary gland, thymus, lung, stomach, and skin. Primary LELC of the lung is very rare, with only limited information in the literature. We presented a case of a 66-year-old white man with a T2N0M0 lymphoepithelioma-like carcinoma of the lung. Immunohistochemical analysis was negative for Epstein-Barr virus. Observation of the nasopharynx and a computerized tomography of the cavum were normal.     

Large cell lymphoepithelioma-like carcinoma of the lung

Lymphoepithelioma-like carcinoma of the lung is a rare tumor that is considered a subtype of undifferentiated large cell carcinoma with abundant invasion by lymphocytes. Although initially described as a tumor occurring in the nasopharynx, this type of carcinoma has since been seen in many other organs. We report the case of a 59-year-old male smoker diagnosed with lymphoepithelioma-like carcinoma.     

Chemoradiotherapy for advanced lymphoepithelioma-like carcinoma of the lung

Lymphoepithelioma-like carcinoma (LELC) of the lung, an Epstein-Barr virus-associated undifferentiated carcinoma, is a rare entity of pulmonary malignancy. It tends to affect young non-smoking Asians and is often resectable. However, little is known of the treatment of the even rarer locally advanced or metastatic cases. We report our experience of three Chinese patients with advanced LELC of the lung who were treated with combination-chemotherapy (5-fluorouracil, leucovorin, and cisplatin) and radiotherapy. The encouraging response of these patients supports the use of this regime in other patients.     

Primary lymphoepithelioma-like carcinoma within an intralobular pulmonary sequestration.

A 31-yr-old Chinese female, a nonsmoker, presented with digital clubbing and coughing. Diagnostic evaluation revealed a pulmonary sequestration in the left lower lobe. During surgery a tumour was discovered, which turned out to be a lymphoepithelioma-like carcinoma. These tumours are mainly found in Asians, and are associated with the Epstein Barr virus and not with smoking. They are thought to have a better prognosis and to be more chemosensitive. The need for surgical treatment of pulmonary sequestration and the recognition of lymphoepithelioma-like carcinoma as a distinct clinicopathological entity is emphasized.     

A case of lymphoepithelioma-like carcinoma of the colon with ulcerative colitis

Follow-up colonoscopy of a 25-year-old Japanese man with ulcerative colitis (UC) who had undergone endoscopic mucosal resection twice for early colon cancers revealed the presence of a new 1.5-cm-diameter tumor in the sigmoid colon. It was diagnosed by preoperative biopsy as a poorly differentiated adenocarcinoma. Sigmoidectomy was performed, and the pathological findings revealed lymphoepithelioma-like carcinoma (LEC). In situ hybridization to detect Epstein-Barr virus (EBV)-encoded small RNAs showed positive signals in stromal lymphocytes, but weak signals in the tumor cells. The association between EBV and LEC was obscure in this case. Unlike typical UC-mediated colon cancers, the lesion was poorly differentiated, and negative for p53 signals immunohistochemically. These findings may hint at a novel mechanism of carcinogenesis in UC-mediated colorectal cancer.     

Applied molecular pathology in oncology

In the past decades in molecular biotechnology marked advances were made which led to the development of a special branch of pathology and according to some concepts an independent discipline, molecular pathology. This discipline deals with investigations of processes associated with the genesis and development of diseases at the nucleic acid level, proteins coded by these nucleic acids and their signal pathways. To this end molecular-biological techniques are used and the results are put into context with diagnostic and therapeutic procedures of other medical disciplines. It provides extremely valuable information for clinical therapy, in particular of patients with oncological diseases. In the submitted paper a review of some methods used in molecular pathology is given which may be applied in oncological practice. At present some of them are already integrated into common therapeutic protocols. Despite the apparent high cost of new molecular diagnostic methods this will in the long run lead to a reduction of costs spent on less sensitive, less effective and less specific tests as well as to a reduction of unnecessary examinations and to much more successful treatment.