Case Report Pulmonary Lymphoepithelioma-Like Carcinoma (PLELC) With a Completed Metabolic Response after Chemoradiotherapy: A Case Report and Review of the Literature
by Elísabet González Del Portillo1⁂, Macarena Teja Ubach2⁂, Isabel Esteban Rodríguez3,5, Marta Rodríguez Roldán1, Oliver Higuera Gómez4, Julia Villamayor4,5, Aurea Manso de Lema1, Rosa María Morera López1, Laura Gutierrez-Sainz4,5*‡, Javier de Castro Carpeño4,5‡
1Radiation Oncology Department, Hospital Universitario La Paz, Madrid, Spain.
2Radiation Oncology Department, Hospital Universitario San Francisco de Asís/Hospital Universitario La Milagrosa, Madrid, Spain.
3Pathology Department, Hospital Universitario La Paz, Madrid, Spain.
4Medical Oncology Department, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.
5Biomarkers and Experimental Therapeutics in Cancer, IdiPAZ, Madrid, Spain.
⁂Both authors contributed equally to this study.
‡Both authors are senior authors.
*Corresponding author: Laura Gutierrez Sainz, Medical Oncology Department. Hospital Universitario La Paz, Biomarkers and Experimental Therapeutics in Cancer, P.º de la Castellana, 261, Fuencarral-El Pardo, 28046 Madrid, Spain.
Received Date: 14 January 2024
Accepted Date: 18 January 2024
Published Date: 22 January 2024
Citation: González Del Portillo E, Teja Ubach M, Esteban Rodríguez I, Rodríguez Roldán M, Higuera Gómez O, et al. (2024) Pulmonary Lymphoepithelioma-Like Carcinoma (PLELC) With a Completed Metabolic Response after Chemoradiotherapy: A Case Report and Review of the Literature. Ann Case Report 09: 1600. https://doi.org/10.29011/2574-7754.101600.
Abstract
Pulmonary Lymphoepithelioma-Like Carcinoma (PLELC) is a rare subtype of lung cancer that typically appears in young non-smoker patients and mainly in the Asian population. At the time of diagnosis, symptoms are usually nonspecific. Histological examination is the gold standard for diagnosis. Compared with other lung cancer subtypes, PLELC appears to have a better prognosis. We report a locally advanced PLELC in a never smoker Asian female treated with chemo radiotherapy achieving a complete and maintained response. We also reviewed the available data on the treatment of these patients in the literature.
Keywords: Pulmonary Lymphoepithelioma-Like Carcinoma; Epstein - Barr virus; Chemotherapy; Radiotherapy
Introduction
Pulmonary Lymphoepithelioma-Like Carcinoma (PLELC) was first described in 1987 in a 40 year-old female, and it was associated with the Epstein - Barr virus (EBV) [1]. According to the 2015 WHO Classification of Lung Tumors, it is categorized as an infrequent epithelial tumor subtype, which accounts for less than 1% of all lung malignances [2]. PLELC is more common in the Asian population, young people with non-smoking history, without differences between genders [3]. Clinical manifestations are nonspecific. Histopathological examination is the gold standard for the diagnosis of PLELC. PLELC appears to have a better prognosis, with longer Overall Survival (OS) and ProgressionFree Survival (PFS) compared to other subtypes of lung cancer [4]. Predictive prognostic factors have been reported, although clinical evidence is not conclusive [5].
There are no clinical trials to establish the standard of care. Only retrospective studies have attempted to determine prognostic factors and which therapeutic strategy is better for these patients [5,6]. In early stages, surgery is recommended. Locally advanced and inoperable patients can be treated with Chemotherapy (ChT) and Radiotherapy (RT) [7]. Metastatic disease can also be treated with ChT regimens, although immunotherapy treatment is playing an increasingly important role [7–9].
Here, we present a patient with locally advanced PLELC treated with a combination of radiotherapy and chemotherapy.
Case Presentation
A 74-year-old never smoker Asian female presented in November 2021 with dyspnea and weight loss, and the chest Computed Tomography (CT) scan showed a mass in the left upper lobe of the lung and mediastinal lymph nodes. On physical examination, the patient presented good performance status and the examination of the nasopharynx was normal.
A Fiber Optic Bronchoscope (FOB) and an Endobronchial Ultrasound (EBUS) were performed but there was no evidence of malignancy in the samples. The study was completed by an 18FDG-PET-CT and it confirmed lung mass about 8 cm, and its
Standardized Uptake Value (SUV) maximum was 16.4 (Figure 1A). In addition, left mediastinal and hilar lymph node involvement was described (Figure 1B). Lymph nodes at the left axillary level with affinity for 18FDG were also observed. Distant metastases were excluded. Pulmonary function tests were normal.