Objective To investigate the clinicopathologic features, diagnosis, treatment and prognosis of the primary lymphoepithelioma-like carcinoma (PLELC) of the lung. Methods Clinical and pathological data of one patient with PLELC of the lung were reviewed. PLELC of the lung was analyzed through review of literatures. Results A mass in the upper lobe of the left lung and atelectasis were detected by CT in a 36 year old nonsmoker male. He presented with cough, expectoration, fever and shortness of breath for one month. Neoplasm in left main bronchus was observed through bronchoscopy. Histological study showed cohesive clusters of comprising syncytial-appearing cells with vesicular nuclei and tumor infiltrating lymphocytes. Immunohistochemistry showed positive expression of Epstein-Barr virus (EBV) encoded small nuclear RNA. Nasal CT scan was negative for suspicious nasopharyngeal mucosal lesion or tumor. Then he was diagnosed as PLELC. The patient received docetaxel+nedaplatin regimens for 6 cycles with stable disease, but one month later after the end of chemotherapy, he was readmitted to hospital for dyspnea. CT scans showed progression of the lesion with massive pericardial effusion and pleural effusion. The patient could not tolerate chemotherapy, then received supportive treatment and died soon. Totally 18 Chinese articles and 25 foreign articles were screened out. Literature review suggested that patients with PLELC of the lung usually occurred in young nonsmokers and without gender difference. PLELC of the lung was closely associated with EBV infection. Its clinical manifestations were not specific, so that histopathological and immunohistochemical analyses were the main method of diagnosis. PLELC of the lung may respond to chemotherapy and radiotherapy. Surgery-based multimodality treatment was recommended. Patients with early or resectable disease had better prognosis, but patients with unresectable disease had poor prognosis. Conclusions PLELC of the lung may be closely associated with EBV infection. Histopathological and immunohistochemical analysis is the main method of diagnosis. Surgery-based multimodality treatment should be recommended because of its high response to chemotherapy and radiotherapy. Patients with early or resectable disease have better prognosis.
Primary pulmonary lymphoepithelioma-like carcinoma (PPLELC) is a rare type of lung cancer with special characteristics of epidemiology, clinical diagnosis, treatment and prognosis. It has close relationship with Epstein-Barr virus (EBV) infection and has prominent regional feature. Most patients are young and non-smoking. There is no specificity of clinical manifestation. Most patients are asymptomatic at the time of diagnosis. As for treatment, the standard treatment for early stage disease is complete resection. Platinum-based doublet chemotherapy has been applied in locally advanced disease as the first line therapy. Due to its rarity, the treatment of advanced PPLELC is still lack of evidence of large sample randomized controlled trial. Whether target therapy or immunotherapy is effective is worth further study. This article reviews the research progress of PPLELC, to give a particular sight for clinicians and provides a better understanding of this rare tumor for researchers.
Objective To evaluate the expression level of nuclear factor kappa B (NF-κB) in patients with Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphoma (DLBCL), and to examine its impact on patients’ clinical characteristics and prognosis. Methods Patients with EBV-positive DLBCL who were diagnosed and treated at West China Hospital of Sichuan University between January 2010 and December 2020 were selected as the research subjects. Clinical data were retrospectively collected. According to the expression of NF-κB, the patients were divided into an NF-κB-positive group and an NF-κB-negative group, and the clinical characteristics were compared between the two groups. Kaplan-Meier method was used for survival analysis. Results A total of 414 patients with DLBCL were collected, and EBV-encoded small RNAs were positive in 37 cases (8.9%). Among the 37 EBV-positive patients, NF-κB positivity was observed in 13 cases (35.1%), while among the 377 EBV-negative patients, NF-κB positivity was observed in 144 cases (38.2%), without statistically significant difference (χ2=0.134, P=0.714). No significant difference in clinical characteristics was found between the NF-κB-positive group and the NF-κB-negative group of EBV-positive patients (P>0.05). The 3-year overall survival (OS) rates for the NF-κB-positive and NF-κB-negative groups were 46.2% and 58.3%, respectively, the 5-year OS rates were 19.2% and 29.2%, respectively, and the median OS was 32 vs. 39 months (P=0.441). The corresponding 3-year and 5-year progression-free survival (PFS) rates were 46.2% vs. 41.7% and 19.2% vs. 20.8%, respectively, and the median PFS was 31 vs. 24 months (P=0.933). Conclusion There is no difference in the expression of NF-κB between EBV-positive and EBV-negative DLBCL patients, and the expression of NF-κB has no impact on the clinical characteristics or the prognosis of EBV-positive DLBCL patients.