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Journal of Cancer Research and Therapeutics, Vol. 5, No. 4, October-December, 2009, pp. 300-301 Case Report Lymphoepithelioma-like carcinoma of the uterine cervix Kaul Rashmi, Gupta Neelam, Sharma Jaishree, Gupta Sourav Department of Pathology, Indira Gandhi Medical College, Shimla, Himachal Pradesh Code Number: cr09071 PMID: 20160367 DOI: 10.4103/0973-1482.59916 Abstract Lymphoepithelioma-like carcinoma (LELC) of the uterine cervix is a rare variant of squamous cell carcinoma (SSC). It differs from the usual SSC of the cervix in its morphology and clinical behavior and shows a better prognosis than the more common SSC of the cervix. We report a case of LELC of the cervix, diagnosed on the basis of histopathology in a 42-year-old female who presented with a history of postcoital bleeding.Keywords: Cervical carcinoma, histopathology, lymphoepithelioma-like carcinoma Introduction Lymphoepithelioma, originally described as a neoplasm of the nasopharynx, is a syncytial growth pattern of undifferentiated malignant cells with prominent lymphoplasmacytic stromal infiltration. Tumors with histological features similar to those of nasopharyngeal lymphoepithelioma have been identified in anatomic sites other than the nasopharynx, such as the salivary gland, lung, thymus, and stomach, and have been termed lymphoepithelioma-like carcinoma (LELC). This type of tumor is also identified in the uterine cervix and has shown a better outcome than the usual squamous cell carcinoma (SCC) of the cervix because of lack of lymph node metastasis [1] Case Report A multiparous 42-year-old woman, native of Himachal Pradesh, was admitted to the gynecology ward with a history of postcoital bleeding for the last 6 months. The general physical examination was normal. On pelvic examination, the cervix was found to be hard, bulky, and bleeding on touch. The parametria and pelvic wall were not involved. The other pelvic organs were normal FIGO stage 1. Rest of the systemic examination was normal. Cervical punch biopsy was done. A histopathological examination revealed sheets of undifferentiated carcinoma cells admixed with lymphocytes, eosinophils, and plasma cells [Figure - 1]. Microscopically, the tumor epithelial cells were large and contained scant ill-defined cytoplasm, oval and large round vesicular nuclei with prominent nucleoli, syncytial growth patterns, and numerous mitoses (4-10 mitoses per 10 HPF). The nuclear membrane was irregular and enfolded with peripheral deposits of chromatin along the membrane. The prominent lymphoid reaction that was the sine qua non for the diagnosis consisted of mature lymphocytes that were often admixed with plasma cells and histiocytes and occasionally, the neutrophils. The tumor exhibited widespread hemorrhagic necrosis and eosinophilic hyaline-like material interspersed among the tumor cells [Figure - 2]. On the basis of the histopathological examination, the diagnosis of LELC of the uterine cervix was made. Metastasis workup was negative. The patient underwent radical hysterectomy and pelvic lymph node dissection. Her postoperative course was uneventful, and she remains free of disease 12 months after diagnosis. Discussion LELC of the uterine cervix is a rare variant of SSC. It was first reported by Hamazaki et al. in 1968. [2] In the female genital tract, LELC has been reported in the vulva, vagina, uterine cervix, and endometrium. [3] LELC of the uterine cervix is uncommon; only a small number of cases have been reported. This type of tumor constitutes 0.7% of all primary cervical malignancies. A review of the literature on this relatively rare tumor shows that the incidence of this LELC is higher in Asia than in the West, just as lymphoepithelial carcinoma of the nasopharynx is more common in Asia than in the West. [1] LELC typically affects the younger population of women. It may grossly range from no visible cervical lesion to a large exophytic cervical mass. [4] The association with the Epstein-Barr virus (EBV) is still controversial and has only been demonstrated in Asian patients. Two specific EBV variants, the Taiwan and CAO strains, have been isolated in patients with lymphoepitheliomas in Taiwan and the People′s Republic of China, respectively. [1] Because of the higher incidence of these tumors in Asian patients, it is possible that genetic factors related to geography or ethnicity influence susceptibility to the EBV genome. [1] The role of EBV and human papillomavirus in the pathogenesis of LELC of the uterine cervix in Western women remains unclear. [5] Histopathologically, LELC is characterized by syncytial aggregates of undifferentiated tumor cells with indistinct cytoplasmic margins, vesicular nuclei with prominent nucleoli, and lack of glandular or squamous differentiation. Tumor cells are surrounded by a marked inflammatory infiltrate which probably represents host response to the tumor. This typical microscopic appearance helps in differentiating cervical LELC from the poorly differentiated SSC and lymphoproliferative lesions. [6] The outcome has been better than the usual SSC of the cervix. The differential diagnosis includes nonkeratinizing SSC with prominent stromal inflammation, carcinoma with intense stromal eosinophilia, glassy cell carcinoma, malignant lymphoma (especially lymphoepitheloid − Lennert′s lymphoma), and metastatic Schmincke−Regaud tumor. [7] The prognosis is good only by surgical treatment. Radiation therapy also appears to be effective in eradicating localized, low-stage disease (radiosensitive). [4] In conclusion, cervical LELC is rare but a distinct clinicopathological entity that warrants a high index of suspicion amongst clinicians and pathologists. References
Copyright 2009 - Journal of Cancer Research and Therapeutics The following images related to this document are available:Photo images[cr09071f2.jpg] [cr09071f1.jpg] |
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