原发性肺淋巴上皮瘤样癌1例并文献复习

A case report of pulmonary lymphoepithelioma-like carcinoma and review of the literature

目的 提高对肺淋巴上皮瘤样癌临床特点、发病机制、诊断及治疗的认识。方法 报道2021年5月2日复旦大学附属华山医院呼吸科收治的l例肺淋巴上皮瘤样癌,并复习国内外相关文献。结果 男,57岁。咳嗽伴痰中带血2周,胸部CT示左下肺前基底段不规则斑片影,支气管肺泡灌洗液病原微生物二代测序(mNGS)见大量爱泼斯坦巴尔病毒(EBV)序列,CT引导下经皮肺穿刺获得组织病理示淋巴上皮瘤样癌。行左下肺切除术,术后予以化疗和免疫治疗。此病咳嗽为最常见症状。CT大多数表现为胸膜附近的孤立性肺结节或团块影。特征性病理学表现是间质和癌细胞之间有致密淋巴细胞及浆细胞浸润,EBV检测阳性。与其他非小细胞肺癌(NSCLC)亚型比较具有较低的转移率,预后好,大部分病人可手术治疗且罕有复发。结论肺淋巴上皮瘤样癌与EBV相关,临床和影像学表现无特征性,预后较其他NSCLC亚型好。

Objective To improve the the understanding of the clinical features,pathogenesis,diagnosis and treatment of pulmonary lymphoepithelioma-like carcinoma (PLELC).Methods One case of patient with PLELC who diagnosed in Huashan Hospital affiliated to Fudan University on May 2021 was described,and relevant domestic and foreign literatures were reviewed.Results A 57-year-old male had cough and bloody sputum for 2 weeks.Chest CT showed solitary consolidation image in the left lower lobe.A large number of EBV sequences were found in mNGS of bronchoalveolar lavage fluid.CT-guided Histopathology obtained by lower percutaneous lung aspiration showed lymphoepithelioma-like carcinoma.Left lower pneumonectomy was performed,and adjuvant chemotherapy and immune checkpoint inhibitor (ICI) were given after pneumonectomy.Cough was the most common clinical presentations.The most consistent CT finding was a pulmonary nodule or mass with a lobulated border.The characteristic pathological manifestation of PLELC was the infiltration of dense lymphocytes and plasma cells between the stroma and cancer cells,and the EBV test was positive.It has a lower metastasis rate and a good prognosis compared with other non-small cell lung cancer (NSCLC) subtypes.Most patients can be treated with surgery and recurrence was rare.Conclusions PLELC was associated with EBV,with no characteristic clinical and imaging manifestations,and has a better prognosis than other NSCLC subtypes.