Lymphoepithelial Carcinoma of the Nasal Cavity With EBV Infection in a North African Man

Abstract

We report the case of a 58-year-old Tunisian man who presented with a 2 months' history of left nasal obstruction and one episode of epistaxis. Nasal endoscopy revealed a polypoid mass of the left nasal septum. Magnetic resonance imaging showed a left nasal cavity tumor with erosion of the orbit. Diagnosis of nasal cavity lymphoepithelial carcinoma EBV positive was performed on biopsy. The patient was treated by chemotherapy and radiotherapy. No tumor recurrence has been reported with a follow-up of 12 months.

A Rare Case of Sinonasal Lymphoepithelial Carcinoma Presented With Clinically Stage IV Disease

“…Treatment response has been reported to be very good with recently published cases showing complete response with no evidence of disease recurrence up to 5 years of follow-up. [2][3][4]7,8,11 Our case is unique in that our patient presented with clinical vertebral metastases along with regional lymph node metastases. In light of these metastases, it was decided after a tumor board discussion to start the patient on chemotherapy while radiotherapy and surgery were deferred.…”

“…12 The majority of cases present with nasal obstruction, epistaxis, facial pain and, in the presence of invasive growth, proptosis and cranial nerve palsies. [3][4][5]11,12 One case in our literature review also presented with anosmia and ageusia, which is due to invasion of tumor to the olfactory bulb, frontal lobe, and probably brain stem. 5 As compared to nasopharyngeal carcinoma wherein almost all cases involve EBV, SLECs are associated with EBV in approximately 90% of cases.…”

“…7,15,16 Additionally, SNUC is not associated with EBV. 4,6,15,16 Mucosal melanomas can be distinguished from SLEC in that they usually lack syncytial growth, vesicular nuclear chromatin and, instead, tend to have a plasmacytoid appearance. 7 Melanoma markers such as SOX10, S100, HMB-45, Melan A, tyrosinase, and MITF-1 are further helpful in distinguishing these tumors from SLEC.…”

“…11 However, LEC is known to be radiosensitive. [2][3][4]7,8,11 Yet, the initial treatment for maxillary sinus tumors has traditionally been surgery. In our literature review, cases that were limited to the sinuses received surgery with radiation; whereas the cases with regional lymph node metastases, orbital or brain invasion, at the time of presentation received chemotherapy in addition to radiation (Table 1).…”

“…1,2 Sinonasal lymphoepithelial carcinoma is found worldwide but is most common in Southeastern Asia. [2][3][4][5] The World Health Organization defines SLEC as ''a squamous cell carcinoma morphologically similar to nonkeratinizing nasopharyngeal carcinoma, undifferentiated subtype''. 2 Most of the cases usually present with locally aggressive disease with or without regional lymph node metastases.…”