Lymphoepithelioma-Like Carcinoma of the Breast: A Diagnostic and Therapeutic Challenge

Abstract

also present an overview of our patient's proposed treatment in the context of the 16 other reported lelc cases. CASE PRESENTATIONA 55-year-old postmenopausal woman originally from Ghana presented with a 4-week history of left breast tenderness and an upper outer quadrant mobile breast mass. She had been mammographically screened, with the most recent mammogram (performed 1 year before her presentation) having demonstrated no abnormalities. Her past medical history was unremarkable, with a surgical history of Cesarean section, tubal ligation, and hernia repair. She was gravida 2, para 2, with menopause having occurred at age 53. On systems review, she denied fevers, chills, or night sweats. No weight loss was reported, and she was asymptomatic but for left breast tenderness.Physical examination revealed no cervical or axillary adenopathy, but was significant for a diffusely swollen left breast with a discrete, mobile 4-cm mass. The exam was otherwise noncontributory.Mammography revealed a 3-to 4-cm upper outer quadrant density with spot compression views showing lobulated margins. No evidence of calcifications was noted. Breast ultrasonography showed a 4.3×3.5×2.6-cm lobulated, poorly marginated, hypoechoic solid mass. Computed tomography of the thorax, abdomen, and pelvis showed no evidence of distant metastases and the presence of an 8-cm left breast mass with a uniform low-density component (Figure 1).Fine-needle aspirate yielded a cellular specimen noteworthy for single and groups of abnormal elongated cells with visible nucleoli presenting together with lymphocytes and plasma cells. A bone marrow biopsy revealed normocellular marrow with no evidence of lymphoproliferative disorder.An excisional biopsy was followed by 3 successive pathology reviews. The initial consultant ABSTRACTWe present a patient with lymphoepithelioma-like carcinoma (lelc) of the breast whose diagnosis is illustrative of the pathology nuances that must be taken into account to successfully reach correct identification of the disease. We also present an overview of our patient's proposed treatment in the context of 16 other reported lelc cases. Although lelc cases are rare, a sufficient number have been reported to discern the natural history of this pathologic entity and to undertake a review of those cases and of the application of oncologic first principles in their management. Given the potential for locoregional spread and distant metastases in lelc, adjuvant therapy has a role in the treatment of this entity.

Lymphoepithelioma-like Carcinoma of the Breast: A Case Report

“…In 5 of the 21 cases reported in the literature, axillary lymph node metastasis was identified, in our patient metastases was not observed in 23 lymph nodes dissected from the axilla (1,(11)(12)(13)(14). Immunohistochemical staining results of 19 patients out of 21 reported cases in the literature are given in Table 2.…”

“…Lymphoepithelioma is a carcinoma with undifferentiated cytomorphological features, and was first identified in the nasopharynx, however its presence in multiple other organs was later reported (1,6). LELC is used synonymously with lymphoepithelioma and lymphoepithelial carcinoma (6).…”

“…Kumar et al (4) have reported the first LELC of the breast in 1994. LELC of the breast has been described as carrying similar morphological features with undifferentiated nasopharyngeal carcinoma (1)(2)(3)(4)(5). A total of 21 breast LELC cases have been reported in the literature, thus our patient is presented together with these reports due to its rarity.…”

“…Essentially two histological patterns are present in these tumors: "Regaud pattern" and "Schminke pattern", and it is reported that distinguishing between these two patterns actually does not have a prognostic significance. However, recognizing these patterns and distinction from breast carcinomas and lymphoma containing dense lymphocytic infiltrate is important (1,6,8). In the case presented, "Schminke pattern" was observed in almost all areas.…”

“…Regaud and Schminke first described lymphoepithelioma-like carcinoma (LELC) in 1921, as an undifferentiated carcinoma accompanied by prominent lymphocytic infiltration and located in the nasopharynx (1,2). Schminke and Regaud have identified the patterns in which malignant cells are present either in isolation (Schminke's pattern) or syncytial masses, nests or islands (Regaud's pattern) (3).…”