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Lymphoepithelioma-like Carcinoma of the Lung: Radiologic Features of an Uncommon Primary Pulmonary Neoplasm

Joseph M. Hoxworth1, Douglas K. Hanks2, Philip A. Araoz3, Brett M. Elicker1, Gautham P. Reddy1, W. Richard Webb1, Jessica W. T. Leung1 and Michael B. Gotway1,4

1 Department of Radiology, University of California, San Francisco, 505 Parnassus Avenue, Room M-391, Box 0628, San Francisco, CA 94110.
2 Department of Pathology, San Francisco General Hospital, San Francisco, CA 94110.
3 Department of Radiology, Mayo Clinic, Rochester, MN 55905.
4 Scottsdale Medical Imaging, Ltd., an Affiliate of Southwest Diagnostic Imaging, Scottsdale, AZ 85252.


Figure 1
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  		Fig. 1A —69-year-old white man (patient 3) with primary pulmonary lymphoepithelioma-like carcinoma presenting as solitary pulmonary nodule. Soft-tissue window from unenhanced thoracic CT shows 1-cm peripheral nodule (arrow) contacting pleura.

 

Figure 2
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  		Fig. 1B —69-year-old white man (patient 3) with primary pulmonary lymphoepithelioma-like carcinoma presenting as solitary pulmonary nodule. Thoracic CT scan (3-mm collimation) obtained 1 min after IV contrast administration shows enhancement (45 H) of nodule (arrow).

 

Figure 3
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  		Fig. 1C —69-year-old white man (patient 3) with primary pulmonary lymphoepithelioma-like carcinoma presenting as solitary pulmonary nodule. Lung window highlights irregular nodule margins (arrow).

 

Figure 4
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  		Fig. 2A —51-year-old Chinese woman (patient 2) with primary pulmonary lymphoepithelioma-like carcinoma. Soft-tissue window from axial unenhanced thoracic CT shows noncalcified 2.6-cm nodule (arrow) in right middle lobe.

 

Figure 5
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  		Fig. 2B —51-year-old Chinese woman (patient 2) with primary pulmonary lymphoepithelioma-like carcinoma. Lung window highlights irregular, lobulated nodule margins (arrow). Ground-glass halo is also seen.

 

Figure 6
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  		Fig. 2C —51-year-old Chinese woman (patient 2) with primary pulmonary lymphoepithelioma-like carcinoma. Axial T1-weighted MR image shows right paratracheal lymphadenopathy (arrow) of low signal intensity.

 

Figure 7
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  		Fig. 2D —51-year-old Chinese woman (patient 2) with primary pulmonary lymphoepithelioma-like carcinoma. Axial T1-weighted MR image after IV gadolinium administration shows right paratracheal lymphadenopathy enhancement (arrow).

 

Figure 8
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  		Fig. 3A —31-year-old Chinese woman (patient 1) with primary pulmonary lymphoepithelioma-like carcinoma that recurred after resection. Images A-C were obtained before resection and D-F were obtained after resection. Contrast-enhanced thoracic CT scan shows 2.7 x 3.8 cm lobulated mass (arrows) in right lower lobe with extensive pleural and mediastinal contact and central necrosis.

 

Figure 9
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  		Fig. 3B —31-year-old Chinese woman (patient 1) with primary pulmonary lymphoepithelioma-like carcinoma that recurred after resection. Images A-C were obtained before resection and D-F were obtained after resection. Low-power (20x) photomicrograph of H and E-stained cell block from biopsy of pulmonary lesion shows island of malignant carcinoma cells (arrows) surrounded by lymphoplasmacytic cell population.

 

Figure 10
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  		Fig. 3C —31-year-old Chinese woman (patient 1) with primary pulmonary lymphoepithelioma-like carcinoma that recurred after resection. Images A-C were obtained before resection and D-F were obtained after resection. In-situ hybridization study confirms presence of strong nuclear labeling for EBV-encoded small nuclear RNAs (arrows).

 

Figure 11
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  		Fig. 3D —31-year-old Chinese woman (patient 1) with primary pulmonary lymphoepithelioma-like carcinoma that recurred after resection. Images A-C were obtained before resection and D-F were obtained after resection. T1-weighted (TR/TE, 500/9) axial MR image through upper lumbar spine shows abnormal low-signal-intensity tissue (arrows) in paravertebral region and extending into neural foramen.

 

Figure 12
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  		Fig. 3E —31-year-old Chinese woman (patient 1) with primary pulmonary lymphoepithelioma-like carcinoma that recurred after resection. Images A-C were obtained before resection and D-F were obtained after resection. T1-weighted (700/9) axial MR image after IV administration of gadolinium shows intense enhancement of abnormal paravertebral soft tissue (arrows) extending into neural foramen.

 

Figure 13
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  		Fig. 3F —31-year-old Chinese woman (patient 1) with primary pulmonary lymphoepithelioma-like carcinoma that recurred after resection. Images A-C were obtained before resection and D-F were obtained after resection. T2-weighted (3,000/80.2) axial MR image shows mild T2 prolongation (arrows) in abnormal paravertebral tissue extending into neural foramen. T2 signal hyperintensity is mild, perhaps because of extensive lymphocytic cellularity of tumor.

 

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