Clin Endosc.  2015 Nov;48(6):549-552. 10.5946/ce.2015.48.6.549.

Esophageal Lymphoepithelioma-Like Carcinoma with Unique Daisy-Like Appearance

• Olmez S
• Can A
• Yavuz A
• Iliklerden UH
• Bulut G

• KMID: 2380414
• DOI: http://doi.org/10.5946/ce.2015.48.6.549

Abstract

Due to differences in prognosis and management, it is important to subclassify esophageal carcinoma. Esophageal lymphoepithelioma-like carcinoma (LELC) is extremely rare, with only a few cases reported to date. Review of the literature revealed case reports describing lesions with similar histology. We present a 69-year-old man with a giant pedunculated-polypoid lesion of the esophagus shrinking the lumen. Endoscopic excision of the tumor was performed and final histopathological diagnosis was confirmed to be LELC. In contrast to a previous case with a more aggressive course and a recurrent lesion, our patient died of his disease within 8 months of diagnosis. Here we discuss the endoscopic and radiologic findings of the case and a review of the literature.

Keyword

Lymphoepithelioma-like carcinoma; Esophagus; Prognosis

MeSH Terms

Aged
Diagnosis
Esophagus
Humans
Prognosis

Figure

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  Fig. 1. Thoracic computed tomography (CT) scan with intravenous contrast medium administration. (A) Examination revealed nodular soft tissue lesion narrowing the esophageal lumen at the level of the carina. The size of the lesion measured 13×10 mm in diameter. (B) Enlargement of the lesion was detected and mediastinal lymphadenopathies were established at 6-month follow-up on thoracic CT scan. (C) Abdominal CT imaging revealed liver metastasis.

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  Fig. 2. Upper endoscopic examination. (A) Endoscopy revealed a giant pedunculated polypoid lesion partially shrinking the esophageal lumen at the level of 23 cm from the incisor. Yellowish-white exudative secretion over the polypoid lesion was determined. The combination of polypoid tumor and mucosal changes constituted the unique endoscopic “daisy-like” appearance. (B) Esophageal mucosa was irregular, reddish colored, and contained erosion from the level of the lesion to the cardioesophageal junction. (C) Endoscopic excision polypectomy was performed with snare. (D) Endoscopic examination revealed a giant pedunculated-polypoid lesion totally obliterating the esophageal lumen at the level of 24 cm from the incisor. The lesion surface was ulcerative and had a white exudative feature.

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  Fig. 3. Histopathologic examination of the lesion. (A) The tumor is characterized by sheets of undifferentiated cells with large nuclei and poorly defined cytoplasmic borders, imparting a syncytial appearance (H&E stain, ×200). (B) Strong cytoplasmic staining with cytokeratin in lymphoepithelioma-like carcinoma (CK, ×200).

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