Lymphepithelioma Like Invasive Cervical Cancer

Abstract

Introduction/Background Lymphoepithelioma-like carcinoma (LELC) of the uterine cervix is a rare variant of squamous cell carcinoma of the uterine cervix, composing 0.7% of primary cervical tumors. It is usually composed of nests of poorly differentiated epithelial cells encircled by a noticeable lymphocytic infiltrate, which is the hallmark of this tumor. Even though is poorly differentiated, it appears to have a better outcome than the usual squamous cell carcinoma of the uterine cervix due to lack of lymph metastases. It may be linked with HPV virus infection, or Epstein Bar virus. Methodology We present a case of a 61-year-old patient, with a main complaint of post-coital bleeding. Speculum examination revealed exophytic papillary growth on the ectocervix, biopsy was done. Histology resulted to be LELC of the uterine cervix. MRI was stage IB2. Radical surgery was done type C1 according to Querleu–Morrow classification picture 1. Results PCR for HPV and Epstein Bar virus from paraffin-embedded tissues which was positive for HPV45 but not for Epstein Bar virus. Histology from the biopsy resulted to be positive for hematoxylin and eosin stain, there were aggregates of atypical epithelial cells and numerous small lymphocytes. Tumor cells are polygonal and display poorly defined eosinophilic cytoplasm, vesicular nuclei with prominent nucleoli and increased mitotic activity, including atypical mitotic figures (picture 100x, other 400x) picture 1, there was also a positive stain for p63, CD3 and CD20. Final staging is pTIIB pN0 pMX L1 V1 R0 G3 FIGO stage IIB NG3 Conclusion It is a rare subtype of cervical cancer, there is a lot unknown due to its rarity, there are published data which confirm its association with HPV and Epstein Bar virus. Commonly it is believed that it is less aggressive due to its less lymph node involvement but data are conflicting it may be more aggressive due to this aggressive treatment is preferred. Larger studies are needed.