Lymphoepithelial carcinoma of the larynx: An unusual response to EXTREME regimen therapy. A new option for treatment?

Submitted: 27 December 2020
Accepted: 2 March 2021
Published: 16 March 2021
Abstract Views: 2167
PDF: 373
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Lymphoepithelial Carcinoma (LEC), an aggressive variant of Squamous Cell Carcinoma (SCC), is an undifferentiated carcinoma with an intermixed reactive lymphoplasmacytic infiltrate. Most cases of LEC occur in the nasopharynx, while it rarely involves other sites. LEC of larynx and hypopharynx is an extremely rare and aggressive neoplasm, characterized by a high propensity to loco-regional dissemination and a poor prognosis; it represents the 0,2% of all tumours of the larynx. Since it is such a rare tumor, the current literature provides only recommendations and there are no treatment guidelines available. A 70-year-old man with laryngeal LEC and both distant and nodal metastases was treated with chemotherapy, following EXTREME regimen therapy. It was classified as a cT3 N3b M1 glottic cancer (Stage IVC, AJCC 8th Ed.), stage IVC. As the response on metastases was unexpectedly encouraging, surgical treatment on T could be performed. Patient underwent to total laryngectomy and bilateral neck dissection. To date, eight months after surgery, the patient is disease free. The unusual clinical course is reported.

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Andryk J, Freije JE, Schultz CJ, et al. Lymphoepithelioma of the larynx. Am J Otolaryngol 1996;17:61-3. DOI: https://doi.org/10.1016/S0196-0709(96)90046-0
Ferlito A. Primary lymphoepithelial carcinoma of the hypopharynx. J Laryngol Otol 1977;91:361-7. DOI: https://doi.org/10.1017/S0022215100083791
Svajdler M Jr, Kaspirkova J, Mezencev R, et al. Human papillomavirus and Epstein-Barr virus in nasopharyngeal carcinoma in a non-endemic eastern European population. Neoplasma 2016;63:107-14. DOI: https://doi.org/10.4149/neo_2016_013
Tardìo JC, Cristobal E, Burgos F, Menarguez J. Absence of EBV genome in lymphoepithelioma-like carcinomas of the larynx. Histopathology 1997;30:126-8. DOI: https://doi.org/10.1046/j.1365-2559.1997.d01-582.x
Kermani W, Belcadhi M, Sriha B, Abdelkéfi M. Epstein–Barr virus-associated lymphoepithelial carcinoma of the larynx. Eur Ann Otorhinolaryngol Head Neck Dis 2015;132:231-3. DOI: https://doi.org/10.1016/j.anorl.2015.05.004
Monteiro F, Baldaia H, Ribeiro L, et al. Epstein–Barr virus–associated with lymphoepithelial carcinoma: a rare tumor of the larynx. Clinical Med Insights: Ear Nose Throat 2019;12:1-4. DOI: https://doi.org/10.1177/1179550619865551
Bray F, Haugen M, Moger TA, et al. Age-incidence curves of nasopharyngeal carcinoma worldwide: bimodality in low-risk populations and aetiologic implications. Cancer Epidemiol Biomarkers Prev 2008;17:2356-65. DOI: https://doi.org/10.1158/1055-9965.EPI-08-0461
Jaipuria B, Dosemane D, Kamath PM, et al. Staging of Laryngeal and Hypopharyngeal Cancer: Computed Tomography versus Histopathology. Ir J Otorhinolaryngology 2018;30:189-94.
Ichikawa Y, Sumi M, Sasaki M, et al. Efficacy of diffusion-weighted imaging for the differentiation between lymphomas and carcinomas of the nasopharynx and oropharynx: Correlations of apparent diffusion coefficients and histologic features. AJNR Am J Neuroradiol 2012;33:761-6. DOI: https://doi.org/10.3174/ajnr.A2834
Nocini R, Molteni G, Mattiuzzi C, Lippi G. Updates on larynx cancer epidemiology. Chin J Cancer Res 2020;32:18-25. DOI: https://doi.org/10.21147/j.issn.1000-9604.2020.01.03
Coskun BU, Cinar U, Sener BM, Dadas B. Lymphoepithelial carcinoma of the larynx. Auris Nasus Larynx 2005;32:189-93. DOI: https://doi.org/10.1016/j.anl.2004.11.014
Toker C, Peterson DW. Lymphoepithelioma of the vocal cord. Arch Otolaryngol 1978;104:161-2. DOI: https://doi.org/10.1001/archotol.1978.00790030047011
Stanley RJ, Weiland LH, DeSanto LW, Neel HB. Lymphoepithelioma (undifferentiated carcinoma) of the laryngohypopharynx. Laryngoscope 1985;95:1077-81. DOI: https://doi.org/10.1288/00005537-198509000-00012
WHO classification of tumor series. Available from: https://whobluebooks.iarc.fr/
Macmillan CA, Kapadia SB, Finkelswtein SD, et al. Lymphoepithelial carcinoma of the larynx and hypopharynx: study of eight cases with relationship to Epstein-Barr Virus and p53 gene alterations, and review of the literature. Hum Pathol 1996;27:1172-9. DOI: https://doi.org/10.1016/S0046-8177(96)90311-1
Frank D, Cheron F, Cho H, et al. Nonnasopharyngeal lymphoepitheliomas (undifferentiated carcinomas) of the upper aerodigestive tract. Ann Otol Rhinol Laryngol 1995;104:305-10. DOI: https://doi.org/10.1177/000348949510400410
Iocca O, Farcomeni A, Di Rocco A, et al. Locally advanced squamous cell carcinoma of the head and neck: A systematic review and Bayesian network meta-analysis of the currently available treatment options. Oral Oncol 2018;80:40-51. DOI: https://doi.org/10.1016/j.oraloncology.2018.03.001
Narozny W, Betlejewski A, Stanklewicz C, Kaminski M. Ventriculosaccular lymphoepithelioma of the larynx: case report and literature review. Head Neck 1998;425-9. DOI: https://doi.org/10.1002/(SICI)1097-0347(199808)20:5<425::AID-HED11>3.0.CO;2-F
Amin MB, Edge S, Greene F, et al (eds). AJCC Cancer Staging Manual, 8th Edition. Springer; 2017. DOI: https://doi.org/10.1007/978-3-319-40618-3_2
De Virgilio A, Costantino A, Mercante G, et al. Transoral robotic surgery and intensity-modulated radiotherapy in the treatment of the oropharyngeal carcinoma: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol. 2020 Jul 21. doi: 10.1007/s00405-020-06224-z. Epub ahead of print. DOI: https://doi.org/10.1007/s00405-020-06224-z
Weiss LM, Gaffey MJ, Shibata D. Lymphoeptihelioma-like carcinoma and its relationship to the Epstein–Barr virus. Am J Clin Pathol 1991;96:156-8. DOI: https://doi.org/10.1093/ajcp/96.2.156
Zbaren P, Borisch B, Lang H, Greiner R. Undifferentiated carcinoma of nasopharyngeal type of the laryngopharyngeal region. Otolaryngol Head Neck Surg 1997;117:688-9. DOI: https://doi.org/10.1016/S0194-5998(97)70053-6
Marioni G, Mariuzzi L, Gaio E, et al. Lymphoepithelial carcinoma of the larynx. Acta Otolaryngol 2002;122:429-34. DOI: https://doi.org/10.1080/00016480260000148
Brandstorp-Boesen J, Falk RS, Evensen JF, et al. Risk of recurrence in laryngeal cancer. PLoS One 2016;11:e0164068. DOI: https://doi.org/10.1371/journal.pone.0164068
Dray T, Vargas H, Weidner N, Sofferman RA. Lymphoepitheliomas of the laryngohypopharynx. Am J Otolaryng 1998;19:263-6. DOI: https://doi.org/10.1016/S0196-0709(98)90129-6
Hammas N, Benmansour N, El Alami El Amine M, et al. Lymphoepithelial carcinoma: a case report of a rare tumor of the larynx. BMC Clinical Pathology 2017;17:24. DOI: https://doi.org/10.1186/s12907-017-0061-0
Steuer CE, El-Deiry M, Parks JR, et al. An update on larynx cancer. CA Cancer J Clin 2017;67:31-50. DOI: https://doi.org/10.3322/caac.21386
Regaud C. Lympho-epitheliome de l'hypopharynx traité par la roentgenthérapie. Bull Soc Franc Otorhinolaryngol 1921;34:209-14.
Schmincke A. Über lymphoepitheliale Geschwülste. Beitr Pathol Anat 1921;68:161-70.
Ibrahimov M, Yilmaz M, Celal MH, et al. Lymphoepithelial carcinoma of the larynx. J Craniofac Surg 2013;24:1049. DOI: https://doi.org/10.1097/SCS.0b013e3182700cd9
Sano D, Fujisawa T, Tokuhisa M, Shimizu M. Real-world treatment outcomes of the EXTREME regimen as first-line therapy for recurrent/metastatic squamous cell carcinoma of the head and neck: a multi-center retrospective cohort study in Japan. Anticancer Res 2019;39:6819-27. DOI: https://doi.org/10.21873/anticanres.13898
Colevas AD, Yom SS, Pfister DG, et al. NCCN guidelines insights: head and neck cancers, version 1.2018. J National Comprehensive Cancer Network 2018;16:479-90. DOI: https://doi.org/10.6004/jnccn.2018.0026
Vermoken J, Mesia R, Rivera F, Remenar E. Platinum-based chemotherapy plus Cetuximab in head and neck cancer. N Engl J Med 2008;359;11. DOI: https://doi.org/10.1056/NEJMoa0802656
Becker M, Moulin G, Kurt AM, et al. Atypical squamous cell carcinoma of the larynx and hypopharynx: radiologic features and pathologic correlation. Eur Radiol 1998;8:1541-51. DOI: https://doi.org/10.1007/s003300050584
Tan E, Mody MD, Saba NF. Systemic therapy in non-conventional cancers of the larynx. Oral Oncology 2018;82:61-8. DOI: https://doi.org/10.1016/j.oraloncology.2018.05.005
De Virgilio A, Costantino A, Mercante G, et al. Present and Future of De-intensification Strategies in the Treatment of Oropharyngeal Carcinoma. Curr Oncol Rep 2020;22:91. DOI: https://doi.org/10.1007/s11912-020-00948-1
Dubey P, Ha CS, Ang KK, et al. Nonnasopharyngeal Lymphoepithelioma of the Head and Neck. Cancer 1998;82:1556-62. DOI: https://doi.org/10.1002/(SICI)1097-0142(19980415)82:8<1556::AID-CNCR18>3.0.CO;2-3
Sone M, Nakashima T, Nagasaka T, et al. Lymphoepithelioma-like carcinoma of the larynx associated with an Epstein-Barr viral infection. Otolaryngol Head Neck Surg 1998;119:134-7. DOI: https://doi.org/10.1016/S0194-5998(98)70185-8
Torabi SJ, Cheraghlou S, Kasle DA, Savoca EL, Judson BL. Nonsquamous cell laryngeal cancers: incidence, demographics, care patterns, and effect of surgery. Laryngoscope 2019;129:2496-2505. DOI: https://doi.org/10.1002/lary.27785
Nachalon Y, Cohen O, Alkan U, Shvero J, Popovtzer A. Characteristics and outcome of laryngeal squamous cell carcinoma in young adults. Oncol Lett 2017;13:1393-7. DOI: https://doi.org/10.3892/ol.2016.5528
Chan JYK, Wong EWY, Ng SK, Vlantis AC. Nonnasopharyngeal head and neck lymphoepithelioma-like carcinoma in the United States: a population-based study. Head Neck 2016;38:E1294-300. DOI: https://doi.org/10.1002/hed.24215

How to Cite

Bugada, D., Trozzi, L., Renna, D., Petruzzi, G., Pichi, B., Ricciardiello, F., D’Ambrosio, C., Bocchetti, M., & Pellini, R. (2021). Lymphoepithelial carcinoma of the larynx: An unusual response to EXTREME regimen therapy. A new option for treatment?. Translational Medicine Reports, 5(1). https://doi.org/10.4081/tmr.9572