Lymphoepithelioma : A case report

Abstract

Introduction

Lymphoepithelioma is a type of poorly differentiated nasopharyngeal carcinoma characterized by prominent infiltration of lymphocytes in the area involved by the tumor .Malignant neoplasms of the nasopharynx are rare, amounting to 2% of the head and neck tumors and to 0.25% of all tumors.1,4 They are more prevalent among males, in a 3:1 ratio when compared to females, and presents two peaks of incidence: young people under 30 years of age.There is an intermediate incidence in population in the Mediterranean basin. It suggests an association with genetic susceptibility, environmental factors and infection by the Epstein Barr virus (EBV).

Case Report

A 8 year old boy had a symptoms of nasal congestion, nasal obstruction . pain and fullness  localized in the right ear, sleeping with open mouth, no history of nasal bleeding of visual disturbance  ,headache ,tinnitus and conductive hearing loss   on the both ( in the period of 3 mounts) ears, timpanometry results during our examinations were :Type B on the right  and type C  on the left  ear. He had complains for these symptoms about few mounts ( 6 ) . On the examination  with rigid endoscope 30  through  left nasal cavity there was enlargement such as  adenoid hypertrophy  in the epipharynx  ,surface  was smooth and not ulcerated macroscopically .but rigid endoscopy through right nasal cavity   was impossible   due to excessive amounts of seromucous  mucus. Routine blood investigations were normal. According to the age and symptoms ,  the decision was adenoidectomy and application of the ventilation  tube Grommet on the right ear. Under general anaesthesia operation was performed and the specimen was sent for histopathology. Post op period was uneventful. Histopathology result was Lymphoepithelial carcinoma. After that CT scan was performed (asimetry on the level of the nasopharynx ,because of the presence of the tu formation ,and the reduction and obstruction  of the air space in the level of  naso and oro-pharynx. In parapharyngeal space bilateral enlargement  of the lymph nodes are detected. After confirmation the patient was referred for the radiotherapy and chemotherapy in university hospital in Turkey.After radiation treatment the patient is in good condition.

Disussion

Epithelial tumors account for 85% of malignant tumors of the nasopharynx, and are divided by the World Health Organization (WHO) according to their differentiation and production of keratin, as: Type I -Carcinoma, Squamous Cell, Type II – Carcinoma nonkeratinized and Type III - undifferentiated carcinomas. Type II and Type III have a positive serological profile for EBV, characterized by the detectionof viral DNA and viral antigens in tumor cells and high antibody titer in patients affected by the tumor 1. The lymphoepithelioma, classified as Type III.The histologic type should be classified according to World Health Organization classification.

Kew words – Lymphoepithelioma,Epipharyngeal tumor ,boys, radiation therapy