Lymphoepithelial carcinoma of the salivary gland: In situ detection of Epstein-Barr virus

Department of Pathology, University of Hong Kong, Queen Mary Hospital Compound, Hong Kong.
Journal of Clinical Pathology (Impact Factor: 2.92). 12/1995; 48(11):1022-7. DOI: 10.1136/jcp.48.11.1022
Source: PubMed


To examine the role of Epstein-Barr virus (EBV) in lymphoepithelial carcinoma of the salivary gland in Hong Kong Chinese.
Ten cases of lymphoepithelial carcinoma of the salivary gland (eight parotid and two submandibular) were examined. In situ hybridisation was used to localise EBER RNA, immunohistochemical methods to detect expression of latent membrane protein 1 (LMP-1) in EBV positive tumours, and Southern blot analysis to examine the clonality of EBV in the two cases where frozen tissue was available.
None of the cases had a history of Sjögren's syndrome or histological evidence of a benign lymphoepithelial lesion. The IgA antibody titre against EBV viral capsid antigen was elevated in four cases. All cases were EBV positive by in situ hybridisation, with a strong uniform positive signal in the epithelial cells, and all cases expressed LMP-1. Southern blot analysis revealed that the clonal episomal form of the virus was present. Two of the three female patients in this series also developed carcinoma of cervix. One of these carcinomas had histological features of a lymphoepithelioma-like carcinoma but was EBV negative.
A consistent association between EBV and lymphoepithelial carcinoma of the salivary gland was found. The presence of the virus in a clonal episomal form, and the expression of LMP-1 viral oncoprotein is further evidence of the role of EBV in the oncogenesis of this tumour.

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    • "Its role in LEC tumorigenesis has long been suggested after EBV DNA was discovered within NPC tumor DNA [15]. Studies looking specifically at LEC have found viral presence in clonal episomal form within malignant tumors, as well as viral LMP-1 oncoprotein expression, further advancing this hypothesis [25]. However, testing for viral proteins may not be sensitive enough, as Bialas et al. report a case in a Caucasian woman who tested negative for viral LMP-1 via immunohistochemistry but positive from in situ hybridization for EBV mRNA (EBER) [11]. "
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    ABSTRACT: Introduction: Lymphoepithelial carcinoma (LEC) of the salivary glands is extremely rare worldwide, with studies limited to small case reports and case series from endemic areas (Southern China, Arctic Inuits) and strong association to Epstein Barr Virus (EBV). Studies on non-endemic regions are even more limited given the reality of only sporadic cases in these areas. Using the National Cancer Database (NCDB), we present the largest study on salivary LEC from a non-endemic region, the United States. Methods: A retrospective review of the NCDB from 1998–2012 for LEC of the major salivary glands was performed. Demographic and clinical variables were extracted for analysis. Multivariate COX regression was used to assess predictors of survival. Results: Two hundred and thirty-eight cases were identified (0.66% of all salivary cancers). Median age at diagnosis was 62 with peak incidence in ages 50–70. Most patients were Caucasian (81.2%), without gender preference. Regional metastasis was common (45.1%) and did not significantly impact survival. Distant metastasis was rare (2%). Overall survival (OS) at 5- and 10 years was 77% and 56%. Surgery and radiotherapy significantly showed better survival outcomes than surgery alone (p < 0.001). Age >62, advanced stage, and dual modality therapy were significant predictors of survival in multivariate analysis. Conclusion: Lymphoepithelial carcinoma in the US mostly affects an older, Caucasian demographic. Regional metastasis is common and survival is fair at 5- and 10 years. Surgery and radiation are recommended for early and advanced disease stages. Age, stage, and therapy are significant predictors of survival outcomes.
    Oral Oncology 11/2015; DOI:10.1016/j.oraloncology.2015.10.019 · 3.61 Impact Factor
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    • "LELC has the same histological patterns as undifferentiated LE and is associated with a variable amount of lymphoid infiltrate in the stroma. However, LELC arises in organs other than nasopharynx, including larynx [6], tonsils [7], salivary glands [8], lung [9], thymus [10], stomach and duodenum [11], breast [12], renal pelvis and urinary bladder [13], uterine cervix [14], endometrium [15-17] ovary [18,19], vulva and vagina [20-22]. EBV is detected in LELCs arising in organs of foregut derivation and in Asian women but rarely in LELCs of other sites or in non-Asian patients [6-22]. "
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    ABSTRACT: Primary lymphoepithelial-like carcinoma of the parotid gland is a rare tumour with an increased incidence among Eskimos and Orientals. In these populations, it is usually associated with Epstein-Barr virus. In Western countries, salivary gland lymphoepithelial-like carcinoma are uncommon and only 14 cases have been described so far; among these, only three cases showed Epstein-Barr virus positivity.Case report: A 45-year-old woman was admitted to Siena Hospital for evaluation of a pre-existent (2 years) painless and tender submandibular mass, rapidly enlarging since two months. On physical examination, a 2.5-cm mass was found in the right parotid. It was firm, mobile and non-tender. Laboratory data were within reference range. Nuclear magnetic resonance detected a 2,5x1,5x1-cm well-circumscribed mass in the deep lobe of the right parotid. A right total paroditectomy with dissection of a satellite lymph node was performed. On the basis of morphological, immunohistochemical and molecular biology findings, a diagnosis of stage II (according to TNM7) Epstein Barr-virus positive, undifferentiated lymphoepithelial-like carcinoma of the parotid gland was made. Twenty months after surgery she was free of disease. Further studies seem to be necessary to completely elucidate the oncogenic role of Epstein Barr-virus in these tumors, which have identical morphology but different prognosis and variable presence of the virus.
    Diagnostic Pathology 07/2013; 8(1):115. DOI:10.1186/1746-1596-8-115 · 2.60 Impact Factor
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    • "These have primarily been observed in the upper aerodigestive tract, including the salivary glands (mainly parotid), oral cavity, and tonsils, but have also been found in the stomach, thyroid, bladder, ureters, uterine cervix, ovaries, skin, and other anatomic locations [4] [5] [6] [7] [8] [9]. These tumors comprise a significant proportion of salivary gland carcinomas seen in Chinese and Eskimo populations [5] [10]. "
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    ABSTRACT: Introduction. Lymphoepithelioma-like carcinoma (LELC) of the salivary gland is a rare tumor. Currently, surgery with or without radiotherapy is the recommended treatment for all salivary gland carcinomas. However, in contrast to other high-grade salivary gland carcinomas, LELCs are considered radiosensitive. There are only a few published reports of radiotherapy alone for the treatment of salivary gland LELC. Case. We present two cases of LELC of the salivary gland. One was treated with surgery and postoperative radiotherapy, and the other was given a single cycle of chemotherapy and then radiotherapy. Currently, both patients have no evidence of disease. Conclusion. Radiotherapy as a single modality should be reevaluated. The role of systemic chemotherapy to gain systemic control should be addressed due to noteworthy metastatic disease.
    11/2011; 2011:618650. DOI:10.1155/2011/618650
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