Metastatic stomach lymphoepithelioma-like carcinoma and immune checkpoint inhibitor therapy:A case report

作     者：Guo-Feng Chen Jun Wang Yu Yan Song Xu Jian Chen 

作者机构：Department of Gastroenterology SurgeryThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou 310000Zhejiang ProvinceChina Cancer CenterZhejiang UniversityHangzhou 310000Zhejiang ProvinceChina Department of PathologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou 310000Zhejiang ProvinceChina Department of GastroenterologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou 310000Zhejiang ProvinceChina 

出 版 物：《World Journal of Gastrointestinal Surgery》 (世界胃肠外科杂志（英文版）（电子版）)

年 卷 期：2024年第16卷第5期

页      面：1436-1442页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

基　　金：the Zhejiang Provincial Key Project of Research and Development,No.2019C03043 National Natural Science Foundation of China,No.82203452 Health Science and Technology Plan of Zhejiang Province,No.2022RC165 Clinical Research Fund of Zhejiang Medical Association,No.2021ZYC-A68. 

主　　题：Stomach neoplasm Pulmonary lymphoepithelioma-like carcinoma Metastasis Immune checkpoint inhibitor Case report 

摘      要：BACKGROUND Pulmonary lymphoepithelioma-like carcinoma(PLELC)is a rare type of nonsmall-cell lung cancer.Stomach lymphoepithelioma-like carcinoma(LELC)metastasis secondary to PLELC has not been reported recently.CASE SUMMARY A 64-year-old female was admitted to our hospital for a regular gastroscopy examination with a 6-year history of surgical resection for left PLELC.Positron emission tomography/computed tomography suggested high accumulation of 18F-fludeoxyglucose in the gastric cardia region.Upper gastrointestinal endoscopy confirmed a large mass at the stomach fundus.Immunohistochemistry(IHC)of the biopsy suggested metastatic stomach LELC.Proximal gastrectomy showed that this 6.5 cm×5.0 cm mass was located in the stomach fundus near the cardia.Histopathological examination showed a poorly differentiated carcinoma with prominent lymphoplasmacytic infiltration.IHC demonstrated that the tumor was positive for CK(AE1/AE3),p63,p40,p53,Ki-67(70%),and EGFR(3+)and negative for CK7,CK20,Her2,and CD10.In situ hybridization analysis showed positive staining Epstein-Barr virus-encoded RNA.Tumor programmed cell death ligand 1(PD-L1)expression score was 98%,and the combined positive score was 100,with no evidence of microsatellite instability.Thus,the patient was unequivocally diagnosed with metastatic stomach LELC secondary to pulmonary LELC.After discharge,this patient underwent PD-1 inhibitor treatment(toripalimab,240 mg)every 3 wk for ten cycles,and she has had no tumor recurrence.CONCLUSION For gastric LELC metastasis,PD-1 inhibitor therapy could become a new therapeutic approach,though there is still no evidence from large data sets to support this.