Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2024; 16(5): 1436-1442
Published online May 27, 2024. doi: 10.4240/wjgs.v16.i5.1436
Metastatic stomach lymphoepithelioma-like carcinoma and immune checkpoint inhibitor therapy: A case report
Guo-Feng Chen, Jun Wang, Yu Yan, Song Xu, Jian Chen
Guo-Feng Chen, Jun Wang, Jian Chen, Department of Gastroenterology Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
Jun Wang, Jian Chen, Cancer Center, Zhejiang University, Hangzhou 310000, Zhejiang Province, China
Yu Yan, Department of Pathology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
Song Xu, Department of Gastroenterology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
Co-first authors: Guo-Feng Chen and Jun Wang.
Author contributions: Chen GF and Wang J contributed equally to this work; Chen GF and Wang J wrote draft of the manuscript and participated in the patient’s treatment; Xu S performed the gastroscopy and provided the images; Yan Y, as a pathologist, performed the histological findings; Chen J supervised the study, developed the concept and edited the paper; and all authors have approved the final version of the manuscript.
Supported by 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; and Clinical Research Fund of Zhejiang Medical Association, No. 2021ZYC-A68.
Informed consent statement: Informed written consent was obtained from the patients for the publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian Chen, MD, PhD, Director, Department of Gastroenterology Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou 310000, Zhejiang Province, China. zrchenjian@zju.edu.cn
Received: January 4, 2024
Revised: April 10, 2024
Accepted: April 22, 2024
Published online: May 27, 2024
Processing time: 140 Days and 2.4 Hours
Abstract
BACKGROUND

Pulmonary lymphoepithelioma-like carcinoma (PLELC) is a rare type of non-small-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.

Keywords: Stomach neoplasm, Pulmonary lymphoepithelioma-like carcinoma, Metastasis, Immune checkpoint inhibitor, Case report

Core Tip: Pulmonary lymphoepithelioma-like carcinoma (PLELC) is a rare type of non-small-cell lung cancer. Stomach lymphoepithelioma-like carcinoma (LELC) metastasis secondary to PLELC has not been reported recently. We present a 64-year-old female patient who was admitted to our hospital for a regular gastroscopy examination with a 6-year history of surgical resection for left PLELC. After proximal gastrectomy, histopathological examination showed a poorly differentiated carcinoma with prominent lymphoplasmacytic infiltration, suggesting stomach LELC metastasis. Tumor programmed cell death ligand 1 (PD-L1) expression showed a tumor proportion score of 98% and a combined positive score of 100. After discharge, this patient underwent PD-1 inhibitor treatment for ten cycles and has not experienced tumor recurrence. These findings suggest that for gastric LELC metastasis, PD-1 inhibitor therapy could become a potential therapeutic approach.