2025年 · 第105卷第48期

The patient, a 50-year-old female, was admitted to the thoracic surgery department of Qingdao Municipal Hospital on December 2, 2022 due to "the discovery of a right lung nodule for 1 week". Prior physical health, no smoking history. Specialist examination showed no thoracic deformity, percussion of both lungs showed clear sounds, clear breathing sounds of both lungs, and no dry or wet rales were heard. All tests for lung cancer-related tumor markers were negative at admission. CT examination of head, whole abdomen and whole body bone imaging showed no obvious abnormalities. On December 3, 2022, the results of chest enhancement CT showed a mass of soft tissue density shadow in the middle lobe of the right lung, with a larger cross section of about 73 mm ×38 mm, corresponding bronchial truncation and uneven density. The enhancement scan showed mild to moderate enhancement, vascular enhancement shadow at the edge of the lesion, enlarged right hilar shadow, and lymph node shadow (Figure A is a pulmonary window image, with an arrow showing bronchial truncation; Figure B is a mediastinal window image, with an arrow showing vascular enhancement shadow). On February 6, 2023, general anesthesia and thoracoscopic right middle lobe resection + localized mediastinal lymph node dissection were performed. The pathological results showed poorly differentiated squamous cell carcinoma in the middle lobe of the right lung, with massive lymphocyte infiltration, and lymphoepithelioma-like carcinoma was considered, in which large necrosis, granuloma formation, cholesterol crystals, increased fibrous connective tissue, and cancerous tissue involving the pleura was seen (Figure C, hematoxylin-eosin staining ×100). Immunohistochemistry and in situ hybridization showed positive expression of CK, CK5/6, EBER-ISH, and negative expression of EMA (partially weakly positive), Ki67 (20% positive), CK7, CK20, CD56, TTF-1 and BerEP4 in tumor cells. Based on the clinical manifestations and pathological results, the diagnosis of lung lymphopithelioma-like carcinoma (PPLELC) was made. PPLELC is a rare subtype of non-small cell lung cancer. The typical CT manifestation is a single, well-defined and large round-like solid mass in the lung adjacent to the pleura or mediastinum. After enhancement, it is more specifically manifested as a vascular-like enhancement shadow at the tumor edge, forming a "vascular embedding sign". The pathological characteristics of PPLELC mainly show that a large number of lymphocyte infiltration is mixed in cancer cells. The cancer cells are usually polygonal, with large nuclei and syncytial arrangement. Surgical resection is the main treatment for patients with PPLELC, while multimodal treatment is usually used for patients with advanced or metastatic disease.