Primary lymphoepithelioma-like carcinoma of the esophagus with metastatic lymph node and gastric cancer

Upper gastrointestinal lymphoepithelioma-like carcinoma (LELC) is a rare disease—especially esophageal LELC (ELELC). Here, we report a surgically treated case of ELELC with gastric carcinoma. The patient was a 68-year-old asymptomatic Japanese man. Endoscopy revealed a submucosal-like protruding tumor located in the anterior wall of the esophagus 31–33 cm from the upper incisors and a slightly ulcerative lesion at the antrum of stomach. Histopathological diagnosis from biopsy of the esophageal lesion revealed a poorly differentiated squamous cell carcinoma; the stomach lesion was found to be well-differentiated tubular adenocarcinoma. CT showed a swollen lymph node along the left recurrent nerve. On the basis of a diagnosis of esophageal and gastric cancer, we performed esophagectomy with three-field lymph node dissection and partial gastrectomy. Histopathology of the resected esophageal tumor revealed solid nests of cancer cells, with substantial infiltration of lymphoid cells into the stroma. There were poorly differentiated cancer cells with large nuclei in the lymph node. In situ hybridization for Epstein–Barr virus showed no nuclear signal in the tumor cells. Immunohistochemistry gave a diagnosis of ELELC.