Cytomorphological features of lymphoepithelial carcinoma of submandibular gland in an adolescent male

Abstract

A case of lymphoepithelial carcinoma (LEC) occurring in right submandibular gland of a 13-year-old Indian male is presented, wherein the lesion unveiled itself only after multiple fine needle aspiration (FNA) procedures. This unusual neoplasm has high frequency of occurrence in Eskimos and a predilection for the parotid gland. The aspirates obtained were highly cellular comprising tight clusters of atypical epithelial cells with admixture of lymphocytes. Histopathological examination of the resected submandibular gland and lymph node chain was consistent with the diagnosis of LEC. Immunohistochemistry (IHC) revealed cytokeratin (CK)-positive and S-100-negative tumor cells lying admixed with CD45-positive lymphoid cells. A detailed otorhinolaryngological examination with inclusion of multiple biopsies was found negative for any primary tumor. Although histopathological features of this entity are well established, only a handful of case reports describing cytological features of this entity are present in medical literature. We conclude that the cytomorphological features of LEC are sufficiently distinctive to at least, suggest a possibility of this lesion.

Keywords: Fine needle aspiration; lymphoepithelial carcinoma; submandibular gland.

Figure 1

Highly cellular smears showing cohesive aggregates of atypical epithelial cells lying against a background of mature lymphocytes (H and E, x100). Inset shows atypical cells having indistinct cytoplasmic borders, large vesicular nucleus with single to multiple prominent nucleoli and finely granular chromatin (H and E, ×1000)

Figure 2

(a) Histopathological section of LEC showing nests and islands of tumor cells embedded in a densely lymphoid and fibrotic stroma (H and E, ×400); (b) Pan-CK immunostain highlighting tumor cells (IHC, ×1000); (c) CD45 decorating the interspersed lymphoid cells (IHC, ×1000)