# Diagnostic challenges in laryngeal lymphoepithelial carcinoma: A case report of misdiagnosis and clinical implications

## TL;DR

A rare case of laryngeal lymphoepithelial carcinoma was initially misdiagnosed as chronic inflammation, highlighting the importance of detailed histology and immunostaining for accurate diagnosis and effective treatment.

## Contribution

This case report emphasizes the diagnostic challenges of laryngeal LEC and the importance of immunohistochemistry in distinguishing it from benign conditions.

## Key findings

- Laryngeal LEC was misdiagnosed as chronic inflammation due to nonspecific symptoms and Schmincke pattern.
- Radiotherapy led to symptomatic improvement in the patient with EBER-negative laryngeal LEC.
- Accurate diagnosis of LEC requires immunohistochemistry for CK, p40, and EBER.

## Abstract

Laryngeal lymphoepithelial carcinoma (LEC) is a rare and diagnostically complex malignancy, often overlooked due to its nonspecific presentation and common association with smoking. Prompt and accurate diagnosis is crucial for achieving optimal patient outcomes.

A 63-year-old Chinese male with a two-year history of persistent hoarseness and throat discomfort initially diagnosed as chronic inflammation. However, further evaluation revealed vestibular fold swelling and right vocal cord thickening. Surgical resection confirmed laryngeal LEC with a Schmincke pattern, CD20+ B-cell infiltration, positive cytokeratin (CK) and p40 immunostaining, and negative Epstein-Barr virus-encoded RNA (EBER). Following radiotherapy, the patient experienced symptomatic improvement.

Laryngeal LEC is often EBER-negative and challenging to diagnose. This case highlights the need to consider LEC even with benign-appearing findings. Accurate diagnosis relies on detailed histology and IHC, especially CK and p40.Radiotherapy is an effective treatment for EBER-negative laryngeal LEC.

Laryngeal LEC is a smoking-associated, EBER-negative rare malignancy that typically responds well to radiotherapy, yielding a favorable prognosis. This case underscores the necessity of considering laryngeal LEC in similar clinical presentations to avoid misdiagnosis.

•Rare case of LEC initially misdiagnosed as chronic inflammation•Schmincke pattern and B-lymphocyte-rich stroma complicated intraoperative frozen section diagnosis•Highlights the importance of considering laryngeal LEC in differential diagnosis of laryngeal lesions•Emphasizes the role of IHC (CK, p40, p53) and FISH (EBER) in accurate diagnosis of laryngeal LEC•Reports successful treatment with radiotherapy, underscoring favorable prognosis of laryngeal LEC

Rare case of LEC initially misdiagnosed as chronic inflammation

Schmincke pattern and B-lymphocyte-rich stroma complicated intraoperative frozen section diagnosis

Highlights the importance of considering laryngeal LEC in differential diagnosis of laryngeal lesions

Emphasizes the role of IHC (CK, p40, p53) and FISH (EBER) in accurate diagnosis of laryngeal LEC

Reports successful treatment with radiotherapy, underscoring favorable prognosis of laryngeal LEC