Primary lymphoepithelial carcinoma of the hypopharynx: an extremely rare non-nasopharyngeal presentation

Introduction: A 66-year-old male complained of throat discomfort and odynophagia. Laryngeal fiber optic examination was normal but narrow band imaging was suspicious. USG-FNAC from a cervical lymph node was positive for malignant metastatic carcinoma cells. CECT revealed obliteration of the left pyriform fossa till the level of cricoid cartilage, abutting the ala of the thyroid cartilage, arytenoid cartilage and prevertebral muscles. UGIE revealed an ulcerated mass lesion in the left pyriform fossa. Histopathological examination revealed stratified non-keratinized squamous epithelial lined tissue with subepithelial stroma showing large round to polygonal tumour cells. The tumour cells were surrounded by a lymphoid stroma. On immunohistochemistry the tumour cells were positive for pancytokeratin and negative for CD45, chromogranin and synaptophysin. Lymphocytes were positive for CD45. The diagnosis of lymphoepithelial carcinoma was established. The tumour was inoperable and was treated by radiotherapy. Conclusions: Lymphoepithelial carcinoma is the primary entity of the nasopharynx but rarely seen at sites like oropharynx, larynx and hypopharynx. Only around 50 non-nasopharyngeal cases have been reported till date out of which only 10–12 were in the hypopharynx. Radiotherapy is the mainstay of treatment whereas surgery can be considered for a local disease.