Primary Epstein–Barr virus-negative lymphoepithelioma-like carcinoma of the supraglottic larynx mimicking nasopharyngeal carcinoma: a case report

Abstract Lymphoepithelioma-like carcinoma (LELC) of the larynx is exceptionally rare and can closely mimic undifferentiated nasopharyngeal carcinoma. A 78-year-old man presented with progressive dysphonia and dysphagia. Endoscopy and computed tomography showed a supraglottic lesion with bilateral cervical lymphadenopathy (cT2N2M0). Biopsy demonstrated poorly differentiated non-keratinizing carcinoma with dense lymphoid stroma and a Schmincke-type pattern. Tumor cells were positive for p40, p63, and pancytokeratins; Epstein–Barr virus testing was negative. After exclusion of a nasopharyngeal primary, the diagnosis of primary laryngeal LELC was established. Definitive cisplatin-based chemoradiotherapy with intensity-modulated radiotherapy (70 Gy in 35 fractions) achieved complete clinical and radiological response at 12 months with preserved swallowing and phonatory function.