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

introduction and importanceLaryngeal 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. CASE PRESENTATION: 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. CLINICAL DISCUSSION: 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.

conclusionLaryngeal 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.