A Rare Case of Epstein-Barr Virus-Encoded RNA In Situ Hybridization-Negative Lymphoepithelial Carcinoma With a Nonneoplastic Scar: A Case Report and Literature Review

The etiology of pulmonary lymphoepithelioma-like carcinoma (PLELC) remains unclear. We report the case of an 83-year-old man with a history of smoking who presented without any significant complaints. Computed tomography (CT) performed to investigate emphysema revealed a nodular shadow in the left upper lobe. A subsequent CT performed three months later showed an increase in the size of the nodule, raising suspicion of lung cancer. Thoracoscopic partial left upper lobectomy was conducted, and pathological examination confirmed left PLELC with a granulomatous reaction, classified as pT1bN0M0, stage IA2. Despite negative Epstein-Barr virus (EBV)-encoded small RNA (EBER) in situ hybridization, serum anti-viral capsid antigen immunoglobulin G (VCA IgG) and anti-Epstein-Barr nuclear antigen (EBNA) IgG antibodies were positive, indicating a history of Epstein-Barr virus infection. The postoperative course was uneventful, and the patient was discharged on the sixth postoperative day (POD). No adjuvant chemotherapy was administered, and the patient remained disease-free nine months after surgery. The interplay between scarring and carcinogenesis in PLELC remains poorly understood, highlighting the need for further case investigations.