Stage IV EBV-positive lymphoepithelioma-like lung cancer with brain metastasis

What happened, in summary

This 52-year-old Chinese woman first presented in 2003 after 3 generalized seizures over 3 months. Brain MRI showed a left parieto-occipital mass that was suspected to be metastatic disease. CT scans found a 2.3 cm lesion in the right lung as the only major abnormality. Transthoracic needle aspiration confirmed an undifferentiated lung carcinoma favoring lymphoepithelioma-like carcinoma, and the tumor was positive for Epstein-Barr virus by in-situ hybridization. Evaluation of the postnasal space and nasal endoscopy did not show another EBV-related primary cancer. Her team first treated the symptomatic brain metastasis with whole brain radiotherapy, 30 Gy over 13 days, while seizures were controlled with phenytoin. She then received treatment to the lung primary with paclitaxel/carboplatin given concurrently with 60 Gy conformal radiation over 30 fractions in 6 weeks. Surveillance scans showed no recurrence for 4 years. In the fifth year, a local lung recurrence appeared and was treated with right middle lobectomy; margins were clear and 17 resected lymph nodes were benign. She then received 4 cycles of gemcitabine/carboplatin. After another 2 disease-free years, scans found a retroperitoneal/posterior mediastinal soft-tissue mass. It was completely resected and confirmed as metastasis from the lung lymphoepithelioma-like carcinoma. She then received docetaxel/carboplatin. Six months after that surgery, and 8 years after presentation, she remained well and disease-free. The long timeline is notable: she had initial control of brain and lung disease, then separate treatable recurrences years later, each managed with local therapy plus platinum-based chemotherapy when feasible. This supports the final disease-free status despite the aggressive initial presentation.