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Case Report Open Access

Adjuvant immunotherapy plus chemotherapy and maintenance immunotherapy for pulmonary lymphoepithelioma‑like carcinoma with hepatitis B virus infection, KRAS mutation and high expression of programmed death ligand 1: A case report

  • Authors:
    • Jing Zhu
    • Qing-Gui Xu
    • Jiao Zhu
    • Rui-Xiang Zhou
    • Yu-Chuan Zhou
    • Zhi-Ke Li
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    Affiliations: Department of Oncology, The Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
    Copyright: © Zhu et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 257
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    Published online on: April 22, 2026
       https://doi.org/10.3892/ol.2026.15612
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Abstract

Pulmonary lymphoepithelioma‑like carcinoma (PLELC) is a rare subtype of non‑small cell lung cancer, often associated with Epstein‑Barr virus (EBV) infection. It typically exhibits distinct epidemiological and molecular features compared to other lung malignancies. However, the clinical behavior and optimal therapeutic strategies for PLELC, particularly in the presence of concomitant viral infections or specific genetic mutations, remain poorly defined. This report comprehensively outlines the treatment process of a 58‑year‑old female patient diagnosed with PLELC in the right middle lobe of the lung. Following surgical resection, the diagnosis was confirmed as PLELC, which was found to be associated with hepatitis B virus (HBV) infection, KRAS mutation and high expression of programmed death ligand 1 (PD‑L1). The patient subsequently received adjuvant treatment with immunotherapy (penpulimab) combined with chemotherapy, followed by penpulimab maintenance therapy, resulting in a progression‑free survival of >44 months. At present, the patient is still alive and healthy, and can undergo regular follow‑ups and re‑examinations. Notably, preoperative testing showed a positive EBV status, which became negative post‑surgery. This case highlights several key aspects. First, it examines the diagnostic and therapeutic characteristics of PLELC with a positive EBV test result before surgery that turned negative after surgical resection. Second, it assesses the influence of high PD‑L1 expression and concurrent HBV infection on the efficacy and safety of immunotherapy. Third, it explores the clinical implications of the KRAS mutation in this unique tumor subtype. The overarching goal of this exploration is to offer valuable clinical guidance for managing this rare and understudied subtype of lung cancer, particularly in the context of multimodal therapy involving immunotherapy.
View Figures

Figure 1

Pathology and IHC of the pulmonary
lymphoepithelioma-like carcinoma. (A and B) Histological analysis.
(A) heterologous cells were arranged in clusters (magnification,
×40); (B) the nuclei of heterologous cells were vacuolated and the
nucleoli were clear (magnification, ×200; H&E staining); the
arrows point at heterologous cells. (C-I) IHC analysis. (C)
Cytoplasmic CK5/6 was positive, the arrows point at positive CK5/6
cytoplasm; (D) nuclear P40 was positive; the arrows point at
positive P40 nuclear; (E) thyroid transcription factor-1 was
negative; (F) Napsin A was negative; (G) nuclear EBER was positive;
the arrows point at positive EBER nuclear; (H) proliferation index
Ki-67 positive ~50%, the arrows point at positive Ki-67 nuclear;
(I) PD-L1 detection microscopic image: Tumor proportion score=55%
(magnification, ×100), the arrows point at positive PD-L1 nuclear.
CK, cytokeratin; PD-L1, programmed cell death ligand 1; EBER,
Epstein-Barr virus-encoded small RNA; IHC,
immunohistochemistry.

Figure 2

Chest CT images of the pulmonary
lymphoepithelioma-like carcinoma patient. (A) Preoperative in
November 2021 (lesion measuring 37.21 mm, arrow). (B) Before the
first chemotherapy after surgery in January 2022 (the lesion is not
visible). (C) After the first chemotherapy session after surgery in
March 2022 (no obvious recurrence or metastasis). (D) In February
2025 (no obvious recurrence or metastasis).
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Copy and paste a formatted citation
Spandidos Publications style
Zhu J, Xu Q, Zhu J, Zhou R, Zhou Y and Li Z: Adjuvant immunotherapy plus chemotherapy and maintenance immunotherapy for pulmonary lymphoepithelioma‑like carcinoma with hepatitis B virus infection, KRAS mutation and high expression of programmed death ligand 1: A case report. Oncol Lett 31: 257, 2026.
APA
Zhu, J., Xu, Q., Zhu, J., Zhou, R., Zhou, Y., & Li, Z. (2026). Adjuvant immunotherapy plus chemotherapy and maintenance immunotherapy for pulmonary lymphoepithelioma‑like carcinoma with hepatitis B virus infection, KRAS mutation and high expression of programmed death ligand 1: A case report. Oncology Letters, 31, 257. https://doi.org/10.3892/ol.2026.15612
MLA
Zhu, J., Xu, Q., Zhu, J., Zhou, R., Zhou, Y., Li, Z."Adjuvant immunotherapy plus chemotherapy and maintenance immunotherapy for pulmonary lymphoepithelioma‑like carcinoma with hepatitis B virus infection, KRAS mutation and high expression of programmed death ligand 1: A case report". Oncology Letters 31.6 (2026): 257.
Chicago
Zhu, J., Xu, Q., Zhu, J., Zhou, R., Zhou, Y., Li, Z."Adjuvant immunotherapy plus chemotherapy and maintenance immunotherapy for pulmonary lymphoepithelioma‑like carcinoma with hepatitis B virus infection, KRAS mutation and high expression of programmed death ligand 1: A case report". Oncology Letters 31, no. 6 (2026): 257. https://doi.org/10.3892/ol.2026.15612
Copy and paste a formatted citation
x
Spandidos Publications style
Zhu J, Xu Q, Zhu J, Zhou R, Zhou Y and Li Z: Adjuvant immunotherapy plus chemotherapy and maintenance immunotherapy for pulmonary lymphoepithelioma‑like carcinoma with hepatitis B virus infection, KRAS mutation and high expression of programmed death ligand 1: A case report. Oncol Lett 31: 257, 2026.
APA
Zhu, J., Xu, Q., Zhu, J., Zhou, R., Zhou, Y., & Li, Z. (2026). Adjuvant immunotherapy plus chemotherapy and maintenance immunotherapy for pulmonary lymphoepithelioma‑like carcinoma with hepatitis B virus infection, KRAS mutation and high expression of programmed death ligand 1: A case report. Oncology Letters, 31, 257. https://doi.org/10.3892/ol.2026.15612
MLA
Zhu, J., Xu, Q., Zhu, J., Zhou, R., Zhou, Y., Li, Z."Adjuvant immunotherapy plus chemotherapy and maintenance immunotherapy for pulmonary lymphoepithelioma‑like carcinoma with hepatitis B virus infection, KRAS mutation and high expression of programmed death ligand 1: A case report". Oncology Letters 31.6 (2026): 257.
Chicago
Zhu, J., Xu, Q., Zhu, J., Zhou, R., Zhou, Y., Li, Z."Adjuvant immunotherapy plus chemotherapy and maintenance immunotherapy for pulmonary lymphoepithelioma‑like carcinoma with hepatitis B virus infection, KRAS mutation and high expression of programmed death ligand 1: A case report". Oncology Letters 31, no. 6 (2026): 257. https://doi.org/10.3892/ol.2026.15612
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