Primary tracheal lymphoepithelioma-like carcinoma in a young non-smoking male: a case report highlighting the diagnostic value of flow-volume loop
- 1Department of Pulmonary and Critical Care Medicine, Shenzhen Longgang District Central Hospital , ,
Abstract
Background: Primary tracheal lymphoepithelioma-like carcinoma (LELC) is an extremely rare malignancy (<2% of tracheal tumors) strongly associated with Epstein–Barr virus. Tracheal tumors can mimic asthma due to dynamic airway obstruction, often leading to diagnostic delay. The flow-volume loop provides critical clues to central airway obstruction but is frequently overlooked.
Case Presentation: We report a 30-year-old non-smoking male initially misdiagnosed with asthma, whose refractoriness to inhaled corticosteroids prompted spirometry. The flow-volume loop revealed a plateau pattern in both inspiratory and expiratory limbs, consistent with fixed upper airway obstruction which guided chest computed tomography (CT) and bronchoscopy to identify a tracheal polypoid mass. Pathological examination confirmed LELC with positive EBV-encoded small RNAs (EBER) in situ hybridization. The patient underwent endoscopic resection followed by video-assisted thoracoscopic surgery (VATS) tracheal resection-anastomosis with lymphadenectomy. Postoperative pulmonary function testing at 1-year follow-up demonstrated complete normalization of the flow-volume loop morphology, with FEV1 (Forced expiratory volume in 1 s) improved from 0.91L to 3.62L(+298%) and PEF (peak expiratory flow) from 2.03L/s to 6.76 L/s (+233%). The patient remained asymptomatic without recurrence at 1-year follow-up.
Conclusion: This case underscores that, in young patients with asthma-like symptoms refractory to conventional therapy, flow-volume loop analysis should not be deferred, as it can unmask central airway obstruction and expedite the diagnosis of rare tracheal malignancies.
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BibTeX
@article{xiao2026primary,
title = {{Primary tracheal lymphoepithelioma-like carcinoma in a young non-smoking male: a case report highlighting the diagnostic value of flow-volume loop}},
author = {Shan Xiao and Sida Chen and Jintao Ou and Yan Shen},
journal = {Frontiers in medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1965664},
url = {https://europepmc.org/article/PMC/PMC13720881},
note = {CC BY},
}
RIS
TY - JOUR
TI - Primary tracheal lymphoepithelioma-like carcinoma in a young non-smoking male: a case report highlighting the diagnostic value of flow-volume loop
AU - Shan Xiao
AU - Sida Chen
AU - Jintao Ou
AU - Yan Shen
PY - 2026
DA - 2026/10/16
JO - Frontiers in medicine
DO - 10.3389/fmed.2026.1965664
UR - https://europepmc.org/article/PMC/PMC13720881
AB - Background: Primary tracheal lymphoepithelioma-like carcinoma (LELC) is an extremely rare malignancy (<2% of tracheal tumors) strongly associated with Epstein–Barr virus. Tracheal tumors can mimic asthma due to dynamic airway obstruction, often leading to diagnostic delay. The flow-volume loop provides critical clues to central airway obstruction but is frequently overlooked. Case Presentation: We report a 30-year-old non-smoking male initially misdiagnosed with asthma, whose refractoriness to inhaled corticosteroids prompted spirometry. The flow-volume loop revealed a plateau pattern in both inspiratory and expiratory limbs, consistent with fixed upper airway obstruction which guided chest computed tomography (CT) and bronchoscopy to identify a tracheal polypoid mass. Pathological examination confirmed LELC with positive EBV-encoded small RNAs (EBER) in situ hybridization. The patient underwent endoscopic resection followed by video-assisted thoracoscopic surgery (VATS) tracheal resection-anastomosis with lymphadenectomy. Postoperative pulmonary function testing at 1-year follow-up demonstrated complete normalization of the flow-volume loop morphology, with FEV1 (Forced expiratory volume in 1 s) improved from 0.91L to 3.62L(+298%) and PEF (peak expiratory flow) from 2.03L/s to 6.76 L/s (+233%). The patient remained asymptomatic without recurrence at 1-year follow-up. Conclusion: This case underscores that, in young patients with asthma-like symptoms refractory to conventional therapy, flow-volume loop analysis should not be deferred, as it can unmask central airway obstruction and expedite the diagnosis of rare tracheal malignancies.
SN - 2296-858X
ER -