lymphoepithelioma - like carcinoma ( lelc ) is histologically poorly differentiated and characterized by ill - defined borders , prominent stroma , intratumoral lymphoid infiltrate and a syncytial growth pattern . lelc has been reported in the nasopharynx , larynx , thymus , salivary grand , lung , vagina , tonsil , oval cavity , skin , urinary bladder and mammary gland . lelc occurring in the gastrointestinal tract is rare , and some reports are seen in the esophagus and stomach . the report is made as an epstein - barr virus ( ebv)-related cancer by relation with ebv infection . furthermore reports on colon involvement are very rare , only six reports having been seen in a past . the thing reported as ebv - related cancer is only one case , and the connection with ebv is unidentified in the colon . we experienced an example of lelc 5 mm in size that occurred in the sigmoid colon . laboratory studies showed a carcinoembryonic antigen level of 0.7 iu / ml and a ca19 - 9 level of 6.0 ng / ml . colonoscopy revealed the presence of a 7-mm submucosal tumor in the sigmoid colon for which a snare polypectomy was performed . a 7-mm , white submucosal tumor that appeared to be expanding was present in the sigmoid colon ; however , there was no central depression . the use of indigo carmine allowed clear visualization of the tumor margins and revealed no apparent differences between the tumor surface mucosa and the peritumoral mucosa ; moreover , there were no abnormal structural features . the tumor was suggestive of lymphangioma of the colon ; therefore a snare polypectomy was performed ( fig . muscular layers were identified in the radial margins , and there were no findings suggestive of a residual tumor . the resected specimen was a submucosal tumor measuring 2  5  3 mm , and an infiltrative growth suggestive of moderately to poorly differentiated adenocarcinoma was observed in the submucosa ( fig . lymphoid follicle formation with a germinal center was recognized in the circumference of the cancer cell nests ( fig . mucinous components were also seen ; therefore it was believed to be primary colorectal lelc . the tumor exhibited lymphatic invasion and was positive for tub2 , psm ( 1,800 m ) , med , infb , ly2 , v0 , hm0 , vm0 , and budding , and it was grade 1 with positive staining for d2 - 40 ( fig . immunostaining was negative for ck7 and weakly positive for ck20 , which is consistent with the characteristics of colorectal carcinomas . additional noncurative surgical resection was performed , and there were neither any residual tumors in the radial margins nor intra - lymph node metastases in the resected intestine . submucosal tumor of the colon is a rare presentation of colorectal carcinoma , and it is associated with three possible causes . colorectal carcinoma in the form of a submucosal tumor first develops as surface - type early carcinoma and infiltrates the submucosa , where it grows rapidly by infiltrating the muscularis mucosae layer in an extremely early stage , even before horizontal growth . lymphocytic infiltration is induced by a certain cytokine produced by the carcinoma cells during their growth process . malignant and lymphocytic infiltration results in an increase in the amount of submucosal tissue , which in turn results in the presentation of submucosal tumor morphology . it is important to check whether central depression is present when examining submucosal tumor - like lesions because this is one of the features of colorectal carcinoma . no central depression , signs of infiltration , or redness were observed on the mucosal surface of the tumor in the present case . the correlation between ebv infection and lelc of the larynx , stomach and lungs has been thoroughly demonstrated . lelc reportedly occurs at various sites , including the esophagus , stomach , salivary glands , lungs , thymus , skin , uterine cervix , tongue , oral cavity , trachea , pharynx , bladder and vagina . of these ebv - associated carcinomas in organs other than the stomach have also been revealed by immunohistochemistry in several studies . lelc is thought to be associated with ebv . in the stomach , 8592% of lelc cases have been positive for eber . to compare the prevalence of ebv infection between lelc and non - lelc adenocarcinoma , the cases with lelc and gastric carcinoma with lymphoid stroma were extracted from the publication . ebv was detected in 152 ( 86.4% ) of the 176 lelc cases and in 224 ( 6.1%)of the 3,649 non - lelc cases . the prevalence of ebv involvement in lelc was significantly higher than that of the non - lelc cases . consistent with previous studies , the overall odds ratio of ebv involvement in gastric lelc was 80.9 . to our knowledge , only 7 cases , including the present ( 4 males , 3 females ; are range 2585 years , mean age 62.1 years ) , of lelc occurring in the colon have been reported ( table 1 ) [ 3 , 4 , 5 , 6 , 7 , 8 ] . the sites of involvement in these cases were widely distributed from the ascending colon to the rectum . however , endoscopic resection was only performed in the present case . concerning the histological type of lelc , poorly differentiated adenocarcinoma was the most frequent . however lelc is known to be relative less aggressive clinically despite its poorly differentiated features . immunohistochemistry revealed ebv - positive tumor cells in only one case that presented with two tumors and ulcerative colitis in the background mucosa . the case had other colorectal carcinoma , which had been well - differentiated adenocarcinoma and positive for p53 immunoreaction . however , the lesion described here was poorly differentiated and negative for p53 . in the background nonneoplastic epithelial region , dysplasia with a hyperplastic lymphoid stroma was also seen , indicating that the present case was not a typical ulcerative colitis - related carcinoma . other molecular pathways , such as ebv participation , resemble lelc carcinogenesis of other organs . ebv infection may be involved in carcinogenesis in cases with a background of ulcerative colitis by behaving as a stimulating factor for neoplasia in preneoplastic cells . ebv - encoded small rnas in situ hybridization for ebv was conducted for tumor cells and peripheral lymphocytes from the present case in order to examine their association with ebv ; the results were negative ( fig . the association between ebv and lelc needs to be examined in detail , and it is necessary to clarify in future studies whether ebv infection is involved in carcinogenesis .
a 70-year - old female underwent follow - up colonoscopy after colonic polypectomy . 
 the colonoscopy revealed the presence of a 7-mm submucosal tumor in the sigmoid colon . 
 the tumor surface was smooth and covered with normal mucosa . 
 it was diagnosed as a submucosal tumor , and polypectomy was performed . 
 histopathological examination of the resected specimen revealed moderately to poorly differentiated adenocarcinoma measuring 2  5  3 mm with marked peritumoral lymphocytic infiltration and lymphoid follicle formation . 
 it was diagnosed as carcinoma with lymphoid stroma ( lymphoepithelioma - like carcinoma ) , sm ( 1,800 m ) , ly2 , v0 , budding ; grade 1 . 
 we confirmed the indication for noncurative additional surgical resection and performed laparoscopic sigmoid colectomy . 
 no metastases were observed in the dissected lymph nodes .