To the Editor: A 58-year-old man was admitted to our department with complaint of hoarseness. On endoscopical examination, a partially ulcerated lesion of the right vocal cord extending to the anterior commissure was detected. The vocal cords were symmetrically mobile. Head and neck examination revealed no palpable neck masses, and the remainder of the otorhinolaryngologic examination was normal. He had no smoking history, and medical history was unremarkable. Magnetic resonance imaging (MRI) of the neck showed a mass involving the right vocal cord extending the anterior commissure. In addition, there was no pathologic lymph node in the MRI scans of the neck (Fig. 1). To gain additional information about the mass and to perform a biopsy for histopathological investigation, the patient underwent direct microlaryngoscopy under general anesthesia. Fragmented tissue biopsies were histologically investigated. Histologically, the surface epithelium is ulcerated by a tumor and infiltrated lesion is present in the subepithelial tissue. The tumor formed syncytial sheets and nests without evidence of squamous or glandular differentiation, and is densely surrounded by inflammatory cells, largely lymphocytes and plasma cells. Tumor cells are composed of epithelial cells, containing large central nuclei with prominent nucleoli and a large eosinophilic cytoplasm. Pathological study of the surgical specimen revealed an undifferentiated carcinoma with aspects of lymphoepithelioma (Fig. 2). The patient was treated with frontolateral laryngectomy. Right vocal cord and anterior commissure including cartilage piece of the left thyroid cartilage lamina as well as one-third anterior part of the left vocal cord were removed. Definitive histopathological diagnosis was a poorly differentiated squamous cell carcinoma with aspects of lymphoepithelioma. In situ hybridization for Epstein-Barr virus (EBV) and PCR EBVspecific amplification proved to be negative. At that time, after 18 months of follow-up, there was no evidence of recurrence. Lymphoepithelial carcinoma of the larynx accounts for 0.2% of all laryngeal cancers. These tumors are an exceedingly rare and aggressive neoplasm with a propensity for early cervical lymph node and distant metastasis. The most common site of development of primary laryngeal lymphoepithelial carcinoma is the supraglottic region. The relationship between EBV and lymphoepithelial carcinoma of the larynx remains controversial. Despite the small number of cases, the initial results suggest that EBV plays a limited role in the etiology of lymphoepithelial carcinoma of the larynx. The clinical course and optimal treatment of nonnasopharyngeal lymphoepithelioma of the head and neck have not been well described. Although most patients have been treated surgically, this tumor is radiosensitive and radiotherapy should be considered as the main treatment. Neoadjuvant chemotherapy may be recommended in patients with early regional adenopathy in order to decrease the distant metastasis rate. Metin Ibrahimov, MD, Mehmet Yilmaz, MD, Mehmet Halil Celal, MD, Marlen Mamanov, MD, Umur Yollu, MD, Husnu Ozek, MD, Istanbul University Istanbul, Turkey metinibrahimov@gmail.com