Case Report
Copyright ©2008 The WJG Press and Baishidengs. All rights reserved.
World J Gastroenterol. Aug 7, 2008; 14(29): 4694-4696
Published online Aug 7, 2008. doi: 10.3748/wjg.14.4694
Lymphoepithelioma-like hepatocellular carcinoma: A case report and a review of the literature
Sonia Nemolato, Daniela Fanni, Antonio Giuseppe Naccarato, Alberto Ravarino, Generoso Bevilacqua, Gavino Faa
Sonia Nemolato, Daniela Fanni, Alberto Ravarino, Gavino Faa, Department of Cytomorphology, Section of Pathology, Univeristy of Cagliari, Cagliari, 09124, Italy
Antonio GiuseppeNaccarato, Generso Bevilacqua, Depart-ment of Oncology, Section of Pathology, University of Pisa, 56126 Pisa, Italy
Author contributions: Nemolato S designed the research and wrote the paper; Fanni D, Naccarato AG, Ravarino A and Bevilacqua G contributed equally to this work by discussing the immunohistochemical data and histologycal diagnosis; Faa G designed the research and supervised the manuscript.
Correspondence to: Dr. Sonia Nemolato, Department of Cytomorphology, Section of Pathology, Univeristy of Cagliari, Istituto di Anatomia Patologica, Ospedale San Giovanni di Dio, Via Ospedale n. 46, Cagliari 09124, Italy. sonianemolato@libero.it
Telephone: +39-70-6092370
Fax: +39-70-657882
Received: February 19, 2008
Revised: June 3, 2008
Accepted: June 10, 2008
Published online: August 7, 2008
Abstract

Lymphoepithelioma is a particular form of undifferentiated carcinoma, characterized by a prominent lymphoid stroma, originally described in the nasopharynx. Lymphoid stroma-rich carcinomas arising in other organs have been termed lymphoepithelioma-like carcinoma (LELC). In the liver, primary LELCs are very rare, and the majority has been identified as cholangiocarcinomas. Here a rare case of lymphoepithelioma-like hepatocellular carcinoma (HCC) is described. A 47-year old woman presented with abdominal pain. Ultrasonography revealed a liver nodule, 2.2 cm in diameter, localized in the right lobe, adjacent to the gallbladder. Viral markers for hepatic B virus (HBV), hepatic C virus (HCV) and Epstein-Barr virus (EBV) were negative. The nodule was hypoechogenic. The patient underwent surgery, with resection of the nodule. Histology showed hepatocellular carcinoma, characterized by a prominent lymphoid infiltrate. At immunocytochemistry, tumor cells were reactive for Hep Par1 and glypican 3. Immunophenotyping of tumor infiltrating lymphocytes evidenced the predominance of CD8+ cytotoxic suppressor T cells. The postoperative clinical outcome was favorable and the patient was recurrence-free 15 mo after resection. This case, to the best of our knowledge, is the first reported non EBV and non cirrhosis-associated lymphoepithelioma-like hepatocellular carcinoma. The association between the lack of EBV infection, the absence of cirrhosis, a “cytotoxic profile” of the inflammatory infiltrate and a good prognosis could identify a variant of lymphoepithelioma-like HCC with a favorable clinical outcome.

Keywords: Liver; Hepatocellular carcinoma; Tumor infiltrating lymphocytes; Primary liver tumors; Liver lymphoepithelioma