Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 7, 2015; 21(13): 4089-4095
Published online Apr 7, 2015. doi: 10.3748/wjg.v21.i13.4089
Lymphoepithelioma-like cholangiocarcinoma: A mimic of hepatocellular carcinoma on imaging features
Tsan-Chieh Liao, Chien-An Liu, Nai-Chi Chiu, Yi-Chen Yeh, Yi-You Chiou
Tsan-Chieh Liao, Chien-An Liu, Nai-Chi Chiu, Yi-You Chiou, Department of Radiology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
Tsan-Chieh Liao, Chien-An Liu, Nai-Chi Chiu, Yi-Chen Yeh, Yi-You Chiou, National Yang-Ming University School of Medicine, Taipei 11217, Taiwan
Yi-Chen Yeh, Department of Pathology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
Author contributions: Liao TC and Liu CA designed the report, conducted the study, performed the data analyses and interpretation, and wrote and revised the manuscript; Liu CA provided writing assistance and proofreading of the article; Yeh YC performed the histologic interpretation; Chiu NC and Chiou YY provided the material and contributed to discussion about the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Chien-An Liu, MD, Department of Radiology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Beitou District, Taipei 11217, Taiwan. caliu@vghtpe.gov.tw
Telephone: + 886-2-2871212 Fax: + 886-2-2871212
Received: August 14, 2014
Peer-review started: August 14, 2014
First decision: August 27, 2014
Revised: September 10, 2014
Accepted: October 14, 2014
Article in press: October 15, 2014
Published online: April 7, 2015
Abstract

Primary lymphoepithelioma-like carcinoma in the liver is extremely rare. A few cases of lymphoepithelioma-like cholangiocarcinoma have been reported, but few radiologic features were described. We reviewed 23 cases of lymphoepithelioma-like cholangiocarcinoma reported between 1996 and 2014 and describe a rare case of a 35-year-old woman in our hospital who was diagnosed with lymphoepithelioma-like cholangiocarcinoma of the liver and was a hepatitis B carrier. The tumor (1.6 cm) in our patient appeared to be hypoechoic in sonographic images and hypodense in computed tomography (CT) images. In addition, it was homogeneous hypointense in T1-weighted magnetic resonance (MR) images (MRI) and hyperintense in T2-weighted MRI. Dynamic gadolinium-enhanced MRI showed typical image pattern of hepatocellular carcinoma (HCC). The patient underwent a laparoscopic left hepatic lobectomy, and the resected tumor consisted of well-differentiated glandular cells with extensive lymphocytic infiltration that were immunoreactive to CK (AE1/AE3), CD3, and CD20. In addition, the tumor was positive for Epstein-Barr virus-encoded RNA in situ hybridization. Finally, lymphoepithelioma-like cholangiocarcinoma was diagnosed. In previous studies, the incidence is highest among middle-aged people. Most tumors appeared to be hypodense with either hypovascular or hypervascular patterns in CT images. This case report is the first study to address sonography, CT, and MRI observations and delineate pathologic correlations. We suggest that the imaging pattern of lymphoepithelioma-like cholangiocarcinoma, either the typical cholangiocarcinoma pattern or a mimic of HCC, should be considered in the differential lists for HCC.

Keywords: Epstein-Barr virus, Hepatocellular carcinoma, Lymphoepithelioma-like carcinoma, Lymphoepithelioma-like cholangiocarcinoma, Magnetic resonance imaging

Core tip: We report the first case of lymphoepithelioma-like cholangiocarcinoma observed using sonography, computed tomography, and magnetic resonance images and delineate the pathologic correlations. According to a review of previous studies, lymphoepithelioma-like cholangiocarcinoma may affect more middle-aged woman. We suggest that the imaging pattern of lymphoepithelioma-like cholangiocarcinoma, either a typical cholangiocarcinoma pattern or a mimic of hepatocellular carcinoma, should be considered in the differential lists for hepatocellular carcinoma.