Hepatocellular lymphoepithelioma-like carcinoma associated with epstein barr virus: a hitherto unrecognized entity.
OBJECTIVE
Lymphoepithelioma-like carcinoma (LELC) is an undifferentiated carcinoma with a dense lymphoid stroma. It has been reported in diverse organs and shows variable association with Epstein-Barr virus (EBV). Only a few EBV positive cases have been observed in the hepatobiliary system, all of which were considered to be cholangiocarcinomas. We report a unique case of hepatocellular LELC arising in a cirrhotic liver with EBV demonstrated in the tumor cells.


RESULTS
A 39-year-old Hispanic female underwent an orthotopic liver transplant for end stage liver disease secondary to chronic hepatitis C. A high-grade hepatocellular carcinoma with a dense lymphocytic infiltrate was found in the explant as well as in a portal lymph node. Three months posttransplant, the patient developed numerous hepatic nodules with enlarged periaortic and portacaval lymph nodes. Biopsy of the hepatic nodules showed a recurrent hepatocellular carcinoma devoid of a dense lymphocytic infiltrate. Both the primary and recurrent tumors were positive for EBV by molecular studies. The patient eventually expired from liver failure over a 6-week period.


CONCLUSIONS
This case represents the first report of EBV-positive hepatocellular LELC. It is particularly interesting given the precipitous clinical outcome, which was possibly related to immunosuppresive therapy.
Department of Pathology, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229-3900, USA.
Michael W
MW
Si
John A
JA
Thorson
Gregory Y
GY
Lauwers
Paola
P
DalCin
Jaime
J
Furman
D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000235:genetics / Q000473:pathology / Q000821:virology*; D002294:Carcinoma, Squamous Cell / Q000235:genetics / Q000473:pathology / Q000821:virology*; D002880:Chromosomes, Human, Pair 11 / Q000235:genetics; D020031:Epstein-Barr Virus Infections / Q000150:complications* / Q000473:pathology; D005260:Female; D018628:Gene Dosage; D004854:Herpesvirus 4, Human / Q000302:isolation & purification; D006801:Humans; D007150:Immunohistochemistry; D017404:In Situ Hybridization, Fluorescence; D008103:Liver Cirrhosis / Q000821:virology; D008113:Liver Neoplasms / Q000235:genetics / Q000473:pathology / Q000821:virology*; D016031:Liver Transplantation; D008207:Lymphatic Metastasis / Q000473:pathology; D016133:Polymerase Chain Reaction; D014412:Tumor Virus Infections / Q000150:complications* / Q000473:pathology