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.
Si
Michael W
MW
Department of Pathology, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229-3900, USA.
Thorson
John A
JA
Lauwers
Gregory Y
GY
DalCin
Paola
P
Furman
Jaime
J
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