title: Lymphoepitelioma-like hepatocellular carcinoma: a case report and a review of the literature.
abstract: Lymphoepitelioma 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.
authors.affiliation: Department of Cytomorphology, Section of Pathology, University of Cagliari, Istituto di Anatomia Patologica, Ospedale San Giovanni di Dio, Via Ospedale no. 46, Cagliari, Italy. sonianemolato@libero.it
authors.forename: Sonia
authors.initials: S
authors.lastname: Nemolato
authors.forename: Daniela
authors.initials: D
authors.lastname: Fanni
authors.forename: Antonio Giuseppe
authors.initials: AG
authors.lastname: Naccarato
authors.forename: Alberto
authors.initials: A
authors.lastname: Ravarino
authors.forename: Generoso
authors.initials: G
authors.lastname: Bevilacqua
authors.forename: Gavino
authors.initials: G
authors.lastname: Faa
mesh_terms: D002277:Carcinoma / Q000473:pathology; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D008214:Lymphocytes / Q000473:pathology; D008875:Middle Aged