title: Characterization of inflammatory (lymphoepithelioma-like) hepatocellular carcinoma: a study of 8 cases.
abstract: BACKGROUND
  The World Health Organization has recently recognized lymphoepithelioma-like carcinoma, or inflammatory hepatocellular carcinoma, as a variant of hepatocellular carcinoma.
  
  
  OBJECTIVE
  To identify and characterize the inflammatory hepatocellular carcinomas in our institution from 1988 to the present.
  
  
  METHODS
  All cases of hepatocellular carcinoma in our institution from 1988 to the present were reviewed and reclassified as lymphoepithelioma-like carcinoma and were studied in comparison to appropriately matched controls.
  
  
  RESULTS
  Among the 8 cases of lymphoepithelioma-like carcinoma identified, the male to female ratio was 1:3, the mean age was 68.5 years (range, 57-78 years), and all of the cases were seen in noncirrhotic livers. The average numbers of lymphocytes were significantly higher in the cases than in the controls. T cells were predominant, with a uniform distribution of CD4 and CD8 positive cells. Cholangiolar differentiation was seen by K19 positivity as focal in 1 case and diffuse in 2 cases. In situ hybridization for Epstein-Barr virus was negative in all of the cases. Diffuse overexpression of p16 (>75% of cells) was seen in 2 cases, both of which were negative for the presence of transcriptionally active human papilloma virus by in situ hybridization. In our series, 3 of 8 cases (37.5%) showed local recurrence, which was similar to the controls (6 of 18; 33%), P > .99. Although the rate of distant metastases was lower among the cases (12.5%) than the controls (22.2%), the difference was not statistically significant (P > .99).
  
  
  CONCLUSIONS
  We present the first series of 8 cases of lymphoepithelioma-like carcinoma of the liver occurring in patients without cirrhosis and with a female preponderance and the absence of Epstein-Barr virus. Although clinical outcomes were similar to those of controls in our small series, additional data may be required for confirmation.
authors.affiliation: From the Department of Laboratories, Seattle Children's Hospital, Seattle, Washington (Dr Patel); and the Departments of Pathology and Immunology (Drs Liu and Brunt) and Surgery (Drs Vaccharajani and Chapman), Washington University in St Louis, St Louis, Missouri.
authors.forename: Kalyani R
authors.initials: KR
authors.lastname: Patel
authors.forename: Ta-Chiang
authors.initials: TC
authors.lastname: Liu
authors.forename: Neeta
authors.initials: N
authors.lastname: Vaccharajani
authors.forename: William C
authors.initials: WC
authors.lastname: Chapman
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Brunt
mesh_terms: D000368:Aged; D015496:CD4-Positive T-Lymphocytes / Q000473:pathology; D018414:CD8-Positive T-Lymphocytes / Q000473:pathology; D006528:Carcinoma, Hepatocellular / Q000145:classification* / Q000175:diagnosis* / Q000473:pathology; D016022:Case-Control Studies; D019941:Cyclin-Dependent Kinase Inhibitor p16 / Q000378:metabolism; D003937:Diagnosis, Differential; D005260:Female; D004854:Herpesvirus 4, Human; D006801:Humans; D053539:Keratin-19 / Q000378:metabolism; D008113:Liver Neoplasms / Q000145:classification* / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D019941:Cyclin-Dependent Kinase Inhibitor p16; D053539:Keratin-19