title: Lymphoepithelioma-like hepatocellular carcinoma: Case report and review of the literature.
abstract: Lymphoepithelioma-like hepatocellular carcinoma (LEL-HCC) is a rare form of undifferentiated carcinoma of the liver characterized by the presence of an abundant lymphoid infiltrate. Here, a case of LEL-HCC is described. An 81-year-old woman with a chronic hepatitis C infection was referred to the general surgery department of our hospital in August 2013 with a diagnosis of HCC. A past ultrasound examination had revealed a 60 mm-diameter nodular lesion in the third segment of the liver. After a needle biopsy, the lesion was diagnosed as HCC. The patient underwent surgery with a liver segmentectomy. Two additional nodes on the gastric wall were detected during the surgical operation. The histology of the removed specimen showed a poorly differentiated HCC with significant lymphoid stroma. Immunohistochemical studies revealed that the epithelial component was reactive for CK CAM5.2, CK8, CK18, CEA (polyclonal) and was focally positive for hepar-1 and that the lymphoid infiltrate was positive for CD3, CD4 and CD8. The tumor cells were negative for Epstein-Barr virus. The gastric nodes were ultimately determined to be two small gastrointestinal stromal tumors (GISTs). The synchronous occurrence of HCC and GIST is another very uncommon finding rarely described in the literature. Here, we report the clinicopathological features of our case, along with a review of the few cases present in the literature.
authors.affiliation: Andrea Cacciato Insilla, Pinuccia Faviana, Luca Emanuele Pollina, Daniela Campani, Department of Surgical, Medical, Molecular Pathology and Critical Area, Division of Surgical Pathology, University Hospital of Pisa, 56124 Pisa, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Cacciato Insilla
authors.affiliation: Andrea Cacciato Insilla, Pinuccia Faviana, Luca Emanuele Pollina, Daniela Campani, Department of Surgical, Medical, Molecular Pathology and Critical Area, Division of Surgical Pathology, University Hospital of Pisa, 56124 Pisa, Italy.
authors.forename: Pinuccia
authors.initials: P
authors.lastname: Faviana
authors.affiliation: Andrea Cacciato Insilla, Pinuccia Faviana, Luca Emanuele Pollina, Daniela Campani, Department of Surgical, Medical, Molecular Pathology and Critical Area, Division of Surgical Pathology, University Hospital of Pisa, 56124 Pisa, Italy.
authors.forename: Luca Emanuele
authors.initials: LE
authors.lastname: Pollina
authors.affiliation: Andrea Cacciato Insilla, Pinuccia Faviana, Luca Emanuele Pollina, Daniela Campani, Department of Surgical, Medical, Molecular Pathology and Critical Area, Division of Surgical Pathology, University Hospital of Pisa, 56124 Pisa, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: De Simone
authors.affiliation: Andrea Cacciato Insilla, Pinuccia Faviana, Luca Emanuele Pollina, Daniela Campani, Department of Surgical, Medical, Molecular Pathology and Critical Area, Division of Surgical Pathology, University Hospital of Pisa, 56124 Pisa, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Coletti
authors.affiliation: Andrea Cacciato Insilla, Pinuccia Faviana, Luca Emanuele Pollina, Daniela Campani, Department of Surgical, Medical, Molecular Pathology and Critical Area, Division of Surgical Pathology, University Hospital of Pisa, 56124 Pisa, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Filipponi
authors.affiliation: Andrea Cacciato Insilla, Pinuccia Faviana, Luca Emanuele Pollina, Daniela Campani, Department of Surgical, Medical, Molecular Pathology and Critical Area, Division of Surgical Pathology, University Hospital of Pisa, 56124 Pisa, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Campani
mesh_terms: D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis; D001707:Biopsy, Needle; D006528:Carcinoma, Hepatocellular / Q000737:chemistry / Q000473:pathology* / Q000601:surgery / Q000821:virology; D004847:Epithelial Cells / Q000737:chemistry / Q000473:pathology*; D005260:Female; D046152:Gastrointestinal Stromal Tumors / Q000473:pathology; D006498:Hepatectomy; D019698:Hepatitis C, Chronic / Q000150:complications / Q000175:diagnosis; D006801:Humans; D007150:Immunohistochemistry; D008113:Liver Neoplasms / Q000737:chemistry / Q000473:pathology* / Q000601:surgery / Q000821:virology; D008214:Lymphocytes / Q000737:chemistry / Q000473:pathology*; D009378:Neoplasms, Multiple Primary; D013274:Stomach Neoplasms / Q000473:pathology; D014057:Tomography, X-Ray Computed
chemical_list: D014408:Biomarkers, Tumor
keywords: Gastrointestinal stromal tumors; Hepatocellular carcinoma; Lymphoepithelioma; Lymphoepithelioma-like