Nemolato Sonia, Fanni Daniela, Naccarato Antonio Giuseppe, Ravarino Alberto, Bevilacqua Generoso, Faa Gavino
Department of Cytomorphology, Section of Pathology, University of Cagliari, Istituto di Anatomia Patologica, Ospedale San Giovanni di Dio, Via Ospedale no. 46, Cagliari, Italy.
World J Gastroenterol. 2008 Aug 7;14(29):4694-6. doi: 10.3748/wjg.14.4694.
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.
淋巴上皮瘤是未分化癌的一种特殊形式，其特征为淋巴样间质显著，最初在鼻咽部被描述。发生于其他器官的富含淋巴样间质的癌被称为淋巴上皮瘤样癌（LELC）。在肝脏，原发性LELC非常罕见，且大多数已被确定为胆管癌。本文描述了一例罕见的淋巴上皮瘤样肝细胞癌（HCC）病例。一名47岁女性因腹痛就诊。超声检查发现肝脏有一个直径2.2 cm的结节，位于右叶，毗邻胆囊。乙肝病毒（HBV）、丙肝病毒（HCV）和EB病毒（EBV）的病毒标志物均为阴性。该结节呈低回声。患者接受了手术，切除了结节。组织学检查显示为肝细胞癌，其特征为显著的淋巴细胞浸润。免疫细胞化学检查显示，肿瘤细胞对Hep Par1和磷脂酰肌醇蛋白聚糖3呈阳性反应。肿瘤浸润淋巴细胞的免疫表型分析表明，CD8 + 细胞毒性抑制性T细胞占优势。术后临床结果良好，患者在切除术后15个月无复发。据我们所知，该病例是首例报道的非EBV且非肝硬化相关的淋巴上皮瘤样肝细胞癌。EBV感染缺失、无肝硬化、炎症浸润的“细胞毒性特征”与良好预后之间的关联，可能确定了一种具有良好临床结果的淋巴上皮瘤样HCC变体。
