Liao Tsan-Chieh, Liu Chien-An, Chiu Nai-Chi, Yeh Yi-Chen, Chiou Yi-You
Tsan-Chieh Liao, Chien-An Liu, Nai-Chi Chiu, Yi-You Chiou, Department of Radiology, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
World J Gastroenterol. 2015 Apr 7;21(13):4089-95. doi: 10.3748/wjg.v21.i13.4089.
Primary lymphoepithelioma-like carcinoma in the liver is extremely rare. A few cases of lymphoepithelioma-like cholangiocarcinoma have been reported, but few radiologic features were described. We reviewed 23 cases of lymphoepithelioma-like cholangiocarcinoma reported between 1996 and 2014 and describe a rare case of a 35-year-old woman in our hospital who was diagnosed with lymphoepithelioma-like cholangiocarcinoma of the liver and was a hepatitis B carrier. The tumor (1.6 cm) in our patient appeared to be hypoechoic in sonographic images and hypodense in computed tomography (CT) images. In addition, it was homogeneous hypointense in T1-weighted magnetic resonance (MR) images (MRI) and hyperintense in T2-weighted MRI. Dynamic gadolinium-enhanced MRI showed typical image pattern of hepatocellular carcinoma (HCC). The patient underwent a laparoscopic left hepatic lobectomy, and the resected tumor consisted of well-differentiated glandular cells with extensive lymphocytic infiltration that were immunoreactive to CK (AE1/AE3), CD3, and CD20. In addition, the tumor was positive for Epstein-Barr virus-encoded RNA in situ hybridization. Finally, lymphoepithelioma-like cholangiocarcinoma was diagnosed. In previous studies, the incidence is highest among middle-aged people. Most tumors appeared to be hypodense with either hypovascular or hypervascular patterns in CT images. This case report is the first study to address sonography, CT, and MRI observations and delineate pathologic correlations. We suggest that the imaging pattern of lymphoepithelioma-like cholangiocarcinoma, either the typical cholangiocarcinoma pattern or a mimic of HCC, should be considered in the differential lists for HCC.
肝脏原发性淋巴上皮瘤样癌极为罕见。虽有少数淋巴上皮瘤样胆管癌病例的报道，但对其放射学特征的描述较少。我们回顾了1996年至2014年间报道的23例淋巴上皮瘤样胆管癌病例，并描述了我院1例35岁女性的罕见病例，该患者被诊断为肝脏淋巴上皮瘤样胆管癌且为乙肝携带者。我们患者的肿瘤（1.6厘米）在超声图像中表现为低回声，在计算机断层扫描（CT）图像中为低密度。此外，在T1加权磁共振（MR）图像中呈均匀低信号，在T2加权MR图像中呈高信号。动态钆增强MR成像显示出典型的肝细胞癌（HCC）图像模式。患者接受了腹腔镜左肝叶切除术，切除的肿瘤由分化良好的腺细胞组成，伴有广泛的淋巴细胞浸润，对细胞角蛋白（CK，AE1/AE3）、CD3和CD20呈免疫反应性。此外，肿瘤在爱泼斯坦-巴尔病毒编码RNA原位杂交中呈阳性。最终，确诊为淋巴上皮瘤样胆管癌。在以往的研究中，发病率在中年人中最高。大多数肿瘤在CT图像中表现为低密度，伴有低血供或高血供模式。本病例报告是第一项涉及超声、CT和MR观察并阐述病理相关性的研究。我们建议，在HCC的鉴别诊断清单中应考虑淋巴上皮瘤样胆管癌的成像模式，无论是典型的胆管癌模式还是HCC的模仿模式。
