Cacciato Insilla Andrea, Faviana Pinuccia, Pollina Luca Emanuele, De Simone Paolo, Coletti Laura, Filipponi Franco, Campani Daniela
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.
World J Gastroenterol. 2015 Sep 28;21(36):10468-74. doi: 10.3748/wjg.v21.i36.10468.
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.
淋巴上皮瘤样肝细胞癌（LEL-HCC）是一种罕见的未分化型肝癌，其特征是存在大量淋巴细胞浸润。本文描述了一例LEL-HCC病例。一名81岁的慢性丙型肝炎感染女性于2013年8月因肝癌诊断被转诊至我院普通外科。既往超声检查发现肝脏第三段有一个直径60毫米的结节性病变。经针吸活检后，该病变被诊断为肝癌。患者接受了肝段切除术。手术过程中在胃壁上又发现了两个结节。切除标本的组织学检查显示为低分化肝癌，伴有明显的淋巴间质。免疫组织化学研究显示，上皮成分对CK CAM5.2、CK8、CK18、CEA（多克隆）呈阳性反应，对hepar-1呈局灶性阳性，淋巴细胞浸润对CD3、CD4和CD8呈阳性。肿瘤细胞对爱泼斯坦-巴尔病毒呈阴性。胃结节最终被确定为两个小的胃肠道间质瘤（GIST）。肝癌和GIST的同步发生是另一个非常罕见的发现，在文献中很少有描述。本文报告了该病例的临床病理特征，并对文献中现有的少数病例进行了综述。
