J Med Cases

Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc

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Case Report

Volume 6, Number 7, July 2015, pages 297-303

Lymphoepithelioma-Like Hepatocellular Carcinoma: Report of Three Cases and Review of Literature

Figure 1. Gross photograph of right hepatectomy specimen from an 89-year-old female patient with a solitary liver mass. A 5.1 cm well-circumscribed, soft, white mass was present within the resection specimen.

Figure 2. Histopathology of lymphoepithelioma-like hepatocellular carcinoma in the right lobectomy specimen, illustrating the pleomorphic malignant cells and the intimately associated lymphoplasmacytic infiltrate. (A) H&E, × 40. (B) H&E, × 100. (C) H&E, × 200. (D) H&E, × 400.

Figure 3. Immunophenotype of lymphoepithelioma-like hepatocellular carcinoma in the resection specimen, revealing the hepatocellular origin of the malignant cells and a prominent cytotoxic T-cell population, without evidence of Epstein-Barr virus infection. (A) Hep-Par-1, × 100. (B) CD3, × 100. (C) CD4, × 100. (D) CD8, × 100. (E) TIA-1, × 100. (F) EBER chromogenic in situ hybridization, × 100.

**Table 1.** Literature Review of Lymphoepithelioma-Like Hepatocellular Carcinoma
Case number	Author and year	Age (years)	Gender	Underlying liver disease	Cirrhosis	Tumor size (cm)	CD20	CD3	CD8	TIA	EBV	Follow-up duration	Outcome
N/A: information not available. ¹By report, case 6 showed a lymphocytic infiltrate composed primarily of T lymphocytes, demonstrated by positivity for ubiquitin carboxyl-terminal hydrolase L1 (UCHL-1) [12]. ²Case 18 showed cholangiolar differentiation (focal CK19 immunoreactivity) [18]. ³Cases 22 and 23 showed lymphoid infiltrate consisting predominantly of T cells (case 22) or mixed T and B cells (case 23). Immunophenotype of the lymphoid cells is not reported [22].
1	Emile et al, 2000 [10]	50	M	Hepatitis B and C infection	Yes	4.0 cm	Rare	Positive	N/A	Positive	Negative	10 years	Alive without recurrence
2	Emile et al, 2000 [10]	54	M	Previous HCC, status post right hepatectomy 2 years prior to liver transplantation	No	2.0 cm	Rare	Positive	N/A	Positive	Negative	7.7 years	Died of disease
3	Emile et al, 2000 [10]	59	M	Hepatitis B and C	Yes	5.0 cm	Rare	Positive	N/A	Positive	Negative	8 years	Alive without recurrence
4	Emile et al, 2000 [10]	45	M	Hepatitis C	Yes	2.0 cm	Rare	Positive	N/A	Positive	Negative	4.7 years	Alive without recurrence
5	Emile et al, 2000 [10]	64	M	Familial hemochromatosis	Yes	4.0 cm	Rare	Positive	N/A	Positive	Negative	3 years	Alive without recurrence
6¹	Shirabe et al, 1995 [12]	58	F	Hepatitis B infection	Yes	2.2 cm	N/A	N/A	N/A	N/A	N/A	6.9 years	Alive without recurrence
7-17	Wada et al, 1998 [13]	44 - 77 years	10 M:1 F	Hepatitis C viral antibody positive (11/11 cases)	Yes in 6/11 cases	All tumors less than 3 cm (mean 2.2 cm)	Rare	N/A	Positive	N/A	N/A	5 years	Alive (11/11); without recurrence (10/11)
18²	Min et al, 2007 [18]	62	M	None described	No	N/A	N/A	Positive	Positive	N/A	Focal positive EBV ISH, LMP1+	Of unknown duration	Alive without recurrence
19	Si et al, 2004 [19]	39	F	Hepatitis C	Yes	1.0 cm	Positive	Positive	N/A	N/A	Positive	4.5 months	Died of disease
20	Chen et al, 2007 [20]	56	M	Hepatitis C	Yes	3.2 cm	Positive	Positive	N/A	N/A	Negative	21 months	Died of disease
21	Nemolato et al, 2008 [21]	47	F	None described	No	2.2 cm	N/A	Positive	Positive	N/A	Negative	15 months	Alive without recurrence
22³	Choi et al, 2008 [22]	64	M	Alcohol history	No	N/A	N/A	Positive	N/A	N/A	Negative	N/A	Unknown
23³	Choi et al, 2008 [22]	62	F	Clonorchis infection	No	N/A	Positive	Positive	N/A	N/A	Negative	N/A	Unknown
24	Park et al, 2009 [23]	57	M	Hepatitis B	Yes	2.7 cm	Rare	Positive	Positive	N/A	Negative	50 months	Alive without recurrence
25	Current report	89	F	Hepatitis C	No	5.1 cm	Rare	Positive	Positive	Positive	Negative	38 months	Alive without recurrence
26	Current report	64	M	Hepatitis B	No	3.7 cm	Rare	Positive	Positive	Positive	Negative	26 months	Alive without recurrence
27	Current report	60	M	Hepatitis C	No	5.6 cm	N/A	N/A	N/A	N/A	Negative	31 months	Died of disease

Table 1. Literature Review of Lymphoepithelioma-Like Hepatocellular Carcinoma

Case number

Author and year

Age (years)

Gender

Underlying liver disease

Cirrhosis

Tumor size (cm)

CD20

CD3

CD8

TIA

EBV

Follow-up duration

Outcome

N/A: information not available. ¹By report, case 6 showed a lymphocytic infiltrate composed primarily of T lymphocytes, demonstrated by positivity for ubiquitin carboxyl-terminal hydrolase L1 (UCHL-1) [12]. ²Case 18 showed cholangiolar differentiation (focal CK19 immunoreactivity) [18]. ³Cases 22 and 23 showed lymphoid infiltrate consisting predominantly of T cells (case 22) or mixed T and B cells (case 23). Immunophenotype of the lymphoid cells is not reported [22].

Emile et al, 2000 [10]

Hepatitis B and C infection

Yes

4.0 cm

Rare

Positive

N/A

Positive

Negative

10 years

Alive without recurrence

Emile et al, 2000 [10]

Previous HCC, status post right hepatectomy 2 years prior to liver transplantation

2.0 cm

Rare

Positive

N/A

Positive

Negative

7.7 years

Died of disease

Emile et al, 2000 [10]

Hepatitis B and C

Yes

5.0 cm

Rare

Positive

N/A

Positive

Negative

8 years

Alive without recurrence

Emile et al, 2000 [10]

Hepatitis C

Yes

2.0 cm

Rare

Positive

N/A

Positive

Negative

4.7 years

Alive without recurrence

Emile et al, 2000 [10]

Familial hemochromatosis

Yes

4.0 cm

Rare

Positive

N/A

Positive

Negative

3 years

Alive without recurrence

6¹

Shirabe et al, 1995 [12]

Hepatitis B infection

Yes

2.2 cm

N/A

6.9 years

Alive without recurrence

7-17

Wada et al, 1998 [13]

44 - 77 years

10 M:1 F

Hepatitis C viral antibody positive (11/11 cases)

Yes in 6/11 cases

All tumors less than 3 cm (mean 2.2 cm)

Rare

N/A

Positive

N/A

5 years

Alive (11/11); without recurrence (10/11)

18²

Min et al, 2007 [18]

None described

N/A

Positive

N/A

Focal positive EBV ISH, LMP1+

Of unknown duration

Alive without recurrence

Si et al, 2004 [19]

Hepatitis C

Yes

1.0 cm

Positive

N/A

Positive

4.5 months

Died of disease

Chen et al, 2007 [20]

Hepatitis C

Yes

3.2 cm

Positive

N/A

Negative

21 months

Died of disease

Nemolato et al, 2008 [21]

None described

2.2 cm

N/A

Positive

N/A

Negative

15 months

Alive without recurrence

22³

Choi et al, 2008 [22]

Alcohol history

N/A

Positive

N/A

Negative

N/A

Unknown

23³

Choi et al, 2008 [22]

Clonorchis infection

N/A

Positive

N/A

Negative

N/A

Unknown

Park et al, 2009 [23]

Hepatitis B

Yes

2.7 cm

Rare

Positive

N/A

Negative

50 months

Alive without recurrence

Current report

Hepatitis C

5.1 cm

Rare

Positive

Negative

38 months

Alive without recurrence

Current report

Hepatitis B

3.7 cm

Rare

Positive

Negative

26 months

Alive without recurrence

Current report

Hepatitis C

5.6 cm

N/A

Negative

31 months

Died of disease