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Lymphoepithelioma-like Hepatocellular Carcinoma: a Case Report and Review of Literature

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Abstract

We report a case of hepatic lymphoepithelioma-like carcinoma-hepatocellular carcinoma subtype (LEL-HCC) in a 41-year-old man with chronic hepatitis C virus (HCV) infection. The patient presented with abdominal pain and further assessment revealed a hypoechoic mass on ultrasonography. Serum alpha-fetoprotein (AFP) was 13·6 ng/dl. The patient was diagnosed as hepatocellular carcinoma based on the established triphasic computed tomography (TCT) diagnostic criteria and he underwent a surgical resection of the mass. Microscopic examination showed sheets and cords of malignant epithelial cells intermixed with heavy lymphoid infiltrate, with more than 100 tumor-infiltrating lymphocytes (TILs) per 10 high-power-field (HPF). Based on immunohistochemical studies, the malignant cells were positive for Hep Par 1 and glypican 3, focally positive for cytokeratin 7 (CK7), and negative for cytokeratin 20 (CK20). TILs were diffusely positive for cluster of differentiation 3 CD3 with an approximately equal CD4/CD8 ratio. The patient was recurrence free at 25 months after surgery, as evident by CT and serum alpha-fetoprotein level. LEL-HCC is a rare variant of HCC with a relatively better prognosis. Exploring the potential for immune modulator-based therapy in this subset of tumors is highly recommended.

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Abbreviations

AFP:

Alpha-fetoprotein

BCLC:

Barcelona Clinic Liver Cancer

CT:

Computed tomography

CTLA-4:

Cytotoxic T-lymphocyte antigen-4

DAAs:

Direct-acting antiviral

DCV:

Daclatasvir

EASL:

European Association Study of Liver Disease

EBV:

Epstein-Barr virus

HCC:

Hepatocellular carcinoma

INR:

International normalized ratio

LELC:

Lymphoepithelioma-like carcinoma

LEL-CC:

LEL-cholangiocarcinoma

SOF:

Sofosbuvir

TIL:

Tumor-infiltrating lymphocyte

WHO:

World Health Organization

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Authors and Affiliations

  1. Pathology Department, National Liver Institute, Menoufia University, Shibin Al Kawm, Egypt

    Dina Sweed, Mervat M. Sultan, Asmaa Mosbeh, Nermine A. Ehsan & Mohamed H. Abdel-Rahman

  2. Hepatopancreatobiliary Surgery Department, National Liver Institute, Menoufia University, Shibin Al Kawm, Egypt

    Yahya A. Fayed

  3. Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Shibin Al Kawm, Egypt

    Eman Abdelsameea & Imam Waked

Authors
  1. Dina Sweed
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  2. Mervat M. Sultan
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  3. Asmaa Mosbeh
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  4. Yahya A. Fayed
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  5. Eman Abdelsameea
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  6. Nermine A. Ehsan
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  7. Mohamed H. Abdel-Rahman
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  8. Imam Waked
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Contributions

Dina Sweed: conceptualization. Asmaa Mosbeh and Yahya Fayed: methodology, software. Dina Sweed and Nermine Ehsan: data curation, writing—original draft preparation. Mervat Sultan and Asmaa Mosbeh: visualization, investigation. Nermine Ehsan: supervision. Yahya Fayed: software, validation. Dina Sweed: writing—reviewing and editing

Corresponding author

Correspondence to Asmaa Mosbeh.

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Ethical Approval

The study was according to an approved Institutional Review Board (IRB) protocol of the National Liver Institute (NLI), Menoufia University.

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A written informed consent was obtained from the patient to publish this case report and accompanying images.

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The authors declare no competing interests.

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Sweed, D., Sultan, M.M., Mosbeh, A. et al. Lymphoepithelioma-like Hepatocellular Carcinoma: a Case Report and Review of Literature. J Gastrointest Canc 54, 275–281 (2023). https://doi.org/10.1007/s12029-021-00757-0

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  • DOI: https://doi.org/10.1007/s12029-021-00757-0

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