A Case of Lymphocyte-Rich Hepatocellular Carcinoma in a Patient Who Was Treated for Colon Cancer

Abstract

Hepatocellular carcinoma (HCC) primarily originates in the liver with hepatic differentiation. However, HCCs are not homogenous, and approximately 35% of HCC cases are classified as histopathological variants that present distinct pathologic characteristics. In particular, the lymphocyte-rich variant is the rarest subtype accounting for less than 1% of HCCs, which is not well known to date about molecular features and pathophysiology. Herein, we present a case of a patient who was suspected of metastatic liver cancer and confirmed as lymphocyterich HCC pathologically. A 78-year-old woman who underwent a right hemicolectomy for colon cancer was referred to our hospital for a newly detected liver mass. We could not make a decision because of insufficient evidence for diagnosis from imaging studies. After resection, we found that it was a lymphocyte-rich HCC. The pathologic features and prognostic trends of this subtype are also discussed.

Uncommon variants of hepatocellular carcinoma: Not one size fits all

“…Although typical molecular alterations for this variant are not clear, this variant has shown to have high PD-L1 expression. 9,10 To the best of our knowledge, we present first ever reports of FNAC of steatohepatitic variant and lymphocyte-rich variant of HCC.…”

Characterization of lymphocyte‐rich hepatocellular carcinoma and the prognostic role of tertiary lymphoid structures

“…As many as 35% of HCCs are classified into histopathologic variants by clinicopathologic and molecular characteristics 8,23,47 . Recent studies have demonstrated a good correlation between the histologic subtypes and gene mutations: CTNNB1 ‐mutated HCCs with large, well‐differentiated, cholestatic with microtrabecular and pseudoglandular histology; TP53 ‐mutated HCCs with poorly differentiated compact pattern with pleomorphic cells and frequent vascular invasion, scirrhous subtype with TSC1/TSC2 mutations, epithelial to mesenchymal transition; steatohepatitic subtype with frequent IL‐6/JAK/STAT activation without CTNNB1, TP53 and TERT alterations; and macrotrabecular massive subtype with high AFP level, TP53 mutations, FGF19 amplifications, vascular invasion and poor survival 48,49 .…”

“…As many as 35% of HCCs are classified into histopathologic variants by clinicopathologic and molecular characteristics. 8,23,47 Recent studies have demonstrated a good correlation between the histologic subtypes and gene mutations: CTNNB1-mutated HCCs with large, well-differentiated, cholestatic with microtra-…”

“…4 LR-HCC is characterized by favourable clinical outcomes, frequent PD-L1 expression and no association with Epstein-Barr virus. 2,5,6 However, this entity accounts for less than 1% of HCCs, 7,8 and due to the various terminology (HCC with lymphocytic infiltration, HCC with lymphoid stroma, etc. ), 2 its clinicopathologic characteristics and underlying molecular mechanism are still under investigation.…”