Lymphoepithelioma-like hepatocellular carcinoma, case report of a rare indolent subtype of hepatic cancer

Abstract

Background: Lymphoepithelioma - Like Carcinomas (LELC) of the liver are tumors of poorly differentiated epithelial cells with prominent lymphoid cell infiltration of the stroma. Unlike common primary liver cancers, LELC is a rare subtype of primary liver cancer with notably better prognosis. Unfortunately, available data and understanding of this unique cancer type is limited. Case report: A 72-year-old Hispanic female with compensated cirrhosis due to treatment-naïve hepatitis C and Primary Biliary Cirrhosis (PBC) presented with chronic abdominal pain. Computed Tomography scan (CT) of her abdomen at that time showed nodular liver with a mass measuring 4.6 x 3.7 cm in the right hepatic lobe with heterogeneous enhancement on arterial phase associated with mild venous washout, concerning for Hepatocellular Carcinoma (HCC). She was lost to follow up but re-presented 4 years later with an interval increase in the liver mass to 6.4 x 4.8 cm. Staging work up was unremarkable and patient underwent resection of the mass. Histopathologic examination showed moderately differentiated HCC with massive lymphocytic infiltration within the tumor with lymphocyte outnumbering tumor cells and diagnosed as lymphoepithelial-like carcinoma-HCC. The patient remained asymptomatic with no tumor recurrence at 16 months post resection. Conclusion: This report of an indolent course of untreated EBV positive LELC-hepatocellular carcinoma provides valuable insight about this rare tumor type