Non-Epstein-Barr virus associated lymphoepithelioma-like carcinoma of the inferior common bile duct

Abstract

A carcinoma displaying undifferentiated features with dense lymphoplasmacytic infiltration is defined as a lymphoepithelioma-like carcinoma (LEC), and some of LEC is associated with Epstein-Barr virus (EBV). All of the 13 previously reported cases of LEC of the biliary system were intrahepatic in location. Herein, we describe the first case of LEC of the inferior common bile duct. A 68-year-old Japanese man, who had been previously treated for hepatocellular carcinoma using microwave coagulation therapy, was found to have tumors of the common bile duct and pancreas head. Histopathological study of the resected tumor showed solid or cohesive nests of large undifferentiated cells with irregular large vesicular nuclei and nucleoli. Around the tumor cell nests, dense lymphoplasmacytic infiltration was observed. Focal glandular differentiation (approximately 5%) was also present. These histopathological features corresponded morphologically to LEC. Immunohistochemically, the tumor cells were positive for cytokeratin (CK) 7, CK 19 and CA19-9, but negative for CK 20 and Hep Par 1. In situ hybridization for Epstein Barr virus early small RNAs disclosed no nuclear signal in tumor cells. Therefore, a diagnosis of non-EBV-associated LEC of the inferior common bile duct was made. Although the prognosis of the biliary LEC is thought to be better than that of conventional cholangiocarcinoma, the differences in prognosis between EBV-positive and -negative cases have not yet been established. Therefore, additional case studies will be needed to clarify the clinicopathological features of LEC of the biliary tract.

EBV-associated lymphoepithelioma-like carcinoma of the pancreas: Case report with targeted sequencing analysis

“…Histopathological features of biliary LELC are similar with and without EBV association. 3, 8 In the present case, the histologic differential diagnosis included LELC, medullary carcinoma, high grade neuroendocrine carcinoma, and metastatic carcinoma. Medullary carcinoma of the pancreas exhibits poor differentiation, pushing invasion, a syncytial growth pattern, and frequent microsatellite instability.…”

Lymphoepithelioma-like hepatocellular carcinoma: a case report and a review of the literature

“…With regard to neoplasms in the hepatobiliary system, a case of LEL-CCC associated with EBV was first reported in 1996 by Hsu and colleagues [1]. Subsequently, it has been demonstrated that LEL-CCC cases with EBV positivity are relatively abundant [41]. On the other hand, only one case of EBV-positive LEL-HCC has been reported to date [10].…”

Intrahepatic Cholangiocarcinoma With Lymphoepithelioma-like Carcinoma Components Not Associated With Epstein-Barr Virus: Report of a Case

“…19 In lymphoepithelioma-like hepatocellular carcinoma, 87% (7 of 8) of cases were EBV negative, 20,21,23 and 1 case of LELC of the inferior common bile duct was also EBV negative. 24 On the other hand, in ICC with LELC components, 38% (6 of 16) of cases were EBV negative. These results suggest that the involvement of EBV genome integration in LELC depends on the origin of the LELC.…”

“…Neoplasms with features of undifferentiated carcinoma with intense lymphoid stroma are classified as LELCs, and it has been reported that LELCs can occur in various organs, including the salivary gland, 11 thymus, 12 trachea, 13 lung, 14 esophagus, 15 stomach, 16 urinary bladder, 17 uterine cervix, 18 and vagina. 19 To the best of our knowledge, 8 cases of lymphoepithelioma-like hepatocellular carcinoma, [20][21][22][23] 1 case of LELC of the inferior common bile duct, 24 and 16 cases of ICC with LELC component have been reported in the English literature. [2][3][4][5][6][7][8][9][10][25][26][27] In this case, the tumor cells showed positive immunoreactivity for cytokeratin 19 but no immunoreactivity for glypican 3, a useful marker of hepatocellular carcinoma.…”