腹腔鏡下腫瘍切除により診断し得た肝Lymphoepithelioma-like carcinoma（LELC）の一例
症例はC型肝硬変に対して7年前にウイルス学的著効を達成した73歳女性．肝細胞癌のスクリーニング目的の腹部CT検査で肝S7に単発腫瘤を指摘された．経皮的肝腫瘤生検の結果，臨床的に低分化型肝細胞癌と診断し，腹腔鏡下肝腫瘍切除術を施行した．腫瘍は被膜を伴わない結節状の病変であり，病理組織学的所見ではリンパ球を含む炎症細胞浸潤が顕著で，N/C比の高い肝細胞類似の異型細胞の混在を認めた．また免疫染色ではN/C比の高い異型細胞で一部の上皮性マーカーが陽性を示したことからLymphoepithelioma-like carcinoma（LELC）と診断した．術後2年以上経過するが再発は認めていない．LELC...
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| Published in | 肝臓 Vol. 62; no. 11; pp. 724 - 733 |
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| Main Authors | , , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本肝臓学会
01.11.2021
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0451-4203 1881-3593 |
| DOI | 10.2957/kanzo.62.724 |
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| Abstract | 症例はC型肝硬変に対して7年前にウイルス学的著効を達成した73歳女性．肝細胞癌のスクリーニング目的の腹部CT検査で肝S7に単発腫瘤を指摘された．経皮的肝腫瘤生検の結果，臨床的に低分化型肝細胞癌と診断し，腹腔鏡下肝腫瘍切除術を施行した．腫瘍は被膜を伴わない結節状の病変であり，病理組織学的所見ではリンパ球を含む炎症細胞浸潤が顕著で，N/C比の高い肝細胞類似の異型細胞の混在を認めた．また免疫染色ではN/C比の高い異型細胞で一部の上皮性マーカーが陽性を示したことからLymphoepithelioma-like carcinoma（LELC）と診断した．術後2年以上経過するが再発は認めていない．LELCの診断は主として病理学的所見に依存するが，肝細胞癌や肝内胆管癌に類似した特徴をもつため，肝生検では診断が困難であることも少なくない．低分化癌においては常に鑑別に挙げることが重要であると考えられた． |
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| AbstractList | 症例はC型肝硬変に対して7年前にウイルス学的著効を達成した73歳女性．肝細胞癌のスクリーニング目的の腹部CT検査で肝S7に単発腫瘤を指摘された．経皮的肝腫瘤生検の結果，臨床的に低分化型肝細胞癌と診断し，腹腔鏡下肝腫瘍切除術を施行した．腫瘍は被膜を伴わない結節状の病変であり，病理組織学的所見ではリンパ球を含む炎症細胞浸潤が顕著で，N/C比の高い肝細胞類似の異型細胞の混在を認めた．また免疫染色ではN/C比の高い異型細胞で一部の上皮性マーカーが陽性を示したことからLymphoepithelioma-like carcinoma（LELC）と診断した．術後2年以上経過するが再発は認めていない．LELCの診断は主として病理学的所見に依存するが，肝細胞癌や肝内胆管癌に類似した特徴をもつため，肝生検では診断が困難であることも少なくない．低分化癌においては常に鑑別に挙げることが重要であると考えられた． |
| Author | 木岡, 清英 中井, 隆志 濱野, 玄弥 高台, 真太郎 清水, 貞利 川崎, 靖子 金沢, 景繁 井上, 健 福島, 裕子 岡田, 真穂 天野, 優雅 |
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| Copyright | 2021 一般社団法人 日本肝臓学会 |
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| References | 34) Huang Y, Tsung JS, Lin CW, et al. Intrahepatic cholangiocarcinoma with lymphoepithelioma-like carcinoma component. Ann Clin Lab Sci 2004; 34: 476-480 23) Gearty SV, Al Jurdi A, Pittman ME, et al. An EBV+ lymphoepithelioma-like cholangiocarcinoma in a young woman with chronic hepatitis B. BMJ Case Rep 2019; 12: e229520 6) Makannavar JH, KishanPrasad HL, Shetty JK. Lymphoepithelioma-like carcinoma of endometrium; a rare case report. Indian J Surg Oncol 2015; 6: 130-134 2) Nieto-Coronel MT, Perez-Sanchez VM, Salazar-Campos JE, et al. Lymphoepithelioma-like carcinoma of breast: a case report and review of the literature. Indian J Pathol Microbiol 2019; 62: 125-128 17) Si MW, Thorson JA, Lauwers GY, et al. Hepatocellular lymphoepithelioma-like carcinoma associated with epstein barr virus: a hitherto unrecognized entity. Diagn Mol Pathol 2004; 13: 183-189 28) Zhang JW, Yang HY, Xu YY, et al. Surgical treatment for metastasis from lymphoepithelioma-like cholangiocarcinoma in the liver: a case report. Medicine (Baltimore) 2018; 97: e0666 50) Wei JG, Sun AJ, Wang C, et al. Mixed lymphoepithelioma-like hepatobiliary carcinoma: a case report. Chin Med J 2014; 94: 479 37) Kim YB, Park YN, Han JY, et al. Biliary lymphoepithelioma-like carcinoma not associated with Epstein-Barr virus. Arch Pathol Lab Med 1999; 123: 441-443 22) Calderaro J, Rousseau B, Amaddeo G, et al. PD-L1 expression in hepatocellular carcinoma: relationship with clinical and pathological features. Hepatology 2016; 64: 2038-2046 25) Chan AW, Tong JH, Sung MY, et al. Epstein-Barr virus-associated lymphoepithelioma-like cholangiocarcinoma: a rare variant of intrahepatic cholangiocarcinoma with favourable outcome. Histopathology 2014; 65: 674-683 9) Emile JF, Adam R, Sebagh M, et al. Hepatocellular carcinoma with lymphoid stroma: a tumour with good prognosis after liver transplantation. Histopathology 2000; 37: 523-529 29) Shih EJ, Chau IY, Yeh YC, et al. Synchronous hepatocellular carcinoma and lymphoepithelioma-like carcinoma arising from 2 different sites of the liver: a case report. Medicine (Baltimore) 2018; 97: e12548 33) Hsu HC, Chen CC, Huang GT, et al. Clonal Epstein-Barr virus associated cholangiocarcinoma with lymphoepithelioma-like component. Hum Pathol 1996; 27: 848-850 8) Kai Zhang, Changcheng Tao, Zonggui Tao, et al. Lymphoepithelioma-like carcinoma in liver not associated with Epstein-Barr virus: a report of 3 cases and literature review. Diagnostic Pathol 2020; 15: 115 31) Chen TC, Ng KF, Kuo T. Intrahepatic cholangiocarcinoma with lymphoepithelioma-like component. Mod Pathol 2001; 14: 527-532 11) Wang JK, Jin YW, Hu HJ, et al. Lymphoepithelioma-like hepatocellular carcinoma: a case report and brief review of literature. Medicine (Baltimore) 2017; 96: e9416 14) Shinoda M, Kadota Y, Tsujikawa H, et al. Lymphoepithelioma-like hepatocellular carcinoma: a case report and a review of the literature. World J Surg Oncol 2013; 11: 97 20) Patel KR, Liu TC, Vaccharajani N, et al. Characterization of inflammatory (lymphoepithelioma-like) hepatocellular carcinoma: a study of 8 cases. Arch Pathol Lab Med 2014; 138: 1193-1202 38) Labgaa I, Hiotis S, Ward SC. Lymphoepithelioma-like Cholangiocarcinoma: a rare finding with good outcomes. J Clin Gastroenterol 2016; 50: 268 15) Wei J, Liu Q, Wang C, et al. Lymphoepithelioma-like hepatocellular carcinoma without Epstein-Barr virus infection: a case report and a review of the literature. Indian J Pathol Microbiol 2015; 58: 550-553 47) Labgaa I, Stueck A, Ward SC. Lymphoepithelioma-like carcinoma in liver. Am J Pathol 2017; 187: 1438-1444 3) Sathirareuangchai S, Hirata K. Pulmonary Lymphoepithelioma-like carcinoma. Arch Pathol Lab Med 2019; 143: 1027-1030 36) Jeng YM, Chen CL, Hsu HC. Lymphoepithelioma-like cholangiocarcinoma: an Epstein-Barr virus-associated tumor. Am J Surg Pathol 2001; 25: 516-520 18) Nemolato S, Fanni D, Naccarato AG, et al. Lymphoepithelioma-like hepatocellular carcinoma: a case report and a review of the literature. World J Gastroenterol 2008; 14: 4694-4696 41) Ortiz MR, Garijo G, Adrados M, et al. EpsteinBarr virus-associated Cholangiocarcinoma with Lymphoepithelioma-like component. Int J Surg Pathol 2000; 8: 347-351 45) Min HS, Shin E, Jang JJ. Carcinoma with predominant lymphoid stroma in hepatobiliary system--report of 2 cases. Korean J Hepatol 2007; 13: 222-227 21) Chan AW, Tong JH, Pan Y, et al. Lymphoepithelioma-like hepatocellular carcinoma: an uncommon variant of hepatocellular carcinoma with favorable outcome. Am J Surg Pathol 2015; 39: 304-312 7) An SL, Liu LG, Zheng YL, et al. Primary lymphoepithelioma-like hepatocellular carcinoma: report of a locally advanced case and review of literature. Int J Clin Exp Pathol 2015; 8: 3282-3287 1) FT Bosman, World Health Organization, International Agency for Research on Cancer. In: WHO Classification of Tumours of the Digestive System, ed 4, International Agency for Research on Cancer, Lyon, 2010 16) Park HS, Jang KY, Kim YK, et al. Hepatocellular carcinoma with massive lymphoid infiltration: a regressing phenomenon. Pathol Res Pract 2009; 205: 648-652 24) Tan NY, Majumder S, Sridharan M, et al. Metastatic Epstein-Barr virus-positive Lymphoepithelioma-like Cholangiocarcinoma in a young man with ulcerative colitis. Am J Gastroenterol 2017; 112: 518-520 13) Cacciato Insilla A, Faviana P, Pollina LE, et al. Lymphoepithelioma-like hepatocellular carcinoma: case report and review of the literature. World J Gastroenterol 2015; 21: 10468-10474 27) Ling W, Lu C, Huang H, et al. Ultrasonographic findings of intrahepatic lymphoepithelioma-like cholangiocarcinoma associated with Epstein-Barr virus: two cases report. Medicine (Baltimore) 2019; 98: e14206 26) Ding Y, Sun Z, You W, et al. Lymphoepithelioma-like intrahepatic cholangiocarcinoma with Epstein-Barr virus infection: report of a rare case. Ann Transl Med 2019; 7: 497 35) Hur YH, Kim HH, Koh YS, et al. Lymphoepithelioma-like cholangiocarcinoma not associated with Epstein-Barr virus. ANZ J Surg 2011; 81: 652-653 10) Wada Y, Nakashima O, Kutami R, et al. Clinicopathological study on hepatocellular carcinoma with lymphocytic infiltration. Hepatology 1998; 27: 407-414 46) Ishida M, Mori T, Shiomi H, et al. NonEpstein-Barr virus associated lymphoepithelioma-like carcinoma of the inferior common bile duct. World J Gastrointest Oncol 2011; 3: 111-115 40) Liao TC, Liu CA, Chiu NC, et al. Lymphoepithelioma-like cholangiocarcinoma: a mimic of hepatocellular carcinoma on imaging features. World J Gastroenterol 2015; 21: 4089-4095 48) Iris D Nagtegaal, Robert D Odze, David Klimstra, et al. In: WHO Classification of Tumours of the Digestive, ed 5, International Agency for Research on Cancer, Lyon, 2019 19) Shirabe K, Matsumata T, Maeda T, et al. A long-term surviving patient with hepatocellular carcinoma including lymphocytes infiltration--a clinicopathological study. Hepatogastroenterology 1995; 42: 996-1001 12) Chen CJ, Jeng LB, Huang SF. Lymphoepithelioma-like hepatocellular carcinoma. Chang Gung Med J 2007; 30: 172-177 44) Aosasa S, Maejima T, Kimura A, et al. Intrahepatic Cholangiocarcinoma with Lymphoepithelioma-like carcinoma components not associated with Epstein-Barr virus: report of a case. Int Surg 2015; 100: 689-695 49) Filotico M, Moretti V, Floccari F, et al. Very rare liver neoplasm: Lymphoepithelioma-like (LEL) hepatocellular carcinoma. Case Rep Pathol 2018; 2018: 2651716 4) Venyo AK. Primary Lymphoepithelioma-Like Carcinoma of the Prostate Gland: A Review of the literature. Scientifica (Cairo) 2016; 2016: 1876218 42) Szekely E. Lymphoepithelioma-like cholangiocarcinoma (LELC) not associated with Epstein-Barr virus. Am J Surg Pathol 2001; 25: 1464-1466 30) Adachi S, Morimoto O, Kobayashi T. Lymphoepithelioma-like cholangiocarcinoma not associated with EBV. Pathol Int 2008; 58: 69-74 32) Henderson-Jackson E, Nasir NA, Hakam A, et al. Primary mixed lymphoepithelioma-like carcinoma and intra-hepatic cholangiocarcinoma: a case report and review of literature. Int J Clin Exp Pathol 2010; 3: 736-741 5) Raphael V, Jitani AK, Sailo SL, et al. Lymphoepithelioma-like carcinoma of the urinary bladder: a rare case report. Urol Ann 2015; 7: 516-519 43) Vortmeyer AO, Kingma DW, Fenton RG, et al. Hepatobiliary lymphoepithelioma-like carcinoma associated with EpsteinBarr virus. Am J Clin Pathol 1998; 109: 90-95 39) Lee W. Intrahepatic lymphoepithelioma-like cholangiocarcinoma not associated with epstein-barr virus: a case report. Case Rep Oncol 2011; 4: 68-73 |
| References_xml | – reference: 44) Aosasa S, Maejima T, Kimura A, et al. Intrahepatic Cholangiocarcinoma with Lymphoepithelioma-like carcinoma components not associated with Epstein-Barr virus: report of a case. Int Surg 2015; 100: 689-695 – reference: 7) An SL, Liu LG, Zheng YL, et al. Primary lymphoepithelioma-like hepatocellular carcinoma: report of a locally advanced case and review of literature. Int J Clin Exp Pathol 2015; 8: 3282-3287 – reference: 4) Venyo AK. Primary Lymphoepithelioma-Like Carcinoma of the Prostate Gland: A Review of the literature. Scientifica (Cairo) 2016; 2016: 1876218 – reference: 41) Ortiz MR, Garijo G, Adrados M, et al. EpsteinBarr virus-associated Cholangiocarcinoma with Lymphoepithelioma-like component. Int J Surg Pathol 2000; 8: 347-351 – reference: 9) Emile JF, Adam R, Sebagh M, et al. Hepatocellular carcinoma with lymphoid stroma: a tumour with good prognosis after liver transplantation. Histopathology 2000; 37: 523-529 – reference: 39) Lee W. Intrahepatic lymphoepithelioma-like cholangiocarcinoma not associated with epstein-barr virus: a case report. Case Rep Oncol 2011; 4: 68-73 – reference: 25) Chan AW, Tong JH, Sung MY, et al. Epstein-Barr virus-associated lymphoepithelioma-like cholangiocarcinoma: a rare variant of intrahepatic cholangiocarcinoma with favourable outcome. Histopathology 2014; 65: 674-683 – reference: 35) Hur YH, Kim HH, Koh YS, et al. Lymphoepithelioma-like cholangiocarcinoma not associated with Epstein-Barr virus. ANZ J Surg 2011; 81: 652-653 – reference: 2) Nieto-Coronel MT, Perez-Sanchez VM, Salazar-Campos JE, et al. Lymphoepithelioma-like carcinoma of breast: a case report and review of the literature. Indian J Pathol Microbiol 2019; 62: 125-128 – reference: 42) Szekely E. Lymphoepithelioma-like cholangiocarcinoma (LELC) not associated with Epstein-Barr virus. Am J Surg Pathol 2001; 25: 1464-1466 – reference: 50) Wei JG, Sun AJ, Wang C, et al. Mixed lymphoepithelioma-like hepatobiliary carcinoma: a case report. Chin Med J 2014; 94: 479 – reference: 15) Wei J, Liu Q, Wang C, et al. Lymphoepithelioma-like hepatocellular carcinoma without Epstein-Barr virus infection: a case report and a review of the literature. Indian J Pathol Microbiol 2015; 58: 550-553 – reference: 40) Liao TC, Liu CA, Chiu NC, et al. Lymphoepithelioma-like cholangiocarcinoma: a mimic of hepatocellular carcinoma on imaging features. World J Gastroenterol 2015; 21: 4089-4095 – reference: 48) Iris D Nagtegaal, Robert D Odze, David Klimstra, et al. In: WHO Classification of Tumours of the Digestive, ed 5, International Agency for Research on Cancer, Lyon, 2019 – reference: 16) Park HS, Jang KY, Kim YK, et al. Hepatocellular carcinoma with massive lymphoid infiltration: a regressing phenomenon. Pathol Res Pract 2009; 205: 648-652 – reference: 8) Kai Zhang, Changcheng Tao, Zonggui Tao, et al. Lymphoepithelioma-like carcinoma in liver not associated with Epstein-Barr virus: a report of 3 cases and literature review. Diagnostic Pathol 2020; 15: 115 – reference: 30) Adachi S, Morimoto O, Kobayashi T. Lymphoepithelioma-like cholangiocarcinoma not associated with EBV. Pathol Int 2008; 58: 69-74 – reference: 27) Ling W, Lu C, Huang H, et al. Ultrasonographic findings of intrahepatic lymphoepithelioma-like cholangiocarcinoma associated with Epstein-Barr virus: two cases report. Medicine (Baltimore) 2019; 98: e14206 – reference: 6) Makannavar JH, KishanPrasad HL, Shetty JK. Lymphoepithelioma-like carcinoma of endometrium; a rare case report. Indian J Surg Oncol 2015; 6: 130-134 – reference: 34) Huang Y, Tsung JS, Lin CW, et al. Intrahepatic cholangiocarcinoma with lymphoepithelioma-like carcinoma component. Ann Clin Lab Sci 2004; 34: 476-480 – reference: 11) Wang JK, Jin YW, Hu HJ, et al. Lymphoepithelioma-like hepatocellular carcinoma: a case report and brief review of literature. Medicine (Baltimore) 2017; 96: e9416 – reference: 20) Patel KR, Liu TC, Vaccharajani N, et al. Characterization of inflammatory (lymphoepithelioma-like) hepatocellular carcinoma: a study of 8 cases. Arch Pathol Lab Med 2014; 138: 1193-1202 – reference: 47) Labgaa I, Stueck A, Ward SC. Lymphoepithelioma-like carcinoma in liver. Am J Pathol 2017; 187: 1438-1444 – reference: 29) Shih EJ, Chau IY, Yeh YC, et al. Synchronous hepatocellular carcinoma and lymphoepithelioma-like carcinoma arising from 2 different sites of the liver: a case report. Medicine (Baltimore) 2018; 97: e12548 – reference: 10) Wada Y, Nakashima O, Kutami R, et al. Clinicopathological study on hepatocellular carcinoma with lymphocytic infiltration. Hepatology 1998; 27: 407-414 – reference: 3) Sathirareuangchai S, Hirata K. Pulmonary Lymphoepithelioma-like carcinoma. Arch Pathol Lab Med 2019; 143: 1027-1030 – reference: 33) Hsu HC, Chen CC, Huang GT, et al. Clonal Epstein-Barr virus associated cholangiocarcinoma with lymphoepithelioma-like component. Hum Pathol 1996; 27: 848-850 – reference: 18) Nemolato S, Fanni D, Naccarato AG, et al. Lymphoepithelioma-like hepatocellular carcinoma: a case report and a review of the literature. World J Gastroenterol 2008; 14: 4694-4696 – reference: 26) Ding Y, Sun Z, You W, et al. Lymphoepithelioma-like intrahepatic cholangiocarcinoma with Epstein-Barr virus infection: report of a rare case. Ann Transl Med 2019; 7: 497 – reference: 12) Chen CJ, Jeng LB, Huang SF. Lymphoepithelioma-like hepatocellular carcinoma. Chang Gung Med J 2007; 30: 172-177 – reference: 14) Shinoda M, Kadota Y, Tsujikawa H, et al. Lymphoepithelioma-like hepatocellular carcinoma: a case report and a review of the literature. World J Surg Oncol 2013; 11: 97 – reference: 31) Chen TC, Ng KF, Kuo T. Intrahepatic cholangiocarcinoma with lymphoepithelioma-like component. Mod Pathol 2001; 14: 527-532 – reference: 5) Raphael V, Jitani AK, Sailo SL, et al. Lymphoepithelioma-like carcinoma of the urinary bladder: a rare case report. Urol Ann 2015; 7: 516-519 – reference: 17) Si MW, Thorson JA, Lauwers GY, et al. Hepatocellular lymphoepithelioma-like carcinoma associated with epstein barr virus: a hitherto unrecognized entity. Diagn Mol Pathol 2004; 13: 183-189 – reference: 37) Kim YB, Park YN, Han JY, et al. Biliary lymphoepithelioma-like carcinoma not associated with Epstein-Barr virus. Arch Pathol Lab Med 1999; 123: 441-443 – reference: 36) Jeng YM, Chen CL, Hsu HC. Lymphoepithelioma-like cholangiocarcinoma: an Epstein-Barr virus-associated tumor. Am J Surg Pathol 2001; 25: 516-520 – reference: 19) Shirabe K, Matsumata T, Maeda T, et al. A long-term surviving patient with hepatocellular carcinoma including lymphocytes infiltration--a clinicopathological study. Hepatogastroenterology 1995; 42: 996-1001 – reference: 49) Filotico M, Moretti V, Floccari F, et al. Very rare liver neoplasm: Lymphoepithelioma-like (LEL) hepatocellular carcinoma. Case Rep Pathol 2018; 2018: 2651716 – reference: 22) Calderaro J, Rousseau B, Amaddeo G, et al. PD-L1 expression in hepatocellular carcinoma: relationship with clinical and pathological features. Hepatology 2016; 64: 2038-2046 – reference: 32) Henderson-Jackson E, Nasir NA, Hakam A, et al. Primary mixed lymphoepithelioma-like carcinoma and intra-hepatic cholangiocarcinoma: a case report and review of literature. Int J Clin Exp Pathol 2010; 3: 736-741 – reference: 23) Gearty SV, Al Jurdi A, Pittman ME, et al. An EBV+ lymphoepithelioma-like cholangiocarcinoma in a young woman with chronic hepatitis B. BMJ Case Rep 2019; 12: e229520 – reference: 38) Labgaa I, Hiotis S, Ward SC. Lymphoepithelioma-like Cholangiocarcinoma: a rare finding with good outcomes. J Clin Gastroenterol 2016; 50: 268 – reference: 1) FT Bosman, World Health Organization, International Agency for Research on Cancer. In: WHO Classification of Tumours of the Digestive System, ed 4, International Agency for Research on Cancer, Lyon, 2010 – reference: 45) Min HS, Shin E, Jang JJ. Carcinoma with predominant lymphoid stroma in hepatobiliary system--report of 2 cases. Korean J Hepatol 2007; 13: 222-227 – reference: 24) Tan NY, Majumder S, Sridharan M, et al. Metastatic Epstein-Barr virus-positive Lymphoepithelioma-like Cholangiocarcinoma in a young man with ulcerative colitis. Am J Gastroenterol 2017; 112: 518-520 – reference: 28) Zhang JW, Yang HY, Xu YY, et al. Surgical treatment for metastasis from lymphoepithelioma-like cholangiocarcinoma in the liver: a case report. Medicine (Baltimore) 2018; 97: e0666 – reference: 43) Vortmeyer AO, Kingma DW, Fenton RG, et al. Hepatobiliary lymphoepithelioma-like carcinoma associated with EpsteinBarr virus. 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| Snippet | 症例はC型肝硬変に対して7年前にウイルス学的著効を達成した73歳女性．肝細胞癌のスクリーニング目的の腹部CT検査で肝S7に単発腫瘤を指摘された．経皮的肝腫瘤生検の結... |
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| SubjectTerms | LELC Lymphoepithelioma-like carcinoma 経皮的肝腫瘤生検 腹腔鏡下肝腫瘍切除 診断 |
| Title | 腹腔鏡下腫瘍切除により診断し得た肝Lymphoepithelioma-like carcinoma（LELC）の一例 |
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