J Liver Cancer.  2021 Mar;21(1):69-75. 10.17998/jlc.21.1.69.

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

• Song JW
• Chun HS
• Lee JS
• Lee HW
• Kim BK
• Kim SU
• Park JY
• Ahn SH
• Park YN
• Han DH
• Kim DY

• KMID: 2514236
• DOI: http://doi.org/10.17998/jlc.21.1.69

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 lymphocyte-rich 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.

Keyword

Hepatocellular carcinoma; Hepatocellular carcinoma variants; Lymphocyte-rich subtype

Figure

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  Figure 1 Initial computed tomography scan findings. A 3.6 cm sized lobulated mass is observed in segment VII, showing hypodensity compared to normal liver tissue in the pre-contrast phase (A) and peripheral rim enhancement in contrast images (B).

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  Figure 2 Dynamic liver magnetic resonance imaging findings. The mass is enhanced heterogeneously and also shows peripheral rim enhancement in the arterial phase (A). Wash-out in portal phase (B). Hypointensity in hepato-biliary phase (C). In T2-weighted images, it presents moderate hyperintensity (D).

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  Figure 3 Positron emission tomography-computed tomography findings. Increased FDG uptake in the liver mass is observed.

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  Figure 4 Macroscopic findings of the specimen from surgical resection. It exhibits a 3.5×2.5×2.5 cm sized lobulated mass with a thin capsule encapsulating the mass. It contains a small portion of peliosis and necrotic change. Portal vein and bile duct invasion are not seen.

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  Figure 5 Findings on microscopy. Hematoxylin and eosin (H&E) staining showing moderately differentiated hepatic tumor cells and large numbers of intra-tumoral infiltration of lymphocytes, which is referred to as a lymphoepithelioma-like pattern (H&E; ×100 [A], ×400 [B]).

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  Figure 6 Findings on microscopy. Immunohistochemistry showing weakly positive arginase-1 (original magnification, ×200) (A). The cluster of differentiation 3 and 8 (CD3 and CD8) showing diffusely positive T-lymphocyte markers (original magnification, ×100) (B, showing the result of CD8). Programmed death-ligand 1 is positive with 90% of tumor proportion score (original magnification, ×200) (C). Negative findings of Epstein-Barr virus-encoded RNA in-situ hybridization (original magnification, ×200) (D).

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