LIAO Xiaoying , DENG Ruibin , MAI Zhenhao , ZHAN Ping , PENG Zha , ZHOU Shangjun , WANG Zaiguo
  • Hepatobiliary and Pancreatic Center, Dongguan Hospital of Guangzhou University of Chinese Medicine (Dongguan Traditional Chinese Medicine Hospital of Guangdong Province), Dongguan, Guangdong 523000, P. R. China;
WANG Zaiguo, Email: wangzaiguo@sina.com
lymphoepithelioma-like hepatocellular carcinoma; hepatocellular carcinoma; tumor-infiltrating lymphocytes
10.7507/1007-9424.202605101
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Objective To summarize the clinical and pathological features as well as treatment experiences of lymphoepithelioma-like hepatocellular carcinoma (LEL-HCC). Methods The clinical data of a patient with LEL-HCC treated at Dongguan Hospital of Guangzhou University of Chinese Medicine were retrospectively analyzed. Additionally, a literature review of published LEL-HCC case reports was conducted. Results Forty-eight eligible cases were identified from the published literature. ① The clinical features shared by the index case and literature-reported cases are summarized as follows. The patient was a 73-year-old male. The age at onset in previously reported cases ranged from 27 to 89 years (median, 59 years). The gender distribution was consistent with the slight male predominance observed in published data, with males accounting for 60.4% of all cases. The patient presented with abdominal pain, whereas only 22.9% (8/35) of patients in the reviewed studies were symptomatic. The tumor was located in hepatic segments Ⅶ and Ⅷ of the right hepatic lobe, consistent with the literature, in which 57.7% (15/26) of such tumors arose in the right lobe. Immunohistochemistry revealed diffuse positive staining for hepatic parenchymal antigen 1 (HepPar1) and focal positive staining for glypican-3 (GPC3). Among the literature cases, 4/4 exhibited positive HepPar-1 expression, and 6/6 showed positive (including focal) GPC3 staining. Epstein-Barr virus (EBV) testing was negative in this patient, consistent with the epidemiological profile of LEL-HCC, which rarely correlates with EBV infection; the EBV-positive rate in previous studies was 2/2. Imaging revealed progressive and persistent contrast enhancement, rather than the typical “rapid wash-in and washout” pattern seen in conventional HCC. Such atypical enhancement patterns were observed in 50.0% (16/32) of the reviewed cases. The patient remained disease-free at the 6-month postoperative follow-up, consistent with the overall 54.2% (26/48) disease-free survival rate reported in previous literature. ② The discrepancies between the index case and literature-reported cases are summarized as follows. The patient had no history of viral hepatitis or liver cirrhosis, whereas 61.7% (29/47) and 54.5% (24/44) of literature cases had underlying viral hepatitis and liver cirrhosis, respectively. The tumor diameter was 6.5 cm, larger than the mean diameter of 3.5 cm reported in the literature; only 13.0% (6/46) of documented patients had tumors greater than 5 cm in diameter. The index case underwent combined treatment of hepatectomy plus transcatheter arterial chemoembolization, targeted agents and immune checkpoint inhibitors; Simple hepatectomy (segmental / lobar / tumor resection) was the mainstream therapy in 54.2% (26/48) of published cases. To date, only 6 months of postoperative follow-up have been completed, which is shorter than the median follow-up period of 24 months reported in the literature. Long-term survival outcomes warrant further continuous observation. Conclusions LEL-HCC is a rare subtype of HCC. Given the absence of specific clinical and imaging manifestations, it poses a substantial challenge for preoperative diagnosis. Definitive diagnosis is entirely dependent on pathological examination of surgically resected specimens. Despite the generally favorable prognosis of LEL-HCC, the risk of tumor recurrence persists. Therefore, treatment strategies should be highly individualized based on patients’ overall health status and tumor stage, coupled with rigorous long-term postoperative surveillance.

Citation： LIAO Xiaoying, DENG Ruibin, MAI Zhenhao, ZHAN Ping, PENG Zha, ZHOU Shangjun, WANG Zaiguo. Lymphoepithelioma-like hepatocellular carcinoma: a case report and literature review. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2026, 33(7): 947-952. doi: 10.7507/1007-9424.202605101 Copy

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