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Annals of Clinical & Laboratory Science 34:476-480 (2004)
© 2004 Association of Clinical Scientists

Case Report

Intrahepatic Cholangiocarcinoma with Lymphoepithelioma-Like Carcinoma Component

Yenlin Huang1, Jeffrey S-H Tsung1, Chung-Wu Lin2 and Tsung-Yen Cheng3
1 Department of Pathology and Laboratory Medicine, 3 Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center, and 2 Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan

Address correspondence to Jeffrey S-H Tsung, M.D., Department of Pathology and Laboratory Medicine, Koo Foundation Sun Yat-Sen Cancer Center, 125 Lih-Der Road, Taipei 112, Taiwan, ROC; tel 886 2 2897 0011, ext 1408; fax 886 2 2897 2233; e-mail address: tsung{at}mail.kfcc.org.tw.

Abstract

We report an unusual case of intrahepatic cholangiocarcinoma (ICC) with lymphoepithelioma-like carcinoma (LELC) component in a 60-yr-old woman who was found incidentally to have an abdominal mass. Histologically, the tumor showed 2 distinct patterns with dense lymphoplasma cell infiltration. The first pattern, comprising approximately 20% of total tumor volume, showed the features of lymphoepithelioma-like carcinoma, as commonly found in nasopharyngeal carcinoma (NPC). The second pattern was a moderately differentiated cholangiocarcinoma. In situ hybridization for Epstein-Barr virus (EBV)-encoded RNA (EBER) showed positive nuclear labeling of tumor cells in both patterns, but not in surrounding inflammatory cells. By the polymerase chain reaction, the latent membrane protein gene (LMP-1) in this case was shown to have a 30 bp deletion in the C-terminus, a unique feature in high prevalence areas of undifferentiated nasopharyngeal carcinoma, such as in Taiwan. Presence of the EBV genomes and their expression in the cholangiocarcinoma cells suggested that EBV may play an important role in the pathogenesis of ICC with LELC. In this case, it is unclear why only 20% of the glands were transformed into LELC. The mechanism whereby EBV transforms the malignant glands into the distinct morphology resembling NPC warrants further investigation.

Keywords: intrahepatic cholangiocarcinoma, lymphoepithelioma-like carcinoma, Epstein-Barr virus, Epstein-Barr virus-encoded RNA, latent membrane protein-1 gene






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