7例肝脏淋巴上皮瘤样癌临床病理特征及MRI表现

Lymphoepithelioma-like carcinoma in the liver:clinicopathological features and MRI findings of 7 cases

目的:探讨7例肝脏淋巴上皮瘤样癌的临床病理特征及MRI表现。方法:回顾性分析2009年12月至2021年12月在温州医科大学附属第五医院经手术病理证实的7例肝脏淋巴上皮瘤样癌的临床病理及MRI资料。结果:7例患者中男2例,女5例,中位年龄54岁;4例乙型肝炎病毒阳性,丙型肝炎病毒均为阴性,其中1例合并肝硬化,并伴血清甲胎蛋白(AFP)水平升高(389.7 ng/mL)。病理诊断淋巴上皮瘤样肝细胞癌1例,淋巴上皮瘤样胆管细胞癌6例;镜下肿瘤组织内有大量淋巴细胞浸润;EBER原位杂交检测阳性6例。MRI表现为结节样5例,形态规则6例,边界清6例;T_(1)WI呈低信号,T_(2)WI呈高信号,DWI呈稍高信号2例,呈明显高信号5例;强化方式多样:Ⅰ型(快进快出强化)3例;Ⅱ型(持续环状强化)2例;Ⅲ型(边缘性填充式强化)2例;Ⅰ、Ⅱ型病灶可见类包膜样强化;所有病灶均未出现瘤周异常强化、胆管扩张和或肝包膜凹陷。结论:肝脏淋巴上皮瘤样癌临床少见,预后相对较好,病理具有一定特征,MRI上多表现为类圆形的结节,强化方式多样,多见类包膜样强化。

Objective:To investigate the clinicopathological features and MRI findings of 7 cases with lymphoepithelioma-like carcinoma of liver.Methods:A retrospective analysis was carried out focusing on the clinicopathological features and MRI findings of 7 cases with lymphoepithelioma-like carcinoma of liver,who were confirmed by surgery and pathological examination in our hospital from December 2009 to December 2021.Results:Of 7 patients,there were 2 males and 5 females,with a median age of 54 years old.There were 4 cases of HBV(+),and all cases showed HCV(-),among which 1 case was accompanied by liver cirrhosis and elevated serum AFP level(389.7 ng/mL).Further pathological diagnosis reported 1 case of lymphoepithelioma like hepatocellular carcinoma,and 6 cases of lymphoepithelioma like cholangiocarcinoma.Microscopically,there was infiltration of a large number of lymphocytes in the tumor tissue.EBER in situ hybridization was positive in 6 cases.MRI showed that the tumors with nodular appearance in 5 cases,regular morphology in 6 cases and clear boundary in 6 cases.T_(1)WI showed low signal,while T_(2)WI showed high signal.Meanwhile,2 cases showed slightly high signal and 5 cases displayed significantly high signal on DWI.Furthermore,there were various enhancement patterns,including 3 cases of type Ⅰ(wash-in and wash-out enhancement);2 cases of type Ⅱ(continuous annular enhancement);and 2 cases of type Ⅲ(marginal filling enhancement).Capsular-like enhancement was visible in type Ⅰ and Ⅱ lesions.There was no abnormal enhancement around the tumor,no bile duct dilatation or hepatic capsule retraction in all lesions.Conclusion:Clinically rare,lymphoepithelioma-like carcinoma of liver has relatively good prognosis with certain pathological characteristics.MRI manifestations are mainly rounded nodules with various enhancement,mostly capsular-like enhancement.