Background: Lymphoepithelioma-like intrahepatic cholangiocarcinoma (LEL-ICC) is a rare variant of intrahepatic cholangiocarcinoma with distinct clinicopathological and prognostic characteristics. Preoperative diagnosis is notoriously challenging due to nonspecific clinical and imaging features. Case presentation: A 37-year-old asymptomatic woman with hepatitis B virus (HBV) infection was incidentally found to have a liver mass. Magnetic resonance imaging initially suggested focal nodular hyperplasia. The patient underwent laparoscopic partial hepatectomy. Histopathological examination revealed a tumor composed of a typical lymphoepithelioma-like carcinoma component and a well-to-moderately differentiated adenocarcinoma component, accompanied by dense lymphoplasmacytic infiltration. The tumor cells were positive for biliary markers (CK7 and CK19) and strongly positive for Epstein-Barr virus (EBV)-encoded RNA by in situ hybridization. Immunohistochemistry demonstrated a complete loss of p53 expression. Conclusions: This case presents a unique instance of EBV/HBV co-infection characterized by a specific p53-aberrant phenotype. Preoperative misdiagnosis underscores the challenge of radiologic mimicry. Our findings contribute to a more nuanced understanding of LEL-ICC pathogenesis and highlight the potential synergistic role of viral co-infections. Further case accumulation and mechanistic studies are needed.
He et al. (Tue,) studied this question.