7例肝脏淋巴上皮瘤样癌临床病理特征及MRI表现

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；T1WI呈低信号，T2WI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。

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

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. T1WI showed low signal, while T2WI 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.