Hidden Carcinoma: Pitfalls in the Diagnosis of Lymphoepithelioma-Like Cholangiocarcinoma

Int J Surg Pathol. 2020 Dec;28(8):872-878. doi: 10.1177/1066896920921560. Epub 2020 May 19.

Abstract

Lymphoepithelioma-like intrahepatic cholangiocarcinoma is a rare variant of cholangiocarcinoma that is associated with the Epstein-Barr virus. The intimate relationship between the malignant epithelial cells and the numerous lymphoid cells can make the diagnosis challenging on limited tissue samples. We present 2 cases in which the presence of a dense hematolymphoid infiltrate served to mask the diagnosis of carcinoma on initial frozen section and biopsy review, respectively. We bring awareness to this potential diagnostic pitfall and offer morphologic and immunohistochemical clues that may aid in recognition of this unusual and sometimes perplexing carcinoma.

Keywords: EBER; Epstein-Bar virus; lymphoepithelioma-like cholangiocarcinoma.

Publication types

  • Case Reports

MeSH terms

  • Antineoplastic Agents / therapeutic use
  • Bile Duct Neoplasms / diagnosis*
  • Bile Duct Neoplasms / pathology
  • Bile Duct Neoplasms / therapy
  • Bile Duct Neoplasms / virology
  • Bile Ducts, Intrahepatic / diagnostic imaging
  • Bile Ducts, Intrahepatic / pathology*
  • Bile Ducts, Intrahepatic / surgery
  • Biopsy
  • Cholangiocarcinoma / diagnosis*
  • Cholangiocarcinoma / pathology
  • Cholangiocarcinoma / therapy
  • Cholangiocarcinoma / virology
  • Cholangiopancreatography, Magnetic Resonance
  • Diagnostic Errors
  • Epstein-Barr Virus Infections / diagnosis*
  • Epstein-Barr Virus Infections / pathology
  • Epstein-Barr Virus Infections / therapy
  • Epstein-Barr Virus Infections / virology
  • Fatal Outcome
  • Frozen Sections
  • Hepatectomy
  • Herpesvirus 4, Human / genetics
  • Herpesvirus 4, Human / isolation & purification*
  • Hodgkin Disease / diagnosis
  • Humans
  • Middle Aged
  • Pseudolymphoma / diagnosis
  • RNA, Viral / isolation & purification
  • Young Adult

Substances

  • Antineoplastic Agents
  • RNA, Viral