J Korean Med Sci.  2010 Feb;25(2):309-312. 10.3346/jkms.2010.25.2.309.

Hepatocellular Carcinoma with Immature T-Cell (T-lymphoblastic) Proliferation

• Eun S
• Jeon YK
• Jang JJ

• KMID: 1779266
• DOI: http://doi.org/10.3346/jkms.2010.25.2.309

Abstract

Indolent T-lymphoblastic proliferation has been rarely reported in the upper aerodigestive tract. The lymphoid cells associated with this condition have the morphological and phenotypical features of immature thymocytes. However, their pathogenesis and biology are unknown. We present an unusual type of tumor infiltrating lymphocytes in a case with hepatocellular carcinoma, presumed to be a T-lymphoblastic proliferation. A 58-yr-old female patient presented with indigestion and a palpable epigastric mass. The abdominal computed tomography revealed a mass in the S6 region of the liver. A hepatic segmentectomy was performed. Microscopic examination showed dense isolated nests of monomorphic lymphoid cells within the tumor. Immunohistochemically, the lymphoid cells were positive for CD3, terminal deoxymucleotide transferase (TdT) and CD1a. In addition, they showed dual expression of CD4 and CD8. The polymerase chain reaction used to examine the T-cell antigen receptor gamma gene rearrangement showed polyclonal T-cell proliferation. This is the second case of hepatocellular carcinoma combined with indolent T-lymphoblastic proliferation identified by an unusual tumor infiltrating lymphocytes.

Keyword

Lymphocytes, Tumor-Infiltrating; Carcinoma, Hepatocellular; indolent T-lymphoblastic proliferation; Immunohistochemistry

MeSH Terms

Antigens, CD3/metabolism
Antigens, CD4/metabolism
Antigens, CD8/metabolism
Carcinoma, Hepatocellular/*diagnosis/pathology/secondary
DNA Nucleotidylexotransferase/metabolism
Female
Humans
Liver Neoplasms/*diagnosis/immunology/pathology
Lymphocytes, Tumor-Infiltrating/*pathology
Mastectomy, Segmental
Middle Aged
Precursor Cells, T-Lymphoid/*pathology
Precursor T-Cell Lymphoblastic Leukemia-Lymphoma/complications/metabolism/*pathology
Tomography, X-Ray Computed
Antigens, CD3
Antigens, CD4
Antigens, CD8
DNA Nucleotidylexotransferase

Figure

• 

  Fig. 1 Histological and immunohistochemical features. (A) The hepatocellular carcinoma is composed of poorly differentiated cells with trabecular pattern (H&E, ×200). (B) Aggregates of monomorphic lymphoid cells are observed within the hepatocellular carcinoma (H&E, ×100). (C) The lymphocytes show a morphology similar to immature thymocytes (H&E, ×400). (D) Ki67 labeling index is approximately 40% (H&E, ×400). (E) The lymphoid cells are negative for L26 (H&E, ×100). (F) The lymphoid cells are positive for CD3 (H&E, ×100). (G, H) The lymphoid cells show dual expression of CD4 and CD8 (G, CD4; H, CD8) (H&E, ×100). (I) TdT are expressed in lymphoid cells (H&E, ×400).

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