Lymphoepithelioma-like cholangiocarcinoma (LEL-CC) is a type of lymphoepithelioma-like carcinoma (LELC) and a rare variant of primary liver tumor. Although it is uncommon and only 100 cases have been reported thus far, the number of reports has increased in recent years. LEL-CC reportedly occurs more frequently in Asian women; Epstein–Barr virus (EBV) and hepatitis viruses are both strongly associated with tumor development. Here, we describe a 76-year-old woman who exhibited LEL-CC not associated with EBV or hepatitis virus. She was referred to our department with a 3.0-cm × 2.8-cm tumor in the left lobe of the liver. Based on computed tomography and magnetic resonance imaging findings, the tumor was preoperatively diagnosed as hepatocellular carcinoma. Thus, we performed extended left hepatectomy with caudal lobectomy. Histopathological examinations revealed columnar tumor cells with atypical nuclei that proliferated in a cord-like or glandular tubular pattern with dense lymphocytic infiltration. Immunohistochemical analysis showed negative HepPar-1 and arginase findings, indicating non-hepatocyte origin; however, the biliary-type cytokeratins CK7 and CK19 were detected. Based on these findings, the tumor was identified as LEL-CC. EBV-encoded RNA in situ hybridization findings were negative; the patient’s clinical characteristics were not suggestive of hepatitis virus infection. In conclusion, we suggest that clinicians consider LEL-CC as a differential diagnosis for liver tumors in Asian women, including patients without EBV or hepatitis virus.

Background/Objectives: The impact of preoperative zinc (Zn) status on the survival and recurrence of patients with hepatocellular carcinoma (HCC) after hepatectomy remains unclear. This study aimed to clarify whether preoperative Zn deficiency affects the prognosis of patients with HCC undergoing initial curative hepatectomy. Methods: We retrospectively reviewed 105 patients who underwent initial curative hepatectomy for HCC at our institution (2011–2018). Preoperative Zn deficiency was defined as serum Zn < 70 µg/dL. Clinical and tumor parameters were compared between patients with and without Zn deficiency. Disease-free and overall survival were evaluated using the Kaplan–Meier method, and prognostic factors were identified via univariate and multivariate Cox proportional hazards analyses. Subgroup analyses were conducted based on age, gender, and etiology. Results: Among 105 patients, 46 (43.8%) showed Zn deficiency (Zn deficiency group), whereas 59 (56.2%) showed normal Zn (normal Zn group). Compared with the normal-Zn group, the Zn deficiency group showed significantly lower hemoglobin, prothrombin activity, serum albumin, and smaller tumor size (all p < 0.05). The Zn deficiency group experienced significantly worse disease-free survival (p = 0.015) but no difference in overall survival (p = 0.63). On multivariate analysis, zinc deficiency (hazard ratio [HR] 1.83, p = 0.040) and prothrombin activity (HR 0.98, p = 0.042) were independent predictors of worse disease-free survival. Subgroup analysis revealed that Zn deficiency was significantly associated with elevated recurrence risk in patients with HCV-related liver disease (HR 3.67, p = 0.013). Conclusions: Preoperative Zn deficiency is an independent predictor of worse DFS after curative hepatectomy. Although further large-scale studies are required to confirm these findings, evaluating preoperative Zn status may help identify patients at high risk of HCC recurrence.