A recent publication in BIO Integration journal sheds light on key contrast-enhanced ultrasound (CEUS) imaging features that can help differentiate between primary hepatic lymphoepithelioma-like carcinoma (LELC) and hepatocellular carcinoma (HCC). Although primary hepatic LELC is a rare malignant tumor, the number of case reports has been rising, and accurate differentiation from HCC is clinically valuable for follow-up and treatment. This study included 12 patients with confirmed hepatic LELC (average age 60.1 years) and 43 matched patients with HCC (average age 57.4 years), using propensity score matching for comparison. The team analyzed clinical data, B-mode ultrasound (BMUS), and CEUS features to identify distinct imaging characteristics.
The findings reveal significant differences in several diagnostic markers. Hepatic LELC patients showed lower serum levels of a-fetoprotein and des-gamma-carboxy prothrombin compared to HCC patients. In BMUS, LELC masses were mostly hypoechoic, contrasting with the variable echogenicity seen in HCC (p=0.016). Additionally, the “halo sign” appeared in only 16.7% of LELC cases but was more common in HCC cases (58.1%). A notable 75% of LELC cases demonstrated homogeneous hyperenhancement in the arterial phase on CEUS, while HCC cases often showed heterogeneous hyperenhancement (p=0.004). Early washout, a key CEUS feature, was observed in 91.7% of LELC cases versus 46.5% of HCC cases (p=0.005), and peripheral rim-like hyperenhancement was far more frequent in LELC (83.3%) than HCC (11.6%) (p < 0.001).
These distinct imaging features, including hypoechoic presentation, absence of a halo sign, homogeneous hyperenhancement, early washout, and peripheral rim-like hyperenhancement, highlight how BMUS and CEUS can aid in distinguishing hepatic LELC from HCC, thus supporting more accurate diagnosis and better-informed clinical decisions for these conditions.
