case_images: PMC2811303_01
case_images: Histological and immunohistochemical features. (A) The hepatocellular carcinoma is composed of poorly differentiated cells with trabecular pattern (H&E, x200). (B) Aggregates of monomorphic lymphoid cells are observed within the hepatocellular carcinoma (H&E, x100). (C) The lymphocytes show a morphology similar to immature thymocytes (H&E, x400). (D) Ki67 labeling index is approximately 40% (H&E, x400). (E) The lymphoid cells are negative for L26 (H&E, x100). (F) The lymphoid cells are positive for CD3 (H&E, x100). (G, H) The lymphoid cells show dual expression of CD4 and CD8 (G, CD4; H, CD8) (H&E, x100). (I) TdT are expressed in lymphoid cells (H&E, x400).
case_images: jkms-25-309-g001.jpg
case_images: PMC2811303_01_jkms-25-309-g001.jpg
case_images: F1
case_images: The microscopic examination revealed a poorly differentiated hepatocellular carcinoma (Edmonson grade 3) with a macrotrabecular and acinar pattern (Fig. 1A). The lymphoid cells occasionally formed dense isolated nests between the cords of tumor cells (Fig. 1B). They showed monomorphic features with little cytologic atypism (Fig. 1C). On the immunohistochemical staining, the monomorphic lymphoid cells were positive for CD3 (Fig. 1F), terminal deoxynucleotide transferase (TdT) (Fig. 1I) and CD1a. They showed dual expression of CD4 and CD8 (Fig. 1G, H). They were all negative for L26 (Fig. 1E), CD79a, granzyme, CD68, CD5, and c-kit. They had a relatively high Ki-67 labeling index (approximately more than 40%) (Fig. 1D). The polymerase chain reaction to examine the T-cell antigen receptor gamma gene rearrangement, revealed polyclonal T-cell proliferation.