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case_images: Abdominal ultrasound before surgery. A 19.9mmx14.2mm heterogeneous hypoechogenic nodule (white arrow) located at the right lobe of the liver.
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case_images: Abdominal ultrasound demonstrated a slightly heterogeneous hypoechoic nodule in the background of normal hepatic parenchyma in the right lobe of the liver (Figure 1).
case_images: Contrast-enhanced ultrasound (CEUS)before surgery. CEUS showed the lesion (white arrow) was heterogeneous low hyperenhancement and a wedge-shaped high hyperenhancement (blue arrow) around the lesion in the arterial phase (A). The lesion (white arrow) was rapidly washout from the center in the Portal phase (B).
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case_images: Portal phase: The lesion is further washout and shows low enhancement; Delayed phase: The lesion continues to washout and shows low enhancement (Figure 2). 
case_images: Magnetic Resonance Imaging before surgery. MRI showed a lesion (white arrow) with high signal intensity on T2, low signal intensity on T1, and high signal intensity on DWI in segment 6 of the liver. The lesion showed enhancement on arterial phase and faded signal on portal and delayed phases. The hepatobiliary phase showed low signal intensity. (A) T2-weighted image; (B) T1-weighted image; (C) diffusion-weighted images; (D) arterial phase; (E) portal venous phase; (F) delayed phase; (G) hepatobiliary phase. MRI, magnetic resonance imaging.
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case_images: T2-weighted (Figure 3A), a low-intensity mass on T1-weighted images (Figure 3B), and a high-intensity mass on diffusion-weighted images (Figure 3C), which was located in the right lobe of the liver with an estimated magnitude of 18mmx14 mm; a clear margin was also observed. (Gadobenate Dimeglumine) Gd-BOPTA-enhanced MRI revealed heterogeneous enhancement with a vague margin in the arterial phase and contrast medium washout in the portal and delayed phases (Figure 3D-F). The lesions appear as low signal intensity in the hepatobiliary phase and capsular (pseudocapsule) enhancement (Figure 3G). 
case_images: Postoperative gross pathology. A grey foci (white arrow) measuring 2cmx1cmx1cm in the resected segment.
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case_images: A 2cmx1cmx1cm gray, well-defined, non-encapsulated solid mass was grossly identified, 0.5 cm from the nearest resection margin (Figure 4). 
case_images: Pathological and EBER in situ hybridization examinations after surgery. Microscopically, the Liver tumor tissue is composed of moderately differentiated adenocarcinoma cells and stromal infiltrating lymphocytes (A). The tumor cells have obvious atypia, the nucleoli are obvious, and mitotic figures are easy to see (B). EBER-encoded RNA was found positive in tumor tissues (C).
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case_images: Fibrous pseudocapsules were seen in some areas (Figure 5A). The tumor cells have obvious atypia, the cells are round or oval, the nucleoli are obvious, and mitotic figures are easy to see (Figure 5B). Arginase-1 and CD10 were all negative; Hepatocellular carcinoma markers: CD34, GPC3 and GS were all negative while HSP70 was positive; Gastrointestinal stromal tumor markers: CD117 and CD34 were negative; EBV-encoded RNA (EBER) in situ hybridization was performed and found positive in tumor tissues (Figure 5C). The non-neoplastic liver parenchyma with HBsAg positive did not show cirrhosis but fibrosis. All features fulfilled the diagnosis of lymphoepithelioma-like intrahepatic cholangiocarcinoma (LEL-ICC).