Comprehensive management of advanced lymphoepithelioma-like hepatocellular carcinoma with immune-related colitis: a case report and literature review

Lymphoepithelioma-like hepatocellular carcinoma (LEL-HCC) is an exceedingly rare hepatocellular carcinoma subtype characterized by prominent lymphocyte infiltration. LEL-HCC accounts for fewer than 1% of all HCCs, and most patients present with resectable disease at initial diagnosis. For unresectable LEL-HCC, chemoimmunotherapy is employed based on the experience of the attending physician. However, no recognized effective treatment for advanced LEL-HCC has been established. We present the case of a 68-year-old male with unresectable advanced LEL-HCC, which was ultimately diagnosed by laparoscopic partial hepatectomy biopsy after intraoperative needle biopsy proved inconclusive. We chose a therapeutic regimen consisting of micellar paclitaxel plus cisplatin chemotherapy in combination with immunotherapy for the patient. After 5 months of chemoimmunotherapy, the patient achieved partial response (PR) that was sustained for 8 months until the latest follow-up. Notably, grade 3 immune-related colitis occurred 6 months after commencing immune checkpoint inhibitor (ICI) treatment, which was effectively managed with corticosteroids and Infliximab. This report presents the first documented severe immune-related adverse event (irAE) in a patient with LEL-HCC, thereby informing the comprehensive management of this rare malignancy.