艾普斯坦－巴尔病毒相关的淋巴上皮样肝内胆管癌（EBVa LEL-ICC）是一种罕见的肿瘤，其特点是充满肿瘤免疫微环境（TIME）。尽管该肿瘤据报告对免疫治疗敏感，但其反应却不一致。这种降低的敏感性与TIME丰度的减少有关。我们报道了一例EBVa LEL-ICC患者，其TIME丰度降低。该患者因超声发现肝部病变而就诊。初始时，肿瘤对免疫治疗和化疗（IC）敏感，但在短时间内出现耐药。随后，向该患者的治疗中加入立体定向消融放疗（SABR），治疗方案现在包括ICSABR。通过这种联合治疗方案成功达到了肿瘤缩小的效果。因此，手术和ICSABR是在改善EBVa LEL-ICC患者的生存率方面有效的辅助一线IC治疗。本研究的结果支持多学科治疗作为EBVa LEL-ICC的可行治疗策略。 Copyright © 2023 Li，Cheng，Li，Chang，Lv，Xiaoying，Zhang，Yang and Cao.

Epstein-Barr virus-associated lymphoepithelioma-like intrahepatic cholangiocarcinoma (EBVa LEL-ICC) is a rare tumor, characterized by a rich tumor immune microenvironment (TIME). While this tumor is reportedly sensitive to immunotherapy, its response has been inconsistent. This decreased sensitivity was associated with reduced TIME abundance. We report the case of a 53-year-old woman with EBVa LEL-ICC having reduced TIME abundance. The patient presented with a liver lesion, which was detected using ultrasound. Initially, the tumor was sensitive to immunotherapy and chemotherapy (IC), but resistance developed after a short interval. Subsequently, stereotactic ablative radiotherapy (SABR) was added to the patient's treatment, which now consisted of ICSABR. Successful tumor shrinkage was achieved with the combination therapy regimen. Thus, surgery and ICSABR are effective adjuncts to the first-line IC therapy in improving the survival rate of patients with EBVa LEL-ICC. The results of this study support multidisciplinary treatment as a viable treatment strategy for EBVa LEL-ICC.Copyright © 2023 Li, Cheng, Li, Chang, Lv, Xiaoying, Zhang, Yang and Cao.