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Pure Lymphoepithelioma-Like Carcinoma Originating from the Urinary Bladder.

Nagai T, Naiki T, Kawai N, Iida K, Etani T, Ando R, Hamamoto S, Sugiyama Y, Okada A, Mizuno K, Umemoto Y, Yasui T - Case Rep Oncol (2016)

Bottom Line: The final pathological diagnosis was a lymphoepithelioma-like variant of urothelial carcinoma with perivesical soft tissue invasion.The patient subsequently became free of cancer 72 months postoperatively.This suggests that measuring the ADC value of a lymphoepithelioma-like carcinoma prior to operation may be helpful in predicting LELCB.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephro-Urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan.

ABSTRACT
Lymphoepithelioma-like carcinoma of the urinary bladder (LELCB) is a rare variant of infiltrating urothelial carcinoma. We report a case of LELCB in a 43-year-old man. Ultrasonography and cystoscopy revealed two bladder tumors, one on the left side of the trigone and the other on the right side of the trigone. Transurethral resection of the bladder tumors was performed and pathological analysis revealed undifferentiated carcinoma. We therefore performed radical cystectomy and urinary diversion. Immunohistochemically the tumor cells were positive for cytokeratin, but negative for Epstein-Barr virus-encoded small RNA in situ hybridization as found for previous cases of LELCB. The final pathological diagnosis was a lymphoepithelioma-like variant of urothelial carcinoma with perivesical soft tissue invasion. For adjuvant systemic chemotherapy, three courses of cisplatin were administered. The patient subsequently became free of cancer 72 months postoperatively. Based on the literature, pure or predominant LELCB types show favorable prognoses due to their sensitivity to chemotherapy or radiotherapy. An analysis of the apparent diffusion coefficient (ADC) values of bladder tumors examined in our institution revealed that the ADC value measured for this LELCB was relatively low compared to conventional urothelial carcinomas. This suggests that measuring the ADC value of a lymphoepithelioma-like carcinoma prior to operation may be helpful in predicting LELCB.

No MeSH data available.


Related in: MedlinePlus

a–d LELCB in this case. a Microscopic findings at low magnification showed that the tumors had invaded the perivesical soft tissue. H&E stain. b Microscopic findings at high magnification showed that tumor cells (arrows) were surrounded by infiltrating lymphocytes (arrowheads). H&E stain. c Immunohistochemical staining for cytokeratin (AE1/AE3). d Immunohistochemical staining for E-cadherin. e EBER-ISH for this case. Tumor cells were negative. f Lymphoepithelioma of the pharynx in another patient. EBER-ISH of tissues. Tumor cells (arrows) were positive for EBER-ISH (positive control).
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Figure 2: a–d LELCB in this case. a Microscopic findings at low magnification showed that the tumors had invaded the perivesical soft tissue. H&E stain. b Microscopic findings at high magnification showed that tumor cells (arrows) were surrounded by infiltrating lymphocytes (arrowheads). H&E stain. c Immunohistochemical staining for cytokeratin (AE1/AE3). d Immunohistochemical staining for E-cadherin. e EBER-ISH for this case. Tumor cells were negative. f Lymphoepithelioma of the pharynx in another patient. EBER-ISH of tissues. Tumor cells (arrows) were positive for EBER-ISH (positive control).

Mentions: A transurethral resection of bladder tumor (TURBT) was performed. Pathological findings revealed undifferentiated atypical epithelial cells with enlarged nuclei that had formed into sheets to invade the muscle layer. These results indicated a muscle-invasive pT2 undifferentiated carcinoma of the urinary bladder. Radical cystectomy and ileal conduit diversion were performed. Pathological findings revealed large, undifferentiated carcinoma cells with pleomorphic nuclei and prominent nucleoli, the infiltration of inflammatory cells consisting predominantly of lymphocytes, and the reach of their invasion to the perivesical soft tissue of the bladder (fig. 2a, b). The final pathological diagnosis was an invasive urothelial carcinoma, lymphoepithelioma-like variant, pT3. Tumor cells were positive for cytokeratin (AE1/AE3) (fig. 2c) and E-cadherin (fig. 2d). As adjuvant chemotherapy, cisplatin-based systemic chemotherapy was performed, and cancer recurrence was not apparent at the usual follow-up as determined by CT scan and cytological analysis. The patient remained alive and free of cancer 72 months postoperatively.


Pure Lymphoepithelioma-Like Carcinoma Originating from the Urinary Bladder.

Nagai T, Naiki T, Kawai N, Iida K, Etani T, Ando R, Hamamoto S, Sugiyama Y, Okada A, Mizuno K, Umemoto Y, Yasui T - Case Rep Oncol (2016)

a–d LELCB in this case. a Microscopic findings at low magnification showed that the tumors had invaded the perivesical soft tissue. H&E stain. b Microscopic findings at high magnification showed that tumor cells (arrows) were surrounded by infiltrating lymphocytes (arrowheads). H&E stain. c Immunohistochemical staining for cytokeratin (AE1/AE3). d Immunohistochemical staining for E-cadherin. e EBER-ISH for this case. Tumor cells were negative. f Lymphoepithelioma of the pharynx in another patient. EBER-ISH of tissues. Tumor cells (arrows) were positive for EBER-ISH (positive control).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4836139&req=5

Figure 2: a–d LELCB in this case. a Microscopic findings at low magnification showed that the tumors had invaded the perivesical soft tissue. H&E stain. b Microscopic findings at high magnification showed that tumor cells (arrows) were surrounded by infiltrating lymphocytes (arrowheads). H&E stain. c Immunohistochemical staining for cytokeratin (AE1/AE3). d Immunohistochemical staining for E-cadherin. e EBER-ISH for this case. Tumor cells were negative. f Lymphoepithelioma of the pharynx in another patient. EBER-ISH of tissues. Tumor cells (arrows) were positive for EBER-ISH (positive control).
Mentions: A transurethral resection of bladder tumor (TURBT) was performed. Pathological findings revealed undifferentiated atypical epithelial cells with enlarged nuclei that had formed into sheets to invade the muscle layer. These results indicated a muscle-invasive pT2 undifferentiated carcinoma of the urinary bladder. Radical cystectomy and ileal conduit diversion were performed. Pathological findings revealed large, undifferentiated carcinoma cells with pleomorphic nuclei and prominent nucleoli, the infiltration of inflammatory cells consisting predominantly of lymphocytes, and the reach of their invasion to the perivesical soft tissue of the bladder (fig. 2a, b). The final pathological diagnosis was an invasive urothelial carcinoma, lymphoepithelioma-like variant, pT3. Tumor cells were positive for cytokeratin (AE1/AE3) (fig. 2c) and E-cadherin (fig. 2d). As adjuvant chemotherapy, cisplatin-based systemic chemotherapy was performed, and cancer recurrence was not apparent at the usual follow-up as determined by CT scan and cytological analysis. The patient remained alive and free of cancer 72 months postoperatively.

Bottom Line: The final pathological diagnosis was a lymphoepithelioma-like variant of urothelial carcinoma with perivesical soft tissue invasion.The patient subsequently became free of cancer 72 months postoperatively.This suggests that measuring the ADC value of a lymphoepithelioma-like carcinoma prior to operation may be helpful in predicting LELCB.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephro-Urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan.

ABSTRACT
Lymphoepithelioma-like carcinoma of the urinary bladder (LELCB) is a rare variant of infiltrating urothelial carcinoma. We report a case of LELCB in a 43-year-old man. Ultrasonography and cystoscopy revealed two bladder tumors, one on the left side of the trigone and the other on the right side of the trigone. Transurethral resection of the bladder tumors was performed and pathological analysis revealed undifferentiated carcinoma. We therefore performed radical cystectomy and urinary diversion. Immunohistochemically the tumor cells were positive for cytokeratin, but negative for Epstein-Barr virus-encoded small RNA in situ hybridization as found for previous cases of LELCB. The final pathological diagnosis was a lymphoepithelioma-like variant of urothelial carcinoma with perivesical soft tissue invasion. For adjuvant systemic chemotherapy, three courses of cisplatin were administered. The patient subsequently became free of cancer 72 months postoperatively. Based on the literature, pure or predominant LELCB types show favorable prognoses due to their sensitivity to chemotherapy or radiotherapy. An analysis of the apparent diffusion coefficient (ADC) values of bladder tumors examined in our institution revealed that the ADC value measured for this LELCB was relatively low compared to conventional urothelial carcinomas. This suggests that measuring the ADC value of a lymphoepithelioma-like carcinoma prior to operation may be helpful in predicting LELCB.

No MeSH data available.


Related in: MedlinePlus