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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

Kaplan-Meier curves of overall survival rates for pure/predominant and focal types of LELCB.
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Figure 3: Kaplan-Meier curves of overall survival rates for pure/predominant and focal types of LELCB.

Mentions: According to the WHO classification criteria, LELCB is defined as a subtype of undifferentiated carcinomas. To date 105 cases, including this one, have been described in the English language medical literature. LELCB shows carcinomatous components contrasting with lymphocyte infiltration and mimics chronic inflammation or malignant lymphoma; immunohistochemical stains such as for cytokeratin are helpful in distinguishing between these diseases [6, 7]. Between 1991 and June 2015, 84 cases of LELCB, according to the classification of Amin et al. [7], were reported in the English language medical literature. We allocated the 84 cases to two groups – pure/predominant and focal – and investigated their prognoses based on previous reports. Seventy patients (83%) formed the pure/predominant group and 14 patients (17%) formed the focal group. Kaplan-Meier curves of overall survival rates of the pure/predominant and focal groups are shown in figure 3. As a result, the pure/predominant group had as significantly better prognosis than the focal type group (log-rank test, p < 0.001) (fig. 3). The predominant or focal types of LELCB include squamous cell carcinoma, adenocarcinoma and urothelial carcinoma. Containing only LELC, this case seemed to have the characteristics of a pure type of LELCB. Unfortunately, there is at present no established treatment for LELCB because of its rarity as a bladder tumor subtype, with few reports existing for this disease. Some reports describe LELCB as being sensitive to cisplatin, while others suggest that it is possible to preserve the bladder in the case of a pure or predominant type, even if the tumor has invaded the muscle [4, 8, 9, 10]. We conducted a radical cystectomy because TURBT revealed an undifferentiated carcinoma pT2. Adjuvant cisplatin-based chemotherapy was also instituted because radical cystectomy yielded a diagnosis of LELCB pT3. The combination of external beam radiotherapy and chemotherapy to preserve the bladder may be considered a suitable treatment option if the diagnosis prior to radical cystectomy is accurate.


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)

Kaplan-Meier curves of overall survival rates for pure/predominant and focal types of LELCB.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Kaplan-Meier curves of overall survival rates for pure/predominant and focal types of LELCB.
Mentions: According to the WHO classification criteria, LELCB is defined as a subtype of undifferentiated carcinomas. To date 105 cases, including this one, have been described in the English language medical literature. LELCB shows carcinomatous components contrasting with lymphocyte infiltration and mimics chronic inflammation or malignant lymphoma; immunohistochemical stains such as for cytokeratin are helpful in distinguishing between these diseases [6, 7]. Between 1991 and June 2015, 84 cases of LELCB, according to the classification of Amin et al. [7], were reported in the English language medical literature. We allocated the 84 cases to two groups – pure/predominant and focal – and investigated their prognoses based on previous reports. Seventy patients (83%) formed the pure/predominant group and 14 patients (17%) formed the focal group. Kaplan-Meier curves of overall survival rates of the pure/predominant and focal groups are shown in figure 3. As a result, the pure/predominant group had as significantly better prognosis than the focal type group (log-rank test, p < 0.001) (fig. 3). The predominant or focal types of LELCB include squamous cell carcinoma, adenocarcinoma and urothelial carcinoma. Containing only LELC, this case seemed to have the characteristics of a pure type of LELCB. Unfortunately, there is at present no established treatment for LELCB because of its rarity as a bladder tumor subtype, with few reports existing for this disease. Some reports describe LELCB as being sensitive to cisplatin, while others suggest that it is possible to preserve the bladder in the case of a pure or predominant type, even if the tumor has invaded the muscle [4, 8, 9, 10]. We conducted a radical cystectomy because TURBT revealed an undifferentiated carcinoma pT2. Adjuvant cisplatin-based chemotherapy was also instituted because radical cystectomy yielded a diagnosis of LELCB pT3. The combination of external beam radiotherapy and chemotherapy to preserve the bladder may be considered a suitable treatment option if the diagnosis prior to radical cystectomy is accurate.

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