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Presented by George Netto, MD. and prepared by Danielle Wehle, M.D.
Case 6: A 59 year old female presented with hematuria.
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1. Question
Week 271: Case 6
A 59 year old female presented with hematuria. A cystoscopy and transurethral resection was performed.images/605066b.jpg
images/605066a.jpg
images/605066c.jpgCorrect
Answer: Lymphoepithelioma like carcinoma (LELC) of urinary bladder
Histology: The epithelial neoplasm is composed of a proliferation of undifferentiated highly atypical cells arranged in a syncitial pattern with indistinct cytoplasmic borders. Characteristic of LELC, the epithelial cells contain large vesicular nuclei with very prominent nucleoli. The latter is associated with a dense obscuring lymphoid infiltrate. The lymphoid cells are smaller in size. Mitotic figures are easily identified. The tumor extensively invades the muscularis propria. The surface urothelium show no evidence of flat carcinoma in situ (CIS).
Discussion: LELC is a rare type of urinary bladder carcinoma. The associated dense lymphoid host response could lead to a misdiagnosis of such lesions as malignant lymphoma especially on small TUR biopsies with extensive cautery artifact. Immunostains for cytokeratins AE1/AE3, CK7 and EMA could be of help in such cases. The lymphoid infiltrate is usually composed of a mixture of B and T cells. Unlike their nasopharyngeal counterparts, EBV studies for LMP1 and EBER have been shown to be negative in LELC of bladder. Distinguishing bladder tumors with pure or predominant LELC morphology from other undifferentiated and high grade urothelial carcinoma may have implications on patient management given the relatively higher chemotherapy response rates and the potentials for bladder salvage.
Reference(s):
– Lopez-Beltran A, Luque RJ, Vicioso L, Anglada F, Requena MJ, Quintero A, Montironi R. Lymphoepithelioma-like carcinoma of the urinary bladder: a clinicopathologic study of 13 cases. Virchows Arch. 2001 Jun;438(6):552-7.
– Amin MB, Ro JY, Lee KM, Ordonez NG, Dinney CP, Gulley ML, Ayala AG. Lymphoepithelioma-like carcinoma of the urinary bladder. Am J Surg Pathol. 1994 May;18(5):466-73.Incorrect
Answer: Lymphoepithelioma like carcinoma (LELC) of urinary bladder
Histology: The epithelial neoplasm is composed of a proliferation of undifferentiated highly atypical cells arranged in a syncitial pattern with indistinct cytoplasmic borders. Characteristic of LELC, the epithelial cells contain large vesicular nuclei with very prominent nucleoli. The latter is associated with a dense obscuring lymphoid infiltrate. The lymphoid cells are smaller in size. Mitotic figures are easily identified. The tumor extensively invades the muscularis propria. The surface urothelium show no evidence of flat carcinoma in situ (CIS).
Discussion: LELC is a rare type of urinary bladder carcinoma. The associated dense lymphoid host response could lead to a misdiagnosis of such lesions as malignant lymphoma especially on small TUR biopsies with extensive cautery artifact. Immunostains for cytokeratins AE1/AE3, CK7 and EMA could be of help in such cases. The lymphoid infiltrate is usually composed of a mixture of B and T cells. Unlike their nasopharyngeal counterparts, EBV studies for LMP1 and EBER have been shown to be negative in LELC of bladder. Distinguishing bladder tumors with pure or predominant LELC morphology from other undifferentiated and high grade urothelial carcinoma may have implications on patient management given the relatively higher chemotherapy response rates and the potentials for bladder salvage.
Reference(s):
– Lopez-Beltran A, Luque RJ, Vicioso L, Anglada F, Requena MJ, Quintero A, Montironi R. Lymphoepithelioma-like carcinoma of the urinary bladder: a clinicopathologic study of 13 cases. Virchows Arch. 2001 Jun;438(6):552-7.
– Amin MB, Ro JY, Lee KM, Ordonez NG, Dinney CP, Gulley ML, Ayala AG. Lymphoepithelioma-like carcinoma of the urinary bladder. Am J Surg Pathol. 1994 May;18(5):466-73.
