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Presented by Jonathan Epstein, M.D. and prepared by Julie M. Wu, M.D.
Case 4: A 79 year old female presented with hematuria and was noted to have a bladder mass.
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1. Question
Week 349: Case 4
A 79 year old female presented with hematuria and was noted to have a bladder mass which underwent transurethral resection.images/jmw051908/4.1.jpg
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images/jmw051908/4.4.jpgCorrect
Answer: Lymphoepithelioma-like variant of urothelial carncer
Histology: Tumor consists of sheets of cells without differentiation. The cells have fairly monotonous uniform round nuclei with visible nucleoli. There is a brisk lymphocytic infiltrate separating the epithelium into islands as well as interspersed amongst the carcinoma cells.
Discussion: Lymphoepithelioma-like carcinoma of the bladder typically occurs in adult males. Tumors can either be pure or mixed with other patterns of carcinoma including infiltrating urothelial carcinoma, adenocarcinoma or squamous cell carcinoma. The unifying feature is the presence of a heavy inflammatory infiltrate which is typically lymphocytic but in some cases may be mixed. In contrast to lymphoepithelioma occurring in the nasopharynx, lymphoepithelial-like carcinoma in the bladder is not associated with EBV. In some cases the lymphocytic infiltrate may be extremely extensive and almost obscure the underlying carcinoma component. In other cases, as in the current one, the carcinoma component is more obvious with the lymphocytic infiltrate surrounding the epithelial nests. It is not unreasonable to perform stains for cytokeratin to verify its epithelial nature and to rule out other undifferentiated tumors such as lymphoma or less likely a melanoma. The importance of recognizing lymphoepithelial-like carcinoma of the bladder is that cases which are pure may respond to chemotherapy whereby patients may be saved radical surgery.
Reference(s):
– Modern Pathology 20;828-34, 2007Incorrect
Answer: Lymphoepithelioma-like variant of urothelial carncer
Histology: Tumor consists of sheets of cells without differentiation. The cells have fairly monotonous uniform round nuclei with visible nucleoli. There is a brisk lymphocytic infiltrate separating the epithelium into islands as well as interspersed amongst the carcinoma cells.
Discussion: Lymphoepithelioma-like carcinoma of the bladder typically occurs in adult males. Tumors can either be pure or mixed with other patterns of carcinoma including infiltrating urothelial carcinoma, adenocarcinoma or squamous cell carcinoma. The unifying feature is the presence of a heavy inflammatory infiltrate which is typically lymphocytic but in some cases may be mixed. In contrast to lymphoepithelioma occurring in the nasopharynx, lymphoepithelial-like carcinoma in the bladder is not associated with EBV. In some cases the lymphocytic infiltrate may be extremely extensive and almost obscure the underlying carcinoma component. In other cases, as in the current one, the carcinoma component is more obvious with the lymphocytic infiltrate surrounding the epithelial nests. It is not unreasonable to perform stains for cytokeratin to verify its epithelial nature and to rule out other undifferentiated tumors such as lymphoma or less likely a melanoma. The importance of recognizing lymphoepithelial-like carcinoma of the bladder is that cases which are pure may respond to chemotherapy whereby patients may be saved radical surgery.
Reference(s):
– Modern Pathology 20;828-34, 2007
