Quiz-summary
0 of 1 questions completed
Questions:
- 1
Information
Presented by Dr. Jonathan Epstein and prepared by Dr. J. Judd Fite.
Case 1. A 55 year-old man presented with hematuria and underwent a TURB.
You have already completed the quiz before. Hence you can not start it again.
Quiz is loading...
You must sign in or sign up to start the quiz.
You have to finish following quiz, to start this quiz:
Results
Time has elapsed
Categories
- Not categorized 0%
- 1
- Answered
- Review
-
Question 1 of 1
1. Question
Case 1. A 55 year-old man presented with hematuria and underwent a TURB.
Correct
Answer: C. Lymphoepithelioma-like urothelial carcinoma
Histological description: The TUR is replaced by a dense infiltrate with a brisk benign lymphoplasmacytic infiltrate with occasional more prominent neutrophils. Interspersed within the inflammation are small nests and cords of cohesive clusters as well as individual cells containing large nuclei with multiple nucleoli, abundant eosinophilic to amphophilic cytoplasm and frequent mitoses.
Discussion: Lymphoepithelioma-like urothelial carcinoma (LELC) is a variant of infiltrating urothelial carcinoma. If the tumor is a pure LELC it may respond to chemotherapy such that cystectomy can be avoided. When mixed with conventional urothelial carcinoma, their outcome is similar to that for conventional urothelial carcinoma and depends on the stage of the associated carcinoma. If pure LELC, these tumors potentially have a better outcome when treated with chemotherapy. The major differential diagnosis is with large cell lymphoma. In some cases there is overlying CIS or papillary urothelial carcinoma or associated conventional infiltrating urothelial carcinoma which can aid in the diagnosis. In the current case, some of the LELC is composed of cohesive nests consistent with carcinoma. If these features are not present, immunohistochemistry for CK7 and pancytokeratin can help rule out lymphoma, with negative lymphoid markers in the large atypical cells. GATA3 positivity is only present in a minority of cases. In contrast to lymphoepitheliomas of the nasopharynx, LELC is negative for EBV.
Incorrect
Answer: C. Lymphoepithelioma-like urothelial carcinoma
Histological description: The TUR is replaced by a dense infiltrate with a brisk benign lymphoplasmacytic infiltrate with occasional more prominent neutrophils. Interspersed within the inflammation are small nests and cords of cohesive clusters as well as individual cells containing large nuclei with multiple nucleoli, abundant eosinophilic to amphophilic cytoplasm and frequent mitoses.
Discussion: Lymphoepithelioma-like urothelial carcinoma (LELC) is a variant of infiltrating urothelial carcinoma. If the tumor is a pure LELC it may respond to chemotherapy such that cystectomy can be avoided. When mixed with conventional urothelial carcinoma, their outcome is similar to that for conventional urothelial carcinoma and depends on the stage of the associated carcinoma. If pure LELC, these tumors potentially have a better outcome when treated with chemotherapy. The major differential diagnosis is with large cell lymphoma. In some cases there is overlying CIS or papillary urothelial carcinoma or associated conventional infiltrating urothelial carcinoma which can aid in the diagnosis. In the current case, some of the LELC is composed of cohesive nests consistent with carcinoma. If these features are not present, immunohistochemistry for CK7 and pancytokeratin can help rule out lymphoma, with negative lymphoid markers in the large atypical cells. GATA3 positivity is only present in a minority of cases. In contrast to lymphoepitheliomas of the nasopharynx, LELC is negative for EBV.
