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Presented by Jonathan Epstein and prepared by Sintawat Wangsiricharoen
A 68 year old female underwent a TUR of a large bladder mass
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Question 1 of 1
1. Question
A 68 year old female underwent a TUR of a large bladder mass.
Choose the correct diagnosis.
Correct
Answer: B. Lymphoepithelioma-like urothelial carcinoma
Histological Description: There is a brisk benign lymphocytic infiltrate with scattered large nuclei with multiple nucleoli, abundant eosinophilic to amphophilic cytoplasm. These nuclei have scattered mitotic figures, are variably hyperchromatic, and some have irregular shapes.
Discussion: The major differential diagnosis in this case is between large cell lymphoma and lymphoepithelioma-like urothelial carcinoma (LELC). In this case CK7 and GATA3 were positive in the large atypical cells, which were negative for CD45 and CD20, diagnostic of LELC. In order to diagnosis LELC, it is not sufficient to just have a lymphocytic infiltrate associated with invasive urothelial carcinoma. Rather, in LELC sheets, cords, trabeculae of cells are almost effaced by the inflammatory infiltrate closely mimicking lymphoma. In contrast to lymphoepithelioma in the head and neck, LELCs are EBV negative. If the tumor is pure lymphoepithelioma-like carcinoma it may respond to chemotherapy such that cystectomy can be avoided. When LELC is mixed with conventional urothelial carcinoma, their outcome is similar to that for conventional urothelial carcinoma and depends on the stage of the associated carcinoma. Consequently, it is critical to recognize pure LELC as radical cystectomy can be avoided in the presence of muscularis propria invasion.
Incorrect
Answer: B. Lymphoepithelioma-like urothelial carcinoma
Histological Description: There is a brisk benign lymphocytic infiltrate with scattered large nuclei with multiple nucleoli, abundant eosinophilic to amphophilic cytoplasm. These nuclei have scattered mitotic figures, are variably hyperchromatic, and some have irregular shapes.
Discussion: The major differential diagnosis in this case is between large cell lymphoma and lymphoepithelioma-like urothelial carcinoma (LELC). In this case CK7 and GATA3 were positive in the large atypical cells, which were negative for CD45 and CD20, diagnostic of LELC. In order to diagnosis LELC, it is not sufficient to just have a lymphocytic infiltrate associated with invasive urothelial carcinoma. Rather, in LELC sheets, cords, trabeculae of cells are almost effaced by the inflammatory infiltrate closely mimicking lymphoma. In contrast to lymphoepithelioma in the head and neck, LELCs are EBV negative. If the tumor is pure lymphoepithelioma-like carcinoma it may respond to chemotherapy such that cystectomy can be avoided. When LELC is mixed with conventional urothelial carcinoma, their outcome is similar to that for conventional urothelial carcinoma and depends on the stage of the associated carcinoma. Consequently, it is critical to recognize pure LELC as radical cystectomy can be avoided in the presence of muscularis propria invasion.
