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  • Case Study
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Lymphoepithelioma-like carcinoma of the urinary bladder—diagnostic and clinical implications

Abstract

Background A 57-year-old man presented with a 4-week history of intermittent, painless frank hematuria. There were no other symptoms. He had no previous urologic history, is a nonsmoker, and works as a manual laborer.

Investigations Physical examination, ultrasound of the urinary tract, and intravenous urography were all unremarkable. Urine microscopy confirmed more than 5 red blood cells per high-power field, but no malignant cells were seen on cytologic assessment. Flexible cystoscopy revealed a 3 cm, partially solid, solitary lesion on the right lateral wall of the bladder. The tumor was completely resected under general anesthesia.

Diagnosis Histologically, the tumor was described as a G3 pT1 transitional cell carcinoma of the bladder.

Management Following the resection of a solitary recurrence 6 weeks after the initial tumor resection, the patient underwent a standard course of intravesical bacillus Calmette–Guérin therapy. Despite this, another tumor was identified 3 months later. Histologically, this tumor was described as a lymphoepithelioma-like carcinoma, of at least grade G3pT1. The patient underwent radical cystoprostatectomy with ileal conduit formation; no adjuvant systemic chemotherapy was given in light of complete tumor resection. The patient is under continuing, close clinical and radiologic observation and remains free of disease recurrence, 36 months postoperatively.

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Figure 1: Low-power view of pure lymphoepithelioma-like-carcinoma pattern showing tumor cells arranged in solid sheets and nests and intimately associated with a mixed lymphoid infiltrate
Figure 2: High-power view showing glassy-appearing, pleomorphic neoplastic cells with irregular nuclei, prominent nucleoli, ill-defined cytoplasmic borders, and numerous mitoses
Figure 3: The neoplastic cells show intense positivity for cytokeratin (AE1 or AE3), indicating epithelial origin
Figure 4: Comparison of disease-free survival of patients with lymphoepithelioma of the nasopharynx who were treated with or without adjuvant chemotherapy in addition to whole-neck irradiation

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Correspondence to Mathias H Winkler.

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Mayer, E., Beckley, I. & Winkler, M. Lymphoepithelioma-like carcinoma of the urinary bladder—diagnostic and clinical implications. Nat Rev Urol 4, 167–171 (2007). https://doi.org/10.1038/ncpuro0725

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