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21 February 2013 - Case of the Week #267
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Case of the Week #267
A 75 year old woman had a broad-based, 2 x 1 cm, centrally ulcerated mass of the distal ureter, which was excised.
What is your diagnosis?
Lymphoepithelioma-like carcinoma of the ureter
Immunostains highlighted the lymphocytic component (CD45+) and the carcinoma component (AE1-AE3+):
Left to right: CD45, AE1-AE3 (two images)
Lymphoepithelioma-like carcinoma is a rare GU tumor resembling undifferentiated nasopharyngeal carcinoma (lymphoepithelioma), but EBV negative. For that reason, the "-like" is typically added to the name for GU tumors. In the ureter, less than 15 cases have been reported (Kaohsiung J Med Sci 2012;28:509, Ann Diagn Pathol 2010;14:209).
Lymphoepithelioma-like carcinoma is much more common in the Bladder, with similar features at both sites. Undifferentiated keratin+ carcinoma cells are present in syncytial sheets with minimal cytoplasm, prominent nucleoli, numerous mitoses and lymphocytes. Non-neoplastic inflammatory cells are a mixture of CD45+ polyclonal B and T lymphocytes, histiocytes, eosinophils and plasma cells. As noted, the tumor cells are EBV negative.
The differential diagnosis includes:
Excision with negative margins appears to be adequate treatment, with a good prognosis, in the limited number of cases reported in the ureter (Urology 2005;66:1109).
- Florid inflammatory infiltrate: no carcinoma component, although keratin stains or multiple sections may be necessary to confirm their absence
- Large cell undifferentiated carcinoma: tumor cells have distinct cell borders, no prominent lymphocytic component
- Lymphoma: no malignant epithelial component, lymphocytes are clonal
Nat Pernick, M.D., President
and Palak Thakore, Associate Medical Editor
30100 Telegraph Road, Suite 408
Bingham Farms, Michigan (USA) 48025
Alternate email: NatPernick@gmail.com