Urothelial carcinoma - invasive
Lymphoepithelioma-like carcinoma

Author: Nat Pernick, M.D.

Revised: 12 January 2018, last major update December 2014

Copyright: (c) 2002-2018,, Inc.

PubMed Search: Lymphoepithelioma-like carcinoma bladder
Cite this page: Pernick, N. Lymphoepithelioma-like carcinoma. website. Accessed February 20th, 2018.
Definition / general
  • Rare bladder tumor resembling undifferentiated nasopharyngeal carcinoma (lymphoepithelioma), but EBV negative
  • Also called lymphoepithelial carcinoma, but most authors prefer adding “-like” since it is EBV negative, in contrast to the nasopharyngeal tumor
  • Incidence: 0.4%-1.3% of all bladder carcinomas
  • Adults, mean age 67-69 years, range 52-84 years
  • 75% males
Clinical features
  • Rare (< 50 cases described), first reported in 1991 in bladder
  • Patients present with hematuria
  • Not associated with Epstein Barr virus infection in bladder (Hum Pathol 1995;26:1207)
  • Outcome may be similar to urothelial carcinoma when treated by cystectomy (Mod Pathol 2007;20:828)
  • May have similar pathogenesis as high-grade invasive urothelial carcinoma (Am J Surg Pathol 2011;35:474)
Case reports
  • Cystectomy (partial cystectomy not recommended since tumor may be multifocal with coexisting urothelial carcinoma)
Gross description
  • Relatively small tumor in dome, posterior wall or trigone
Microscopic (histologic) description
  • A subtype of urothelial carcinoma resembling lymphoepithelioma of nasopharynx, but EBV negative
  • Lymphoepithelioma-like component should be >50% for diagnosis
  • Undifferentiated tumor cells in syncytial sheets with minimal cytoplasm, prominent nucleoli, numerous mitoses and lymphocytes (Am J Surg Pathol 1994;18:466)
  • Usually muscle invasive
  • Often co-existing urothelial carcinoma and urothelial carcinoma in situ
  • May have markedly pleomorphic epithelial component (Int J Clin Exp Pathol 2009;2:194)
  • Chronic inflammation may obscure tumor cells
  • Non-neoplastic cells are a mixture of polyclonal B and T lymphocytes, histiocytes, eosinophils and plasma cells
  • Report the percentage of lymphoepithelioma-like areas (important for treatment)
Microscopic (histologic) images

Images hosted on PathOut server:

Urothelial carcinoma, lymphoepithelioma-like


AE1 / AE3

Images hosted on other servers:
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CAPSheets and nests of high grade tumor cells in a syncytial pattern with prominent lymphocytesTION

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Marked nuclear pleomorphism

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Fig 1/2: H&E; Fig 3: keratin

Cytology description
  • Single cells or mixed with inflammatory cells
  • Large tumor cells with high nuclear to cytoplasmic ratio, vesicular chromatin, prominent nucleoli (Diagn Cytopathol 2008;36:600)
Positive stains
Undifferentiated cells
  • Cytokeratin (AE1/AE3, CK7) and EMA; often p53

  • B and T cell markers

Negative stains
  • CD45/LCA (for epithelial cells), EBV
  • Usually CK20
Differential diagnosis