Bladder - Lymphoepithelioma-like carcinoma

Home Chapter Home Jobs Conferences Fellowships Books

Bladder

Other Carcinomas

Lymphoepithelioma-like carcinoma

Author: Nat Pernick, M.D. (see Authors page)

Revised: 29 December 2009, last major update - December 2009

Definition

=========================================================================

● Rare bladder tumor resembling undifferentiated nasopharyngeal carcinoma (lymphoepithelioma), but EBV negative

Terminology

=========================================================================

● Also called lymphoepithelial carcinoma, but most authors prefer adding “-like”, since it is EBV negative in contrast to the nasopharyngeal tumor

Epidemiology

=========================================================================

● Adults, mean age 67-69 years, range 52-84 years

● 75% males

Sites

=========================================================================

●

Etiology

=========================================================================

●

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 Path 1995;26:1207)

● Outcome may be similar to urothelial carcinoma (Mod Pathol 2007;20:828)

Prognostic factors

=========================================================================

●

Case reports

=========================================================================

● 65 year old man with hematuria (Ann Saudi Med 2009;29:478)

● 74 year old woman (Archives 2001;125:1383)

Treatment

=========================================================================

● Cystectomy (partial cystectomy not recommended since tumor may be multifocal with urothelial carcinoma)

Clinical images

=========================================================================

●

Gross description (Macroscopy)

=========================================================================

● Relatively small tumor in dome, posterior wall or trigone

Gross images

=========================================================================

Micro description (Histopathology)

=========================================================================

● A subtype of urothelial carcinoma resembling lymphoepithelioma of nasopharynx but EBV negative

● LEL component should be >50% for diagnosis

● Undifferentiated tumor cells in syncytial sheets with minimal cytoplasm, prominent nucleoli, numerous mitoses and lymphocytes (AJSP 1994;18:466)

● Usually muscle invasive

● Often have coexisting urothelial carcinoma

● May have markedly pleomorphic epithelial component (Int J Clin Exp Pathol 2009;2:194)

Micro images

=========================================================================

Sheets and nests of high grade tumor cells in a syncytial pattern with prominent lymphocytes #1; #2; #3; #4; #5; #6; #7

Cords of cells; rare glandular features; focal clear cell features; marked nuclear pleomorphism; muscularis propria invasion

At low magnification, the malignant epithelial elements are intimately intermixed with lymphoid tissue. (Courtesy of Dr. George Reichel, Lubbock, TX.)

At higher magnification, the anaplastic epithelial cells are conspicuous. These cells reacted positively with antibodies to cytokeratins.

Overlying carcinoma in situ; overlying adenocarcinoma in situ

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

AE1/AE3; AE1/AE3; pan-cytokeratin; CK7; CD3 (T cells)/CD20 (B cells)

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)

Cytology images

=========================================================================

●

Positive stains

=========================================================================

● Undifferentiated cells - cytokeratin (AE1/AE3, CK7) and EMA

● Lymphocytes - B and T cell markers

Negative stains

=========================================================================

● CD45/LCA (for epithelial cells), EBV; usually CK20

Electron microscopy descriptions

=========================================================================

●

Electron microscopy images

=========================================================================

Molecular / cytogenetics description

=========================================================================

●

Molecular / cytogenetics images

=========================================================================

Differential Diagnosis

=========================================================================

● Florid chronic cystitis: no malignant epithelial component although it may be hard to find

● Lymphoma: no malignant epithelial component

● Small cell carcinoma: molding or crush artifact, no prominent nucleoli, usually no prominent lymphocytic component

● Undifferentiated urothelial carcinoma: no prominent lymphocytic component

Additional references

=========================================================================

●

End of Bladder > Other carcinomas > Lymphoepithelioma-like carcinoma

This information is intended for physicians and related personnel, who understand that medical information is often imperfect, and must also be interpreted in the context of a patient's clinical data using reasonable medical judgment. This website should not be used as a substitute for the advice of a licensed physician.

All information on this website is protected by copyright of PathologyOutlines.com, Inc. Information from third parties may also be protected by copyright. Please contact us at copyrightPathOut@gmail.com with any questions (click here for other contact information)..