Bladder, ureter & renal pelvis
Urothelial carcinoma-invasive

Deputy Editor-in-Chief: Debra Zynger, M.D.
Daniel Anderson, M.D., M.B.A.
Maria Tretiakova, M.D., Ph.D.

Topic Completed: 1 February 2018

Minor changes: 11 June 2020

Copyright: 2002-2020,, Inc.

PubMed Search: Lymphoepithelioma-like variant bladder

Daniel Anderson, M.D., M.B.A.
Maria Tretiakova, M.D., Ph.D.
Page views in 2019: 1,995
Page views in 2020 to date: 1,597
Cite this page: Anderson D, Tretiakova M. Lymphoepithelioma-like. website. Accessed September 21st, 2020.
Definition / general
Essential features
  • Rare variant of urothelial carcinoma resembling undifferentiated carcinoma of the nasopharynx
  • Composed of sheets of undifferentiated, pleomorphic cells with syncytial appearance, admixed with obscuring inflammatory infiltrate
  • Also called lymphoepithelial carcinoma but most authors prefer adding "-like" since it is EBV negative, in contrast to the nasopharyngeal tumor
  • Derived from urothelium, often admixed with conventional urothelial component
  • May have similar pathogenesis as high grade invasive urothelial carcinoma (Am J Surg Pathol 2011;35:474)
  • Not associated with Epstein-Barr virus (EBV) (Urology 2005;66:1109)
Clinical features
Radiology description
  • May show enhancing soft tissue mass in the renal pelvis or ureter, involvement of the renal parenchyma or hilar fat
Radiology images

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Scan showing enhancing
lesion from right renal pelvis

Prognostic factors
Case reports
  • There are no specific guidelines regarding management
  • In bladder, pure lymphoepithelioma-like carcinoma is reportedly more responsive to chemotherapy
Gross description
  • In bladder, relatively small tumor in dome, posterior wall or trigone
Gross images

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Tumor present in renal
pelvis with extension
into adjacent parenchyma
and hilar fat tissue

Microscopic (histologic) description
  • Microscopically resembles undifferentiated nasopharyngeal carcinoma
  • Pleomorphic, undifferentiated round or spindle cell carcinoma with ill defined borders (Am J Surg Pathol 1994;18:466)
  • Arranged in syncytial sheets, nests or individual cells with abundant mixed inflammatory cells often obscuring the neoplastic cells (Am J Surg Pathol 1994;18:466)
  • Nonneoplastic cells are a mixture of polyclonal B and T lymphocytes, histiocytes, eosinophils and plasma cells
  • May be pure or mixed, onsider recording proportion of variant (Int J Clin Exp Pathol 2009;2:194)
  • Surface urothelium may demonstrate carcinoma in situ (CIS)
  • Can have focal glandular and clear cell differentiation
Microscopic (histologic) images

Contributed by Maria Tretiakova, M.D., Ph.D.

Lymphoepithelioma-like carcinoma of the ureter

Lymphoepithelioma-like carcinoma of the bladder

Case of the Week #267

Urothelial carcinoma, lymphoepithelioma-like


AE1 / AE3

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Urothelial carcinoma, lymphoepithelioma-like

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Lymphoepithelioma-like carcinoma of the renal pelvis

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
Negative stains
Differential diagnosis
Board review style question #1
Which statement about lymphoepithelioma-like carcinoma of the urinary tract is false:

  1. Cytokeratin positive
  2. Derived from the kidney parenchyma
  3. GATA3 is expressed
  4. Not associated with Epstein-Barr Virus in contrast to nasopharyngeal carcinoma.
Board review answer #1
B. The epithelial cells are thought to derive from the urothelium. They are seen in nests and syncytial sheets in a dense inflammatory background which can obscure visualization of the tumor cells.

Reference: Lymphoepithelioma-like carcinoma

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