Figure 1 - uploaded by Tateki Yoshino
Content may be subject to copyright.
Cystoscopy revealed a thumb tip-sized bladder tumor at the trigone. The tumor was solid and broad-based. asterisk, flexible cystoscope; arrow, neck of bladder
Source publication
Background
Lymphoepithelioma-like carcinoma is an undifferentiated carcinoma with histological features similar to undifferentiated, non-keratinizing carcinoma of the nasopharynx. Lymphoepithelioma-like carcinoma of the urinary bladder is uncommon with a reported incidence of 0.3%– 1.3% of all bladder cancer. We report a Japanese case of predominan...
Context in source publication
Similar publications
Purpose:
Reduced quality of life after cystectomy has made bladder preservation a popular research topic for muscle-invasive bladder cancer (MIBC). Previous research has indicated significant tumor downstaging after neoadjuvant chemotherapy (NAC). However, maximal transurethral resection of bladder tumor (TURBT) was performed before NAC to define...
Citations
... No standard treatment is followed for patients presenting with LELC of the urinary bladder, mainly due to the rarity of this malignancy and the variety of baseline patient profiles. Radical cystectomy followed by chemotherapy and transurethral resection of the tumour with chemotherapy and/or radiotherapy has been shown to be effective [5][6][7][8]. Most cases described in the literature have been described in patients <90 years old, with only one case reported in a 97-year-old woman who was treated with transurethral resection of the tumour without chemotherapy and no follow-up [9]. ...
Lymphoepithelioma-like carcinoma of the urinary bladder is a rare variant of infiltrating urothelial carcinoma. Diagnostic and therapeutic manipulations are not yet standardised, due to the rarity of the tumour, with surgery and chemotherapy being reported as potential therapeutic options. We report on a case of lymphoepithelioma-like carcinoma of the bladder in a 93-year-old female patient and discuss the pathological features and therapeutic options of the neoplasm. Due to her increased age and associated comorbidities such as hypertension, diabetes mellitus and ischemic heart disease, the patient was treated with transurethral resection of the tumour and subsequent cisplatin-based chemotherapy but unfortunately died of chemotherapy-related complications.
... A total of 60 patients diagnosed with LELCB with a median age of 69.5 (interquartile range: 61-75 years) were identified in the SEER database from 1999 to December 2015. LR was performed, and 95 cases from 28 published articles in English from 1993 to 2021 were extracted to verify the performance of prognostic classification derived from the SEER cohort (Supplementary Figure 1) (2,9,10,(12)(13)(14)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32). The baseline characteristics, including age, gender, radiation therapy, tumor extent, and surgery approaches, were statistically similar in both data sets, except for the administration of chemotherapy ( Table 1). ...
Purpose: This study aimed to investigate the prognostic factors of patients with lymphoepithelioma-like carcinoma of the urinary bladder (LELCB) and explore the value of surgical treatment.
Methods: Data of patients with LELCB were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. The multivariate analysis was performed using the stepwise Cox proportional hazards regression model and conditional inference tree method to identify significant prognosticators of overall survival (OS) from the parameters such as age, gender, lymph node involvement, tumor extent, radiation, chemotherapy, and surgery type. Literature review (LR) was performed, and eligible cases were used to validate prognostic classification using the Kaplan–Meier method with log-rank tests.
Results: Sixty patients with a median age of 69.5 years were identified from the SEER database and 91 patients through LR. The Cox analysis identified age, gender, lymph node involvement, and surgical approach as independent prognosticators of OS. Based on the nomogram scores, patients were stratified into three prognostic groups: (I) patients younger than 70 years; (II) patients older than 70 years, who received bladder-sparing therapy (BST); and (III) patients older than 70 years undergoing radical cystectomy (RC). Patients in group II had the worst outcomes in terms of OS compared with patients in groups I and III ( p < 0.001 and p = 0.03, respectively). A similar survival pattern was found in the LR cohort.
Conclusion: The nomogram provided individualized prognostic quantification of OS in patients with LELCB. BST could yield favorable outcomes when treating LELCB, especially for younger patients, whereas older patients might derive more survival benefit from RC.
... It has been reported in the literature that, as a result of the suppressive effect of prominent lymphoid infiltration and cytotoxic T lymphoid response on tumor cells, prognosis is better in patients with tumors classified pure and predominant, compared to focal (10,11). However, due to a limited number of cases, no definitive comment can be made about the prognosis of these cases. ...
... Nasopharyngeal carcinomas do not express cytokeratin 7, whereas bladder lymphoepitheliomalike carcinomas express. Morphological parameters, such as the syncytial pattern of the tumor cells, are more helpful in differentiation from conventional UCs with intense inflammation (8)(9)(10). ...
... It has been reported that, in cases in which only TUR was applied, disease-free survival was shorter in cases with focal lymphoepithelioma-like UC, compared to pure or predominant cases. It has also been reported that radical cystectomy is not required in all cases showing muscle invasion, especially pure and predominant lymphoepithelioma-like UC cases can be followed up by chemotherapy and/or radiotherapy after TUR or partial cystectomy, and radical cystectomy and adjuvant chemotherapy are required in muscle invasive cases with focal lymphoepithelioma-like UC (10)(11)(12). ...
Lymphoepithelioma-like urothelial carcinoma, which was first identified by Zukerberg, constitutes 0,4-1,3% of all urothelial carcinomas and has similar histomorphological features with nasopharyngeal lym-phoepithelioma. We report a case of predominant lymphoepithelioma like bladder carcinoma in a 72 years old male patient. Transurethral resection of the bladder and adjuvant intravesical Bacillus Calmette Guerin treatment was applied. The patient is currently at the 16th month after diagnosis and no recurrence or metastasis has been observed in cystoscopic and radiological examinations. (www.actabiomedica.it)
... Thus, presently there is still confusion regarding the long term aggressiveness of the disease and thus the role for adjuvant therapy is still debated. Generally they are considered sensitive to radiotherapy and chemotherapy [6,7], while some Japanese centers advocate adjuvant chemoradiotherapy [2]. ...
Lymphoepitheliomas are a type of undifferentiated carcinomas primarily described in the nasopharyngeal cavity. In the urinary tract, they are typically, but uncommonly seen in the urinary bladder, although occasional cases have been reported in the renal pelvis, ureter and urethra. Lymphoepithelioma-like carcinoma of the urinary bladder, fi rst reported by Zuckerberg, et al. in 1991, is uncommon with a reported incidence between 0.4 and 1.3% of all bladder carcinomas.We report the case of an 82 year old gentleman, who presented with a bladder mass, which was post surgical intervention, diagnosed to be a Lymphioepitelioma like carcinoma, with an aim to add to the available literature, and help re-visit and establish appropriate treatment strategies.
... The LEV of UC is characterized by syncytial growth pattern of a malignant epithelial component with prominent nuclei and nucleoli, which is densely infiltrated by lymphoid cells predominantly composed of cytotoxic T lymphocytes (63) (Figure 2). These cells may resemble metastatic tumours from the nasopharynx and the strong expression of CK7 would be able to demonstrate a urothelial origin of tumour (64). Other differential diagnosis of malignant lymphomas, undifferentiated UC with lymphocytic infiltrate and small cell carcinoma of the bladder can also be differentiated with the relevant IHC. ...
Bladder cancer is a heterogenous disease that is associated with tangible mortality in muscle invasive disease. The WHO 2016 classification of urothelial tumours reflects the contemporary approach towards histological variants in bladder cancer, including variants of urothelial carcinoma and non-urothelial variants. This review focuses on variant histology in urothelial carcinoma, and discusses the importance of accurate histological diagnosis, and subsequent risk stratification and therapeutic decision making based on proper variant recognition. Most urothelial variants are associated with poorer outcomes compared to conventional urothelial carcinoma, although some perform reasonably better. However, high quality evidence detailing optimal treatment and survival outcomes are still lacking in literature, due to the rarity of these cases.
... The most controversial issue is the prognosis and approach to the patient with Lymphoepithelial-Like carcinoma of urinary bladder. It has been suggested that patients with this type of malignancy have more favorable prognosis compared to the conventional invasive urothelial carcinoma as long as it is single (4,6,7,9,(14)(15)(16). However, if this type of malignancy is associated with carcinoma in situ, the mode of treatment will be different. ...
... N.M. Pantelides et al suggested that there is a growing evidence for the efficiency of chemotherapy coupled with TUR-B as part of a bladder-preserving treatment option (16). Sten Holmang et al. believed that diffusely pure or predominant lymphoepithelial-like carcinoma had good prognosis and when treated with locoregional therapy there was no evidence of disease for 4 years, while the patient with focal Lymphoepithelial-like carcinoma had a poor prognosis similar to conventional bladder carcinoma of the same size and stage. ...
Lymphoepithelial - like carcinoma, is rarely recognized in the urinary bladder and less commonly occurs with papillary transitional cell carcinoma i.e. mixed pattern. Also, less uncommon is the occurrence of carcinoma in situ changes in the adjacent urothelium of these tumors. Here, a case of lymphoepithelial - like carcinoma and papillary transitional cell carcinoma associated with carcinoma in situ changes of urothelium of the urinary bladder has been reported the prognosis of this type of malignancy as well as its management will be discussed. Meanwhile, immunohistochemical stains have been carried out to differentiate it from lymphoma of the urinary bladder and the findings will be discussed.
... Yoshino et al. reported 13 cases treated with transurethral resection of bladder tumor (TURBT) and chemotherapy: only 9 pure and 2 predominant and 2 mixed (predominant or focal) with a mean follow-up of 37 mounts (72-2 mounts) with no evidence of disease when published (Table 1). This literature data shows that a combination of TURB and adjuvant chemotherapy is probably effective against pure or predominant LELCB [17]. ...
Lymphoepithelioma-like carcinoma of the bladder (LELCB) is a rare variant of urothelial
carcinoma first described by Zukerberg in 1991 and confirmed as a variant of urothelial carcinoma by the WHO classification of tumors of the urinary system.
LELCB is characterized by a marked infiltration of lymphocytes in the area involved by the tumor which may coexist with the conventional urothelial carcinoma. LELCB are classified according to the percentage of lymphoepithelioma component within the tumor with the prognosis depending on the percentage.
We report a new case of pure LELCB occurring in 63 years women presenting with hematuria. Ultrasonography and cystoscopy revealed a large tumor on the left lateral wall of the bladder. Transurethral resection of the bladder tumor (TURBT) was performed. Pathological and immunohistochemical analysis revealed a high-grade muscle-invasive LELCB (G3pT2).
The patient underwent an adjuvant systemic chemotherapy with no recurrence after a ten months follow-up.
To our knowledge, this is the second Moroccan case of LELCB reported in the English literature.
Due to its rare occurrence prognosis and ideal therapeutic management of LELCB have not been clearly established yet but literature findings encourage the adoption of a conservative approach in treatment of LELCB.
... With regards to predictors of OS, the seemingly paradoxical finding of high-grade disease having a better prognosis can be explained by several high-grade NPC variants having improved prognosis, likely from increased radiosensitivity [13,14]. Moreover, grade as coded in the NCDB is not defined to be the same as WHO grade and/or Epstein-Barr virus association (the number of unknown values is also quite large for this parameter). ...
Purpose: The standard of care for stage I (T1N0) nasopharyngeal cancer (NPC) is definitive radiotherapy (RT). Given the phase III evidence supporting combined chemoradiotherapy (CRT) for stage II NPC, we investigated practice patterns and outcomes associated with administration of chemotherapy to RT alone for stage I NPC.
Methods: The National Cancer Data Base (NCDB) was queried for clinical T1N0 primary NPC cases (2004–2013) receiving curative-intent RT. Patients with unknown RT/chemotherapy status were excluded, as were benign/sarcomatous histologies and receipt of pharyngectomy. Patient, tumor, and treatment parameters were extracted. Logistic regression analysis ascertained factors associated with receipt of additional chemotherapy. Kaplan–Meier analysis was used to evaluate overall survival (OS) between patients receiving RT versus CRT. Cox proportional hazards modeling determined variables associated with receipt of OS.
Results: In total, 396 patients were analyzed. Chemotherapy was delivered in 147 patients (37%). On multivariate analysis, patients treated at academic/integrated centers were less likely to receive chemotherapy (p = .008); a racial predilection was noted, as non-black/non-white patients were also less likely to receive chemotherapy (p = .006). Respective 5-year OS in patients receiving RT alone versus CRT were 77% and 75% (p = .428). Receipt of chemotherapy did not independently predict for greater OS (p = .447).
Conclusions: These data do not support the routine addition of chemotherapy to definitive RT for T1N0 NPC.
... LELC occurs in various organs, including salivary glands, thymus, lung, skin, stomach, uterine cervix and breast. Its occurrence in the urinary system is rare [1]. ...
... Until 2014, only 93 cases with LELCB were reported. Most LELCB occurred in their seventh decades with male predominance [1,6]. The presenting symptoms of LELCB were similar to urothelial carcinomas. ...
... It is clinically difficult to distinguish bladder tumor variants. The pathological 4 differential diagnosis includes malignant lymphoma, undifferentiated urothelial carcinoma with prominent lymphoid infiltrate, chronic cystitis and small cell carcinoma [1]. LELC is classified histologically according to lymphoepithelioma component as pure (100%), predominant (≥50%) or focal (<50%). ...
Lymphoepithelioma-like carcinoma (LELC) is an undifferentiated carcinoma with histological features similar to undifferentiated, non-keratinizing carcinoma of the nasopharynx. LELC occurs in various organs, including salivary glands, thymus, lung, skin, stomach, uterine cervix and breast. Its occurrence in the urinary system is rare. The reported incidence rate of lymphoepithelioma-like carcinoma of the bladder
(LELCB) is ranging from 0.3% to 1.3% of all bladder cancers. The primary urothelial LELC was described for the first time by Zukerberg et al in 1991 [5]. Until 2014, only 93 cases with LELCB were reported. Most LELCB occurred in their seventh decades with male predominance [1,6]. The presenting symptoms of LELCB were similar to urothelial carcinomas. Gross hematuria and irritative voiding disorders were
the most common complaints of these patients. Here we presented a LELCB for sharing our experience.
... It is clinically difficult to distinguish bladder tumor variants. The pathological differential diagnosis includes malignant lymphoma, undifferentiated urothelial carcinoma with prominent lymphoid infiltrate, chronic cystitis, and small cell carcinoma [1]. LELC is classified histologically according to lymphoepithelioma component as pure (100%), predominant (≥50%), or focal (<50%). ...
... LELC occurs in various organs, including salivary glands, thymus, lung, skin, stomach, uterine cervix, and breast. Its occurrence in the urinary system is rare [1]. The reported incidence rate of LELC of the bladder (LELCB) ranges classification [1]. ...
... Its occurrence in the urinary system is rare [1]. The reported incidence rate of LELC of the bladder (LELCB) ranges classification [1]. The metastatic potential of LELC seems low [2,7]. ...
