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| IJCEP Copyright © 2007-All rights reserved. |
| International Journal of Clinical and Experimental Pathology |
Int J Clin Exp Pathol 2(2),194-199;2009
Case Report
Pleomorphic Lymphoepithelioma-like Carcinoma of the Urinary Bladder
Oluwole Fadare, Idris L. Renshaw and Christopher Rubin
Department of Pathology, Wilford Hall Medical Center, Lackland AFB, TX, USA; Department of Pathology, University of Texas Health
Science Center at San Antonio, San Antonio, TX, USA and 3Vanguard Pathology Associates, Austin, TX, USA
Received 3 June 2008; Accepted and available online 15 June 2008
Abstract: Lymphoepithelioma-like carcinoma (LELC) of the urinary bladder is often mixed with conventional transitional cell carcinoma
and/or other histotypes. The pathologist’s determination of the morphologic purity of a given LELC at the biopsy stage is a clinically
relevant endeavour, because there is some anecdotal evidence suggesting that pure or predominant LELC may be comparatively
chemosensitive and have a favorable prognostic profile, which may potentially offer the possibility of effective therapy without bladder
resection. The precise degree of cellular pleomorphism that is allowed in a pure LELC is unclear. We describe herein an otherwise
conventional and pure LELC that showed, in a localized area that constituted approximately 25% of the overall tumor volume, a two to six
fold variation in nuclear size, including multinucleated tumor cells. These pleomorphic areas were set in the same lymphoplasmacytic
infiltrate as their conventional counterparts, and similarly displayed cellular syncytia. We performed a detailed immunophenotypic
comparison between the conventional areas and the pleomorphic areas. No significant differences were found between the 2 areas in
overall lymphoplasmacytic or histiocytic density, lymphocytic CD4/CD8 ratio, and lymphoplasmacytic kappa/lambda ratio. Similarly, both
displayed similar qualitative and quantitative staining indices for p53, Ki67, cytokeratin AE1/AE3 and p16INKa. Scattered cells were
cytoplasmically beta-catenin positive exclusively in the pleomorphic areas; however these cells were not notably larger than the cells in
the conventional areas. Both components were immunohistochemically negative for HMB-45, CD1a, the estrogen receptor, Epstein-Barr
virus, CD117, D2-40, CD56, cytokeratin 20 and chromogranin. Clinicopathologic analysis of a series of cases is required to establish if
there is any significance to nuclear pleomorphism in LELC. However, the phenotypic similarity between the 2 areas in this case, the
intimate admixture of the pleomorphic cells with the lymphoplasmacytic infiltrate, and their syncytial pattern of growth, all suggest that pure
LELC may display marked nuclear pleomorphism, and that this finding may not, in of itself, be a valid basis for removing a case from the
“pure” group.(IJCEP806002).
Key Words: Bladder, lymphoepithelioma, lymphoepithelioma-like
Full text PDF
Address all correspondences to: Oluwole Fadare, MD, Wilford Hall Medical Center Department of Pathology, 2200 Bergquist Dr., Ste 1,
Lackland AFB, TX 78236, USA, Email address: oluwolefadare@yahoo.com
Case Report
Pleomorphic Lymphoepithelioma-like Carcinoma of the Urinary Bladder
Oluwole Fadare, Idris L. Renshaw and Christopher Rubin
Department of Pathology, Wilford Hall Medical Center, Lackland AFB, TX, USA; Department of Pathology, University of Texas Health
Science Center at San Antonio, San Antonio, TX, USA and 3Vanguard Pathology Associates, Austin, TX, USA
Received 3 June 2008; Accepted and available online 15 June 2008
Abstract: Lymphoepithelioma-like carcinoma (LELC) of the urinary bladder is often mixed with conventional transitional cell carcinoma
and/or other histotypes. The pathologist’s determination of the morphologic purity of a given LELC at the biopsy stage is a clinically
relevant endeavour, because there is some anecdotal evidence suggesting that pure or predominant LELC may be comparatively
chemosensitive and have a favorable prognostic profile, which may potentially offer the possibility of effective therapy without bladder
resection. The precise degree of cellular pleomorphism that is allowed in a pure LELC is unclear. We describe herein an otherwise
conventional and pure LELC that showed, in a localized area that constituted approximately 25% of the overall tumor volume, a two to six
fold variation in nuclear size, including multinucleated tumor cells. These pleomorphic areas were set in the same lymphoplasmacytic
infiltrate as their conventional counterparts, and similarly displayed cellular syncytia. We performed a detailed immunophenotypic
comparison between the conventional areas and the pleomorphic areas. No significant differences were found between the 2 areas in
overall lymphoplasmacytic or histiocytic density, lymphocytic CD4/CD8 ratio, and lymphoplasmacytic kappa/lambda ratio. Similarly, both
displayed similar qualitative and quantitative staining indices for p53, Ki67, cytokeratin AE1/AE3 and p16INKa. Scattered cells were
cytoplasmically beta-catenin positive exclusively in the pleomorphic areas; however these cells were not notably larger than the cells in
the conventional areas. Both components were immunohistochemically negative for HMB-45, CD1a, the estrogen receptor, Epstein-Barr
virus, CD117, D2-40, CD56, cytokeratin 20 and chromogranin. Clinicopathologic analysis of a series of cases is required to establish if
there is any significance to nuclear pleomorphism in LELC. However, the phenotypic similarity between the 2 areas in this case, the
intimate admixture of the pleomorphic cells with the lymphoplasmacytic infiltrate, and their syncytial pattern of growth, all suggest that pure
LELC may display marked nuclear pleomorphism, and that this finding may not, in of itself, be a valid basis for removing a case from the
“pure” group.(IJCEP806002).
Key Words: Bladder, lymphoepithelioma, lymphoepithelioma-like
Full text PDF
Address all correspondences to: Oluwole Fadare, MD, Wilford Hall Medical Center Department of Pathology, 2200 Bergquist Dr., Ste 1,
Lackland AFB, TX 78236, USA, Email address: oluwolefadare@yahoo.com