Lymphoepithelioma-like carcinoma of the urinary bladder: a clinicopathologic study of 13 cases

Lymphoepithelioma-like carcinoma (LELCA) of the urinary bladder is a rare v ariant of bladder cancer characterized by a malignant epithelial component densely infiltrated by lymphoid cells. It is characterized by indistinct cy toplasmic borders and a syncytial growth pattern. These neoplasms deserve r ecognition and attention. chiefly because they may be responsive to chemoth erapy. We report on the clinicopathologic features of 13 cases of LELCA rec orded since 1981. The chief complaint in all 13 patients was hematuria. The ir ages ranged from 58 years to 82 years. All tumors were muscle invasive. A significant lymphocytic reaction was present in all of these tumors. Ther e were three pure LELCA and six predominant LELCA with a concurrent transit ional cell carcinoma (TCC). The remainder four cases had a focal LELCA comp onent admixed with TCC. Immunohistochemistry showed LELCA to be reactive ag ainst epithelial membrane antigen and several cytokeratins (CKs; AE1/AE3, A E1, AE3, CK7, and CK8). CK20 and CD44v6 stained focally. The lymphocytic co mponent was composed of a mixture of T and B cells intermingled with some d endritic cells and histiocytes. Latent membrane protein 1 (LMP1) immunostai ning and in situ hybridization for Epstein-Barr virus were negative in all 13 cases. DNA ploidy of these tumors gave DNA histograms with diploid peaks (n = 7) or non-diploid peaks (aneuploid or tetraploid; n = 6). All patient s with pure and 66% with predominant LELCA were alive, while all patients h aving focal LELCA died of disease. Our data suggest that pure and predomina nt LELCA of the bladder appear to be morphologically and clinically differe nt from other bladder (undifferentiated and poorly differentiated conventio nal TCC) carcinomas and should be recognized as separate clinicopathologica l variants of TCC with heavy lymphocytic reaction relevant in patient manag ement.