Lymphoepithelioma-like carcinoma (LELCA) of the urinary bladder is a rare variant of bladder cancer characterized by a malignant epithelial component densely infiltrated by lymphoid cells. It is characterized by indistinct cytoplasmic borders and a syncytial growth pattern. These neoplasms deserve recognition and attention, chiefly because they may be responsive to chemotherapy. We report on the clinicopathologic features of 13 cases of LELCA recorded since 1981. The chief complaint in all 13 patients was hematuria. Their ages ranged from 58 years to 82 years. All tumors were muscle invasive. A significant lymphocytic reaction was present in all of these tumors. There were three pure LELCA and six predominant LELCA with a concurrent transitional cell carcinoma (TCC). The remainder four cases had a focal LELCA component admixed with TCC. Immunohistochemistry showed LELCA to be reactive against epithelial membrane antigen and several cytokeratins (CKs; AE1/AE3, AE1, AE3, CK7, and CK8). CK20 and CD44v6 stained focally. The lymphocytic component was composed of a mixture of T and B cells intermingled with some dendritic cells and histiocytes. Latent membrane protein 1 (LMP1) immunostaining 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 patients with pure and 66% with predominant LELCA were alive, while all patients having focal LELCA died of disease. Our data suggest that pure and predominant LELCA of the bladder appear to be morphologically and clinically different from other bladder (undifferentiated and poorly differentiated conventional TCC) carcinomas and should be recognized as separate clinicopathological variants of TCC with heavy lymphocytic reaction relevant in patient management.

These results are protected by a patent at the Spanish Office of Patents and Trademarks (Reference: P201131992) Objective• To determine the efficacy of coenzyme Q10 (CoQ10) in preventing renal injury in patients with lithiasis undergoing extracorporeal shockwave lithotripsy (ESWL). Patients and Methods• Prospective, randomised, double-blind, placebo-controlled clinical trial of 100 patients with renal lithiasis who were treated with ESWL.• The patients were distributed randomly into two groups receiving either placebo or CoQ10 (200 mg/day), a powerful antioxidant with vasoactive properties, orally administered during the week before ESWL and for 1 week after.• Renal dysfunction markers, vasoactive hormones, oxidative stress, plasma levels of several interleukins and vascular resistance index (VRI) using Doppler ultrasound were evaluated the week before ESWL, 2 h before ESWL and at 2 h, 24 h and 7 days after ESWL. Results• There was a significant increase in glomerular filtration (P = 0.013), as well as a decrease in the albumin/creatinine ratio and the β2-microglobulin level (P = 0.02) after 1 week of treatment in the CoQ10 group. These changes were maintained at the follow-up after ESWL.• The administration of CoQ10 was associated with improvement in vasoactive hormone parameters, VRI and interleukin levels. These improvements were maintained until the end of the follow-up period.• However, the administration of CoQ10 was not associated with significant changes in the oxidative stress parameters. Conclusion• Our results indicate that CoQ10 administration improves renal function and vasoactive and inflammation parameter values, allowing for preconditioning before the tissue insult caused by ESWL.

Context Recent studies emphasize the importance of considering the metabolic status to develop personalized medicine approaches. This is especially relevant in prostate cancer (PCa), wherein the diagnostic capability of PSA dramatically drops when considering patients with PSA levels ranging 3-10 ng/mL, the so-called “grey-zone”. Hence, additional non-invasive diagnostic and/or prognostic PCa biomarkers are urgently needed, especially in the metabolic-status context. Objective To assess the potential relation of urine In1-ghrelin (a ghrelin splicing variant) levels with metabolic-related/pathological conditions (e.g. obesity/diabetes/BMI/insulin-glucose levels), and to define its potential clinical value in PCa (diagnostic/prognostic capacity) and relationship with PCa-risk in patients with PSA in the grey-zone. Methods Urine In1-ghrelin levels were measured by radioimmunoassay in a clinically/metabolically/pathologically well-characterized cohort of patients without (n=397) or with (n=213) PCa with PSA in the grey-zone. Results Key obesity-related factors associated with PCa-risk (BMI/diabetes/glucose/insulin) were strongly correlated to In1-ghrelin levels. Importantly, In1-ghrelin levels were higher in PCa patients compared to control patients (with suspect of PCa but negative-biopsy). Moreover, high In1-ghrelin levels were associated with increased PCa-risk and linked to PCa-aggressiveness (e.g. tumour-stage/lymphovascular-invasion). In1-ghrelin levels added significant diagnostic value to a clinical model consisting of age, suspicious-DRE, previous-biopsy, and PSA levels. Furthermore, a multivariate model consisting of clinical and metabolic variables, including In1-ghrelin levels, showed high specificity and sensitivity to diagnose PCa (AUC=0.740). Conclusions Urine In1-ghrelin levels are associated with obesity-related factors and PCa risk/aggressiveness, and could represent a novel and valuable non-invasive PCa biomarker, as well as a potential link in the pathophysiological relationship between obesity and PCa.

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