Carcinoma vesical linfoepitelioma-like: revisión de la literatura y aportación de un nuevo caso

Abstract

Resumen.-OBJETIVO: El carcinoma linfoepitelial o carcinoma linfoepitelioma-like es un raro tumor cuya histología recuerda a los linfoepiteliomas de la nasofaringe. Se ha descrito su presencia en múltiples localizaciones, pero en la vejiga tan sólo se han descrito 55 casos en la literatura. Presentamos un nuevo caso de carcinoma linfoepitelial vesical y hacemos una revisión de todos los publicados anteriormente, con la intención de definir sus características e intentar obtener una pauta terapéutica y pronóstica aplicable a esta patología.Summary.-OBJECTIVE: Lymphoepithelial-carcinoma or lymphoepithelioma-like carcinoma is a rare tumour, the histology of which remembers nasal pharyngeal is lymphoepitheliomas. Their presence has been described in multiple localizations, but only 55 cases have been described in the bladder. We present a new case of bladder lymphoepithelial carcinoma and performed a review of all published cases, with the aim of defining its characteristics and try to obtain a therapeutic and prognostic guide applicable to this disease. METHODS: We reviewed the literature related to lymphoepithelial carcinoma and epidemiological characteristics, treatments administered, and outcomes of the 56 published cases (including ours) have been analyzed, both globally and as a function of histological subtypes following the classification of Amin et al. RESULTS: 56 cases have been described, 40 males and 16 women, with a mean age of 69 years. Nineteen of the pure subtype (33.9%), 20 of the predominant type (35.7%) and 11 focal (19.6%) were diagnosed, without any indications of histology in six of them (10.7%). Regarding tumor stages: 10.7% (6) were T1, 57.1% (32) T2, and 30.4% (17) T3. 58.9% of the cases underwent transurethral resection (TUR), 35.7% radical cystectomy, and 5.4% partial cystectomy. 42.9% did not receive any adjuvant treatment, 30.4% received chemotherapy, and 19.6% radiotherapy. Overall survival was 67.9%, 64.3% disease-free, with a mean and median follow up of 34.5 and 25 months respectively. If we differentiate histological subtypes, 84.3% of the pure, 100% of the predominant, and 76.7% of focal presented infiltration (T2/T3). 78.9% of the pure, 45% of the predominant and 45.5% of the focal underwent TUR. 83% of the pure receive adjuvant treatment, whereas 60% of the predominant and 63% of the focal types did not receive any adjuvant treatment. Disease-free survival for stages T2/T3 was 87.5% for the pure with a median follow up of 39 months, 75% for the predominant with a median follow-up of 22 months and 0% for the focal with a median follow-up of 18 months.CONCLUSIONS: Currently, no specific therapeutic protocol can be established for patients with bladder lymphoepithelial carcinoma, although taking into consideration the apparent good outcome of the pure and predominant subtypes and the bad outcome of the focal subtype, it seems that TUR may be a good alternative in selected patients with pure our predominant histology, even with infiltrative stages. Oppositely, radical treatment with cy...

Lymphoepithelioma-Like Carcinoma of the Bladder: A Case Report of a Rare and Particular Variant of Urothelial Carcinoma

“…This has been explicated by several authors who analyzed the lymphoid inflammatory component in LELCB by the importance of the inflammatory infiltrate and cytotoxic T-lymphocytes reflecting the strong immune response against the tumor cells and potentiating the effect of chemotherapy and radiotherapy [ 10 , 11 , 15 ].…”

Lymphoepithelioma-like carcinoma of the bladder: a case report

“…The lymphoepithelial carcinoma of the nasopharynx is strongly associated with infection with the Epstein–Barr virus (EBV). However, no risk factor is known for LELC of the bladder [ 4 ]; the average age of patients was 65 years with a sex ratio (M:F) of 2:5 [ 4 ].…”

“…Serrano et al [ 4 ] reported a recurrence-free survival in 87.5% of patients who had a pure form and stages T2 or T3. The prognosis of pure forms is linked to the importance of the inflammatory infiltrate and cytotoxic T lymphocytes for two reasons: early onset of symptoms causing patients to seek care, and strengthening the action of substances used in chemotherapy [ 4 ].…”