External Beam Radiotherapy for Focal Lymphoepithelioma-Like Carcinoma in the Urinary Bladder: A Case Report and Literature Review

Abstract

Lymphoepithelioma is a malignant epithelial tumor in the nasopharynx characterized by prominent lymphoid infiltration. Carcinomas that resemble lymphoepitheliomas have been called lymphoepithelioma-like carcinomas and have been reported in other organs. A tumor in the bladder is categorized by the percentage of the total area occupied by the lymphoepithelioma-like carcinoma pattern, with the prognosis dependent on the percentage. We present an 81-year-old man with stage 3 chronic obstructive pulmonary disease and a history of aortic aneurysm repair. The computed tomography scans indicated thickening and irregularity of the bladder wall, with left external iliac lymph node metastasis. His diagnosis was bladder cancer, and the clinical stage was evaluated as T3N1M0. Transurethral resection of the bladder tumor was performed, and the pathological specimen showed that the tumor was composed of undifferentiated malignant cells with sheets and nests arranged in a syncytial pattern, as well as an urothelial carcinoma lesion. A prominent lymphoid reaction accompanied the tumor. The pathological diagnosis was focal-type lymphoepithelioma-like carcinoma containing a component of urothelial carcinoma G3>G2. His general condition was such that he could not tolerate radical cystectomy or systemic chemotherapy. External beam radiotherapy (total 60 Gy) was given to the bladder, including the lymph node metastatic lesion. No cancer recurrence was detected by regular follow-up computed tomography and cystoscopy. He eventually died of other causes 48 months later. Although treatment for focal lymphoepithelioma-like carcinoma generally requires multifocal therapies, in the present case, the bladder became tumor free. We also summarize previously reported lymphoepithelioma-like carcinoma cases treated with radiotherapy.

Pure Lymphoepithelioma-Like Carcinoma Originating from the Urinary Bladder

“…To date 105 cases, including this one, have been described in the English language medical literature. LELCB shows carcinomatous components contrasting with lymphocyte infiltration and mimics chronic inflammation or malignant lymphoma; immunohistochemical stains such as for cytokeratin are helpful in distinguishing between these diseases [ 6 , 7 ]. Between 1991 and June 2015, 84 cases of LELCB, according to the classification of Amin et al [ 7 ], were reported in the English language medical literature.…”

“…LELC of the urinary bladder (LELCB) is a rare variant of infiltrating urothelial carcinoma and was first described by Zukerberg et al in 1991 [ 2 ]. Including this case, there are merely 105 cases in the English language medical literature, with only 8 cases reported as originating from Asian countries [ 3 , 4 , 5 , 6 ]. In 1994, Amin et al [ 7 ] defined three types of LELCB based on the amount of LELC in the tumor – pure (100%), predominant (50–99%) and focal (<50%) –, with the three types determining a patient's prognosis.…”

Lymphoepithelioma-like carcinoma of the urinary bladder:A rare case report

“…On the other hand, focal LELC has a more aggressive character and the best management suitable for this subtype would be multifocal therapies, including radical cystectomy, adjuvant systemic chemotherapy or external beam radiotherapy, as for advanced conventional urothelial carcinoma. [ 13 ]…”

Survival Analysis of Lymphoepithelioma-Like Carcinoma of the Urinary Bladder and the Effect of Surgical Treatment Modalities on Prognosis

“…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).…”