In this report, we summarized the clinicopathologic features of ten cases of lymphoepithelioma-like carcinoma (LELC) of the upper urinary tract (ureter n = 6; renal pelvis n = 4), a rare variant of urothelial cancer characterized by a malignant epithelial component densely infiltrated by lymphoid cells. The initial diagnosis was made on radical nephrectomy in five cases, nephroureterectomy in three cases, and ureterectomy in two others. Four patients had pathologic stage T1 (n = 2) or T2 (n = 2) tumors, and six patients had stage pT3 disease. Microscopically, all tumors contained pure (n = 3) or predominant (n = 7) LELC, which composed 60 to 80% of the entire tumor. Non-LELC tumor component was adenocarcinoma (n = 2), spindle cell carcinoma (n = 1), or high-grade conventional urothelial carcinoma (n = 4). The LELC component was characterized by indistinct cytoplasmic borders and a syncytial growth pattern. Immunohistochemical staining showed LELC to be positive for cytokeratin AE1/AE3, CK7, CK34ßE12 (rare cells), CK5/6 (rare cells), and CK20 (rare cells); rare cells were p40 positive. GATA 3 was positive in all cases in a variable proportion of cells (20-80%). Lymphoid markers showed a polyclonal proliferation of predominant T cells admixed with B cells. In situ hybridization for the HPV genome was negative in all ten cases. Survival analysis showed no differences between LELC and conventional upper urinary tract urothelial carcinoma, pT classification being the only significant prognostic parameter. Morphologic recognition and distinction from other (non-)neoplastic lesions with prominent lymphoid stroma are critical for its clinical management.
Virchows Archiv : an international journal of pathology. 2017 Apr 28 [Epub]
Antonio Lopez-Beltran, Gladell Paner, Ana Blanca, Rodolfo Montironi, Toyonori Tsuzuki, Yoji Nagashima, Shi-Sung Chuang, Khin Than Win, Leo Madruga, Maria R Raspollini, Liang Cheng
Department of Pathology and Surgery, Unit of Anatomical Pathology, Faculty of Medicine, University of Cordoba, 14004, Cordoba, Spain. ., Section of Urology, Departments of Pathology and Surgery, University of Chicago, Chicago, IL, USA., Biomedical Research Unit, Reina Sofia University Hospital, Cordoba, Spain., Section of Pathological Anatomy, School of Medicine, Polytechnic University of the Marche Region, Ancona, Italy., Department of Surgical Pathology, Aichi Medical University, School of Medicine, Yazakokarimata, Nagakute, Japan., Department of Surgical Pathology, Tokyo Women's Medical University Hospital, Tokyo, Japan., Department of Pathology, Chi-Mei Medical Center, Tainan, Taiwan., Pathology Service, Champalimaud Clinical Center, Lisbon, Portugal., Histopathology and Molecular Diagnostics, University Hospital Careggi, Florence, Italy., Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.