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Int J Clin Exp Pathol 2(2),194-199;2009

Case Report
Pleomorphic Lymphoepithelioma-like Carcinoma of the Urinary Bladder

Oluwole Fadare, Idris L. Renshaw and Christopher Rubin

Department of Pathology, Wilford Hall Medical Center, Lackland AFB, TX, USA; Department of Pathology, University of Texas Health Science
Center at San Antonio, San Antonio, TX, USA and 3Vanguard Pathology Associates, Austin, TX, USA

Received 3 June 2008; Accepted and available online 15 June 2008

Abstract: Lymphoepithelioma-like carcinoma (LELC) of the urinary bladder is often mixed with conventional transitional cell carcinoma and/or
other histotypes. The pathologist’s determination of the morphologic purity of a given LELC at the biopsy stage is a clinically relevant
endeavour, because there is some anecdotal evidence suggesting that pure or predominant LELC may be comparatively chemosensitive and
have a favorable prognostic profile, which may potentially offer the possibility of effective therapy without bladder resection. The precise degree
of cellular pleomorphism that is allowed in a pure LELC is unclear. We describe herein an otherwise conventional and pure LELC that showed,
in a localized area that constituted approximately 25% of the overall tumor volume, a two to six fold variation in nuclear size, including
multinucleated tumor cells. These pleomorphic areas were set in the same lymphoplasmacytic infiltrate as their conventional counterparts, and
similarly displayed cellular syncytia. We performed a detailed immunophenotypic comparison between the conventional areas and the
pleomorphic areas. No significant differences were found between the 2 areas in overall lymphoplasmacytic or histiocytic density, lymphocytic
CD4/CD8 ratio, and lymphoplasmacytic kappa/lambda ratio. Similarly, both displayed similar qualitative and quantitative staining indices for
p53, Ki67, cytokeratin AE1/AE3 and p16INKa. Scattered cells were cytoplasmically beta-catenin positive exclusively in the pleomorphic areas;
however these cells were not notably larger than the cells in the conventional areas. Both components were immunohistochemically negative
for HMB-45, CD1a, the estrogen receptor, Epstein-Barr virus, CD117, D2-40, CD56, cytokeratin 20 and chromogranin. Clinicopathologic
analysis of a series of cases is required to establish if there is any significance to nuclear pleomorphism in LELC. However, the phenotypic
similarity between the 2 areas in this case, the intimate admixture of the pleomorphic cells with the lymphoplasmacytic infiltrate, and their
syncytial pattern of growth, all suggest that pure LELC may display marked nuclear pleomorphism, and that this finding may not, in of itself, be a
valid basis for removing a case from the “pure” group.(IJCEP806002).

Key Words: Bladder, lymphoepithelioma, lymphoepithelioma-like

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Address all correspondence to: Oluwole Fadare, MD, Wilford Hall Medical Center Department of Pathology, 2200 Bergquist Dr., Ste 1,
Lackland AFB, TX 78236, USA, Email address: