Nausheen Yaqoob, Naila Kayani, Jaipal Piryani, Mohammad Nasir Sulaiman, Sheema H Hasan.
Lymphoepithelioma-like carcinoma of urinary bladder: (LELCA).
J Pak Med Assoc Jan ;55(9):402-3.

A 55 year old lady presented with the complaint of burning micturition and gross hematuria for the past 5 months. She had past medical history of sphenoid wing meningioma for which she was operated two years back with an uneventful recovery. There were no other known comorbids. There was no history of exposure to carcinogenic material or cigarette smoking. Pelvic ultrasound was normal. Cystoscopy showed a 4x4 cm sessile mass in the right superolateral wall of the bladder invading deep into the bladder muscle. The whole tumor was resected endoscopically. The specimen was sent for histopathology. Gross examination showed multiple irregular fragments of tissue measuring 5 cm in aggregate. Microscopically the tumor was composed of sheets and clusters of large epithelial cells having moderate amount of cytoplasm. The lymphoid background consisted of mature lymphocytes mixed with plasma cells. (Figure 1) Abundant mitotic figures were present. The nuclei were round to oval and vesicular with prominent nucleoli. Glycogen was identified in the epithelial cells. The tumor cells were strongly positive for epithelial markers (CK MNF (Figure 3), CK cam 5.2, CK AE1/AE3 and negative for lymphoid markers (LCA CD45;RO, Pan B;CD20 and CD79a, Pan T; UCHL1) and vimentin. Protein p53 was positive in 80-85% of the nuclei of epithelial cells and negative in the lymphoid cells. Overlying urothelium showed no dysplasia. The tumor was deeply infiltrating into the detrusor muscle. A diagnosis of lymphoepithelioma like carcinoma of the urinary bladder was made.

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