Objective: We report two cases of patients diagnosed with lymphoepithelioma-like carcinomas of the urinary tract. We review the literature of this rare entity. The objective is to clarify the clinical and therapeutic characteristics.
Methods: We present a retrospective review of medical records of two patients diagnosed with lymphoepithelioma-like carcinomas, one in the renal pelvis and the other in the bladder. We review the epidemiology, diagnosis and therapeutic alternatives.
Results: Case 1: A 74-year-old women with past medical history of left radical nephrectomy and retroperitoneal lymphadenectomy six years before for renal pelvis carcinoma type pure lymphoepithelioma-like, stage pT4R0pN1cM0. She received adjuvant chemotherapy with Cisplatin and Gemcitabine. Five years later, she presented tumor recurrence in the left ureteral meatus, this lesion was resected. The pathology reported a high-grade urothelial carcinoma with marked lymphoid component, stage pT1. At follow-up, one year after the last recurrence, the patient was asymptomatic. In tomography control, no local or distant recurrences were objectified. Case 2: A 82-year-old men with diagnosis of muscleinvasive bladder cancer. The tumor caused right obstructive uropathy without extracapsular, regional or remote extension. We performed a radical cystoprostatectomy with bilateral pelvic lymphadenectomy and urinary diversión type cutaneous transureterostomy. The pathology reported a urothelial bladder carcinoma type mixed lymphoepithelioma-like, stage pT4aR1pN2cM0. At six months follow-up, the patient had liver and spleen lesions and retroperitoneal adenopathic nodes, all suggestive of metastases. He is currently receiving symptomatic treatment of their disease.
Conclusions: We emphasize the clinical importance involved in the diagnosis of this entity. The diagnosis influence the aggressiveness of treatment and disease-specific survival. Therefore, concomitant transitional cell carcinoma defines the prognosis. The role of immunohistochemical staining is fundamental, allowing us to confirm the presence of the epithelial component.