Venkatesh Siddharth, Costanza John S, Cox Bettye, Finch Chris, Xu Ya
Baylor College of Medicine, Houston, Texas, USA.
Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas, USA.
Case Rep Pathol. 2025 Aug 21;2025:9068792. doi: 10.1155/crip/9068792. eCollection 2025.
Lymphoepithelioma-like urothelial carcinoma (LELUC) and plasmacytoid urothelial carcinoma (PUC) are rare subtypes. We report a case of simultaneous urothelial carcinoma composed of LELUC and PUC subtypes, along with prostatic adenocarcinoma, with successful clinical management by immunotherapy. The patient, a 54-year-old man with a 40 pack-year smoking history, presented with gross hematuria and dysuria. Imaging revealed focal bladder wall thickening. The patient underwent transurethral resection of bladder tumor (TURBT), followed by cystoprostatectomy. The TURBT revealed LELUC, with muscle invasion. The subsequent cystoprostatectomy specimen displayed a 6.0 cm ulcerative mass, which had focal penetration through the urinary bladder wall. Microscopically, the tumor consisted of sheets of enlarged and pleomorphic tumor cells, mixed with a lymphoplasmacytic infiltrate. Focal plasmacytoid and occasional signet ring cell-like morphologies were observed. Rare tumor cells showed positivity for GATA-3 and p63 immunostains, while the plasmacytoid tumor cells exhibited loss of E-cadherin expression. Additionally, adenocarcinoma of the prostate was present, with a Gleason score of 3 + 3, involving 2% of the prostate tissue. The diagnoses of LELUC, comprising 95% of the tumor, PUC, comprising 5%, and prostatic adenocarcinoma were made. Molecular studies revealed a high tumor mutational burden, and the tumor exhibited PD-L1 expression. The patient received adjuvant immunotherapy with Pembrolizumab and showed no evidence of disease for 3 years up to the time of this report. Morphologic recognition of the various subtypes of urothelial carcinoma, supported by immunohistochemistry, is essential for the proper clinical management of patients. A search of the literature on PubMed revealed no similar cases.
淋巴上皮瘤样尿路上皮癌（LELUC）和浆细胞样尿路上皮癌（PUC）是罕见的亚型。我们报告了一例同时存在LELUC和PUC亚型的尿路上皮癌病例，同时伴有前列腺腺癌，通过免疫治疗获得了成功的临床管理。患者为一名54岁男性，有40年40包年的吸烟史，表现为肉眼血尿和尿痛。影像学检查显示膀胱壁局灶性增厚。患者接受了经尿道膀胱肿瘤切除术（TURBT），随后进行了膀胱前列腺切除术。TURBT显示为LELUC，伴有肌层浸润。随后的膀胱前列腺切除标本显示一个6.0厘米的溃疡性肿块，局部穿透膀胱壁。显微镜下，肿瘤由成片的增大且多形性的肿瘤细胞组成，伴有淋巴细胞和浆细胞浸润。观察到局灶性浆细胞样形态和偶尔的印戒样细胞形态。罕见的肿瘤细胞GATA-3和p63免疫染色呈阳性，而浆细胞样肿瘤细胞E-钙黏蛋白表达缺失。此外，存在前列腺腺癌，Gleason评分为3+3，累及2%的前列腺组织。做出了诊断，其中LELUC占肿瘤的95%，PUC占5%，还有前列腺腺癌。分子研究显示肿瘤突变负荷高，且肿瘤表现出PD-L1表达。患者接受了帕博利珠单抗辅助免疫治疗，截至本报告时，3年内无疾病证据。在免疫组化的支持下，对尿路上皮癌各种亚型的形态学识别对于患者的正确临床管理至关重要。在PubMed上检索文献未发现类似病例。
