Amin M B, Ro J Y, Lee K M, Ordóñez N G, Dinney C P, Gulley M L, Ayala A G
Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston 77030.
Am J Surg Pathol. 1994 May;18(5):466-73. doi: 10.1097/00000478-199405000-00005.
We report the cases of 11 patients who were treated for undifferentiated carcinoma of the urinary bladder with a prominent lymphoid stroma (lymphoepithelioma-like carcinoma [LELC]). The chief complaint of all 11 patients was hematuria. Their ages ranged from 52 to 79 years (mean of 67). All tumors except one invaded the muscle wall and showed the typical syncytial growth pattern of undifferentiated cells with ill-defined cytoplasmic borders, prominent nucleoli, and numerous mitoses. A significant lymphocytic reaction was an essential component of all these tumors. There were three pure LELC tumors without concurrent invasive transitional-cell carcinoma (TCC) or TCC in situ; these cases morphologically simulated large-cell lymphoma. The remainder were mixed TCC and LELC (five predominant and three focal LELC). The tumor cells were immunoreactive for keratin and showed negative results for leukocyte common antigen. The lymphoid population was an admixture of T cells and B cells with a predominance of T cells. Seven patients (four with predominant and three with focal LELC) were treated with various therapeutic methods. Four patients (three with pure and one with predominantly LELC) received only chemotherapy after transurethral resection of the tumor, and follow-up found no evidence of disease for 9-72 months (mean of 38 months). Awareness of an LELC component in a urinary bladder tumor is also important in order to avoid misinterpreting these tumors as malignant lymphoma or severe chronic cystitis. Our data suggest that the pure LELC tumor appears to be morphologically and clinically different from TCC and that it merits recognition as a separate clinicopathologic entity. In addition, there is strong suggestive evidence that it responds to chemotherapy and therefore there is the potential of salvaging bladder function.
我们报告了11例接受治疗的膀胱未分化癌患者,其具有显著的淋巴样间质(淋巴上皮瘤样癌[LELC])。11例患者的主要症状均为血尿。他们的年龄在52岁至79岁之间(平均67岁)。除1例肿瘤外,所有肿瘤均侵犯肌层,并呈现未分化细胞典型的合体细胞生长模式,细胞边界不清、核仁突出且有大量核分裂象。显著的淋巴细胞反应是所有这些肿瘤的重要组成部分。有3例单纯LELC肿瘤,无同时存在的浸润性移行细胞癌(TCC)或原位TCC;这些病例在形态上类似大细胞淋巴瘤。其余为TCC与LELC混合性肿瘤(5例以LELC为主,3例为局灶性LELC)。肿瘤细胞对角蛋白呈免疫反应性,对白血细胞共同抗原呈阴性结果。淋巴样细胞群体为T细胞和B细胞的混合,以T细胞为主。7例患者(4例以LELC为主,3例为局灶性LELC)接受了各种治疗方法。4例患者(3例单纯LELC,1例以LELC为主)在经尿道肿瘤切除术后仅接受了化疗,随访发现9至72个月(平均38个月)无疾病证据。认识膀胱肿瘤中的LELC成分对于避免将这些肿瘤误诊为恶性淋巴瘤或严重慢性膀胱炎也很重要。我们的数据表明,单纯LELC肿瘤在形态和临床上似乎与TCC不同,值得作为一个单独的临床病理实体来认识。此外,有强有力的提示性证据表明它对化疗有反应,因此有挽救膀胱功能的潜力。