Lymphoepithelioma-like carcinoma of the urinary bladder

Lymphoepithelioma-like carcinomas (LELCAs) of the urinary bladder are rare. We report 2 such cases presenting with painless gross hematuria. The first case occurred in a 73-year-old man. Bladder sonography revealed a 2 x 3 cm well-defined tumor beneath the bladder mucosa. Radical cystoprostatectomy revealed lymphoepithelioma-like carcinoma with perivesical soft tissue invasion. Cisplatin-based chemotherapy was given. Computed tomography scan demonstrated no evidence of recurrence 26 months postoperatively. The second case occurred in a 63-year-old man. Cystoscopy revealed a solid tumor at the bladder dome. Transurethral resection of bladder tumor (TUR-BT) demonstrated lymphoepithelioma-like carcinoma with lamina propria invasion. Tumor cells were positive for cytokeratin but negative for leukocyte common antigen. The patient received adjuvant chemotherapy due to suspicious extravesical tumor spread and high-grade tumor characteristics. After tumor recurrence was identified, TUR-BT was performed again and the surgical specimen showed superficial high-grade LELCA. After bacillus Calmette-Guerin instillation, follow-up cystoscopy revealed no recurrence at 10 months postoperatively. Pure LELCA is morphologically different from transitional cell carcinoma and has a more favorable prognosis than high-grade, invasive bladder carcinoma if managed appropriately.