A Rare Case of Primary Bladder Lymphoepithelial Carcinoma

Bladder cancer is a common malignant tumor of the urinary system. Although lymphoepithelial carcinoma can occur in the liver, breast, thymus, lungs, skin, and other organs, its presence in the urinary system is exceptionally rare.

We report the case of a 50-year-old man who presented to our hospital with hematuria. Urinary tract computed tomography revealed a malignant bladder tumor, with an enhancing nodule measuring 9 mm in the posterior wall of the bladder. The patient received transurethral resection of the bladder tumor, followed by arterial embolization chemotherapy and intravenous chemotherapy combined with immunotherapy successively, and finally underwent cystoscopy follow-up to monitor the condition.

After transurethral resection of the bladder tumor, immunohistochemistry revealed tumor cells appearing as syncytial bodies with unclear boundaries. The nuclei were large and vacuolated, with marked infiltration of lymphoplasmacytes observed both between and within the tumor islands. The markers were as follows: cytokeratin 7 (CK7) (+), CK20 (-), S-100 (-), prostate-specific antigen (PSA) (-), Desmin (-), Melanoma (-), Epstein-Barr virus-encoded RNA (EBER) (-), spalt like transcription factor 4 (SALL4) (-), P63 (-), CKpan (+), GATA binding protein 3 (GATA-3) (-), epithelial membrane antigen (EMA) (+), P40 (-), cluster of differentiation (CD)117 (+), CD20 (-), CD3 (-), CD30 (-), placental alkaline phosphatase (PLAP) (-), CD15 (small weak+), and Ki67 (35%+). The patient was diagnosed with lymphoepithelial carcinoma.

The patient remained recurrence-free at 11 months of follow-up after gemcitabine bladder infusion chemotherapy, arterial drug-infusion embolization, systemic chemotherapy, and immunotherapy.