[Bladder lymphoepithelioma-like carcinoma. Bibliographic review and case report].

OBJECTIVE: Lymphoepithelial-carcinoma or lymphoepithelioma-like carcinoma is a rare tumour, the histology of which remembers nasal pharyngeal is lymphoepitheliomas. Their presence has been described in multiple localizations, but only 55 cases have been described in the bladder. We present a new case of bladder lymphoepithelial carcinoma and performed a review of all published cases, with the aim of defining its characteristics and try to obtain a therapeutic and prognostic guide applicable to this disease.
METHODS: We reviewed the literature related to lymphoepithelial carcinoma and epidemiological characteristics, treatments administered, and outcomes of the 56 published cases (including ours) have been analyzed, both globally and as a function of histological subtypes following the classification of Amin et al.
RESULTS: 56 cases have been described, 40 males and 16 women, with a mean age of 69 years. Nineteen of the pure subtype (33.9%), 20 of the predominant type (35.7%) and 11 focal (19.6%) were diagnosed, without any indications of histology in six of them (10.7%). Regarding tumor stages: 10.7% (6) were T1, 57.1% (32) T2, and 30.4% (17) T3. 58.9% of the cases underwent transurethral resection (TUR), 35.7% radical cystectomy, and 5.4% partial cystectomy. 42.9% did not receive any adjuvant treatment, 30.4% received chemotherapy, and 19.6% radiotherapy. Overall survival was 67.9%, 64.3% disease-free, with a mean and median follow up of 34.5 and 25 months respectively. If we differentiate histological subtypes, 84.3% of the pure, 100% of the predominant, and 76.7% of focal presented infiltration (T2/T3). 78.9% of the pure, 45% of the predominant and 45.5% of the focal underwent TUR. 83% of the pure receive adjuvant treatment, whereas 60% of the predominant and 63% of the focal types did not receive any adjuvant treatment. Disease-free survival for stages T2/T3 was 87.5% for the pure with a median follow up of 39 months, 75% for the predominant with a median follow-up of 22 months and 0% for the focal with a median followup of 18 months.
CONCLUSIONS: Currently, no specific therapeutic protocol can be established for patients with bladder lymphoepithelial carcinoma, although taking into consideration the apparent good outcome of the pure and predominant subtypes and the bad outcome of the focal subtype, it seems that TUR may be a good alternative in selected patients with pure our predominant histology, even with infiltrative stages. Oppositely, radical treatment with cystectomy and systemic adjuvant treatment seems to be the best choice for focal subtypes.