Rare primary lymphoepithelioma-like carcinoma of the renal pelvis

Abstract

Lymphoepithelioma-like carcinoma (LELC) is a rare, malignant epithelial tumour which can arise within the upper urinary tract. This letter adds to a previous systematic review and cumulative analysis of 28 published upper urinary tract-LELC cases which provided insight into this disease; however, the current evidence does not provide clinicians with clear guidelines due to its rarity. Therefore, the aim was to report a new case of renal pelvis LELC presented in our hospital. In this instance, we were able to report treatment experience and long-term follow-up results. This patient presented with hypertension and haemturia which initiated further investigation. While ultrasound identified an hypechoic mass, no malignant cells were detected using cytological testing. Abdominal magnetic resonance imaging identified a slightly enhanced mass in the left renal pelvis with no evidence of lymph node metastasis. Ureteroscopic tumor biopsy suggested the existence of urothelial carcinoma, hence, laparoscopic radical left nephroureterectomy with bladder cuff excision was performed. Through patient-practitioner consultations, we decided to adopt a "watch and wait" approach after radical nephroureterectomy rather than administering chemotherapy. Although, we would encourage clinicians to record and publish cases to garner insight into this type of malignant disease.

Keywords: Case report; Lymphoepithelioma-like carcinoma; Prognosis; Radical nephroureterectomy; Treatment; Upper urinary tract.

Figure 1

Clinical imaging and pathological features. A: Magnetic resonance imaging showing a slightly enhancing lesion within the left renal pelvis; B: Haematoxylin and eosin staining showing abundant lymphoid stroma surrounding the large polygonal tumour cells; C: Diffuse cytokeratin 7 immunoreactivity highlighting the epithelial component of the tumour; D: Immunohistochemical staining showing tumour cell without Epstein-Barr virus present.