Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2020; 8(19): 4505-4511
Published online Oct 6, 2020. doi: 10.12998/wjcc.v8.i19.4505
Eight-year follow-up of locally advanced lymphoepithelioma-like carcinoma at upper urinary tract: A case report
Che H Yang, Wei C Weng, Yi S Lin, Li H Huang, Chin H Lu, Chao Y Hsu, Yen C Ou, Min C Tung
Che H Yang, Wei C Weng, Yi S Lin, Li H Huang, Chin H Lu, Chao Y Hsu, Yen C Ou, Min C Tung, Department of Surgery, Division of Urology, Tungs’ Taichung MetroHarbor Hospital, Taichung City 435403, Taiwan
Author contributions: Yang CH was the reviewer of medical charts of this case and responsible for the original draft; Weng WC was the patient’s urologist, reviewing the literature; Ou YC provided comments to the original draft; Lin YS and Huang LH were responsible to the follow-up; Lu CH was responsible for the literature searching and the rationale on writing; Hsu CY and Tung MC were responsible for the important intellectual content and supervisor; Informed consent was conducted by Weng WC and the document was signed under the confirmation of the duty doctor.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Wei C Weng, MD, PhD, Attending Doctor, Dean, Surgeon, Surgical Oncologist, Department of Surgery, Division of Urology, Tungs’ Taichung MetroHarbor Hospital, No. 699, Sec. 8, Taiwan Blvd., Wuqi Dist, Taichung City 435403, Taiwan. wcweng27@gmail.com
Received: May 10, 2020
Peer-review started: May 10, 2020
First decision: June 7, 2020
Revised: June 18, 2020
Accepted: September 2, 2020
Article in press: September 2, 2020
Published online: October 6, 2020
Abstract
BACKGROUND

Urinary tract lymphoepithelioma-like carcinoma is rarely seen. Although it is termed after lymphoepithelioma at the nasopharynx, it behaves more like high grade urothelial carcinoma by immunohistochemical features. Most published literatures focused on its rarity but few discussed results of long-term follow-ups. As no available guidelines are applicable, we postulated that principles should be similar to that of urothelial carcinoma at urinary tract. As of now, this work features the longest follow-up of this cancer at the upper urinary tract.

CASE SUMMARY

A 63-year-old female had a chief complaint of intermittent left flank pain for 2 mo, along with accompanying symptoms including vomiting and body weight loss, about 7 kg over 2 mo. Laboratory data showed normocytic anemia, mildly poor renal function, and hyperparathyroidism. Urine analysis showed mild hematuria. Computed tomography showed a 4.2-cm-width irregular mass over left renal pelvic and enlarged lymph node at the left renal hilum. Whole-body bone scan was negative of active bone lesions. Biopsy from ureteroscopy showed urothelial carcinoma. Specimen from laparoscopic nephroureterectomy with bladder cuff resection showed lymphoepithelioma-like carcinoma with muscular invasion (pT3). She took adjuvant chemotherapies of 2 cycles and full courses of radiation therapy. No recurrence was observed with designed investigative programs.

CONCLUSION

Locally advanced urinary tract lymphoepithelioma-like carcinoma could benefit from nephroureterectomy and bladder cuff excision in terms of recurrence-free survival.

Keywords: Urologic neoplasms pathology, Kidney pelvis, Tomography X-ray computed, Carcinoma mortality, Kidney neoplasms mortality, Case report

Core Tip: Although urinary tract lymphoepithelioma-like carcinoma is rarely seen and no published guideline can be offered, we could still outline feasible principles from immunohistochemical evidence. In our previous experience, guideline of urothelial carcinoma at urinary tract can provide us a promising result. The case in this work comprises of most of the worst scenarios, including mixed histological type, muscular invasion, and involvement of lymph node. However, with left nephroureterectomy with bladder cuff resection and postoperative radiation therapy, our result stands superior to those other published literatures. Thus, in our experiences, the operative methods play the definite roles on patients’ prognosis.