摘要
Abstract
Objective:Lymphoepithelioma-like urothelial carcinoma(LELUC)of the urinary system is a rare malignancy.Currently,no standardized treatment strategy exists,and evidence regarding the efficacy of immune checkpoint inhibitors remains limited.This study aimed to investigate the clinicopathological features and expression of programmed death-ligand 1(PD-L1)in LELUC.
Methods:Seven patients diagnosed with LELUC at the Department of Pathology,Xijing Hospital,Air Force Medical University,from 2013 to 2025 were retrospectively analyzed.Clinical characteristics,histopathology,immunophenotype,and follow-up outcomes were reviewed,and PD-L1 expression was evaluated using immunohistochemistry.
Results:The patients were aged 65 to 73 years(mean 67 years),including 5 males and 2 females.Tumor locations included 4 cases in the renal pelvis and 3 in the bladder.Five patients presented with hematuria,while 2 were admitted due to renal space-occupying lesions detected during routine health examinations.Microscopically,tumors exhibited abundant syncytial-like cells with enlarged,highly atypical nuclei,including binucleated,multinucleated,and degenerative forms,accompanied by dense infiltration of mature lymphocytes in the stroma.Carcinoma cells were arranged in nests,sheets,clusters,or scattered singly,showing marked cytological atypia,rich eosinophilic cytoplasm,and round to oval nuclei,some displaying vacuolated morphology.Most tumor cells contained prominent nucleoli,and mitotic activity varied across cases.Three tumors were classified as pure LELUC,while 4 showed mixed components of conventional urothelial carcinoma.Immunohistochemistry revealed variable expression of GATA-binding protein 3(GATA3),cytokeratin(CK)7,and p63,while CK20 was negative in all cases.The Ki-67 proliferation index ranged from 20%to 40%.Two cases showed strong HER-2 overexpression.Epstein-Barr virus-encoded RNA(EBER)in situ hybridization was negative in all cases.PD-L1(SP263)staining demonstrated tumor cell positivity rates from 30%to 90%,and tumor-associated immune cell positivity from 45%to 70%,with extensive immune cell infiltration in all samples.Background lymphocytes were predominantly CD3-positive T cells.One patient was lost to follow-up,while 6 were followed via telephone for 2 to 100 months,among whom 4 achieved disease-free survival and 2 experienced 2 recurrences,ultimately dying from pulmonary metastases of the tumor.
Conclusion:LELUC is a rare and highly aggressive variant of urothelial carcinoma,and its prognosis requires further investigation.The high PD-L1 expression suggests that immune checkpoint inhibitor therapy may be effective in this tumor subtype.关键词
淋巴上皮瘤样尿路上皮癌/程序性死亡受体配体1/肾盂/膀胱/临床病理特征Key words
lymphoepithelioma-like urothelial carcinoma/programmed death-ligand 1/renal pelvis/bladder/clinicopathological characteristics
