案例報告:腎盂類淋巴上皮瘤樣尿路上皮癌

葉星佐、沈元琦

高雄長庚紀念醫院泌尿科

Case Report: Lymphoepithelioma-Like Urothelial Carcinoma of the Renal Pelvis

Hsing-Tsuo, Yeh, Yuan-Chi Shen

Kaohsiung Chang Gung Memorial Hospital, Department of Urology

Introduction:  Lymphoepithelioma-like carcinoma (LELC) is a rare histologic variant of urothelial carcinoma characterized by poorly differentiated epithelial cells accompanied by dense lymphoid infiltration resembling nasopharyngeal lymphoepithelioma. Although LELC has been reported in several organs, involvement of the urinary tract is uncommon and occurs most frequently in the bladder. LELC arising from the upper urinary tract, particularly the renal pelvis, is exceedingly rare. Because of its rarity, the clinical behavior and optimal management remain incompletely defined. Here, we present a case of locally advanced lymphoepithelioma-like urothelial carcinoma of the renal pelvis that demonstrated a favorable response to chemotherapy.

Case Report:  An 87-year-old woman with a history of hypertension and chronic kidney disease presented with one month of gross hematuria. She denied fever, abdominal pain, or constitutional symptoms. Renal ultrasonography revealed right hydronephrosis, and cystoscopy showed no bladder tumor. Non-contrast abdominal CT demonstrated a 3.3-cm soft-tissue mass in the right renal pelvis with marked hydronephrosis, suspicious for upper tract urothelial carcinoma.

            The patient underwent right hand-assisted retroperitoneoscopic nephroureterectomy with bladder cuff excision. Pathologic examination revealed a 5.5-cm high-grade urothelial carcinoma of the renal pelvis with lymphoepithelioma-like features, characterized by syncytial sheets of poorly differentiated tumor cells accompanied by dense lymphoid infiltration. The tumor invaded the peripelvic fat and renal parenchyma, consistent with pathologic stage pT3Nx. Surgical margins, ureter, and bladder cuff were negative.

            Postoperatively, the patient received adjuvant chemotherapy with gemcitabine and carboplatin. Treatment was complicated by episodes of leukopenia requiring dose adjustment and granulocyte colony-stimulating factor support, but she completed four cycles of therapy. Follow-up CT imaging four months after surgery showed no evidence of disease recurrence.

Discussion: Primary lymphoepithelioma-like carcinoma (LELC) of the upper urinary tract is an exceptionally rare urothelial carcinoma variant characterized by undifferentiated epithelial cells within a dense lymphoid stroma. Despite locally advanced features—as seen in our patient—pure and predominant LELC subtypes generally demonstrate a favorable prognosis, likely due to the robust anti-tumor host immune response. Radical nephroureterectomy remains the standard of care. Furthermore, our patient’s disease-free survival highlights that adjuvant platinum-based chemotherapy can be an effective adjunct for advanced stages, even in elderly populations.