147 Archivio Italiano di Urologia e Andrologia 2016; 88, 2 CASE REPORT Lymphoepithelioma-like carcinoma of the bladder: A case report Konstantinos Stamatiou 1 , Georgios Christopoulos 2 , Aikaterini Tsavari 3 , Kallirhoe Koulia 3 , Kassiani Manoloudaki 3 , Thivi Vassilakaki 3 1 Urology Department, Tzaneio Hospital Pireas, Greece; 2 Department of Internal Medicine, Tzaneio Hospital Pireas, Greece; 3 Pathology Department, Tzaneio Hospital Pireas, Greece. Lymphoepithelioma is a rare histological type of low differentiated carcinoma of the nasopharyngeal region characterized by marked infiltra- tion of lymphocytes in the area involved by tumor. However, carcinomas with this peculiar morphologic feature have been also described in various anatomic locations and they are generally designated «lymphoepithelioma-like carcinomas». Those of the urinary bladder are uncommon as they account of 0.4%-1.3% of all bladder carcinomas. They may coexist with the conventional urothelial carcinoma. Given their rari- ty, there is poor information regarding their behaviour. Here we present a new case of lymphoepithelioma-like carci- noma in the bladder and we discuss its characteristics and prognosis. KEY WORDS: Lymphoepithelioma-like carcinoma; Bladder; Prognosis. Submitted 24 April 2015; Accepted 21 May 2015 Summary No conflict of interest declared. according to the percentance of lymphoepithelioma com- ponent within the tumor. Therefore three types of LELC are described: pure (100%), predominant (> 50%), or focal (< 50%) (3). Their occurrence in the urinary system is very rare and in fact, the reported incidence of LELC in the bladder is between 0.4% and 1.3% of all bladder car- cinomas (4). CASE PRESENTATION A 67-year-old woman suffering from recurrent urinary tract infections presented with macroscopic hematuria for 2 months. Urinalysis was non diagnostic for infection while urine cytology analysis showed markedly atypical urothelial cells. The patient underwent cystoscopic examination, which revealed a large tumor with mixed - polypoid and solid- morphology, located in the right lat- eral wall, the trigon and the dome of the bladder. A com- puted tomography (CT) scan suggested locally advanced disease (Figure 1) however no lymph node involvement, non distant metastasis, and no hydronephrosis were shown. She refused surgical intervention; however, she subsequently agreed to receive treatment after an episode DOI: 10.4081/aiua.2016.2.147 INTRODUCTION Lymphoepithelioma also known as “class III nasopharyn- geal carcinoma” is a rare form of undifferentiated carci- noma of the nasopharyngeal region that is considered a variant of undifferentiated non-keratinizing squamous cell carcinoma. It is characterized by excess inflammato- ry infiltrate of lymphocytes which appears to be inti- mately admixed with the carcinomatous cells. The last are large with vesicular nuclei and prominent nucleoli that are arranged in a dense growth pattern. This tumor displays a strong association with the Epstein Barr virus infection and its incidence exhibits a remarkable geo- graphic variation (1, 2). Reason explaining the above peculiarity is practically unknown. Lymphoepithelioma-like carcinomas (LELC) arise out- side of the nasopharynx, but resemble a lymphoepithe- lioma both morphologically and histologically. They may be found in almost any organ containing epithelial tissue such as the lung, thymus, breast, colon, endometrium, prostate, and skin, as well as urinary bladder, trachea, esophagus, stomach, salivary glands, vulva (3). They may coexist with the conventional adenocarcinomas of the abovementioned organs and therefore they are classified Figure 1. Computed tomography (CT) scan suggested locally advanced disease.