Carcinoma linfoepitelial del tracto urinario. Presentación de dos casos y revisión de la literatura

espanolOBJETIVO: Presentar dos casos de pacientes diagnosticados de carcinomas linfoepiteliales del tracto urinario. Realizamos una revision de la literatura de esta infrecuente entidad, con el fin de aclarar las caracteristicas clinicas y terapeuticas. METODOS: Revision retrospectiva de la historia clinica de dos pacientes diagnosticados de carcinomas linfoepiteliales, uno en pelvis renal y el otro en vejiga. RESULTADOS: Caso 1: Mujer de 74 anos. Se le realiza una nefrectomia radical izquierda y linfadenectomia retroperitoneal por carcinoma de pelvis renal tipo linfoepitelioma like puro, estadio pT4R0pN1cM0. Recibe quimioterapia adyuvante. A los cinco anos presenta recidiva tumoral en el meato ureteral izquierdo que se reseca; es informado como carcinoma uroterial de alto grado, con marcado componente linfoide, estadio pT1. Al ano de seguimiento de la recidiva la paciente se encuentra asintomatica y sin recaida local ni a distancia. Caso 2: Varon de 82 anos diagnosticado de carcinoma vesical infiltrante. Se le realiza una cistoprostatectomia radical con linfadenectomia pelvica y derivacion urinaria. El resultado es un carcinoma urotelial de vejiga tipo linfoepitelioma- like puro, estadio pT4aR1pN2cM0. A los seis meses se objetiva la aparicion de metastasis de organos solidos y ganglionares. Actualmente se encuentra con tratamiento sintomatico de su enfermedad. CONCLUSIONES: Destacar la importancia clinica que implica el diagnostico de esta entidad, ya que puede influir en el tratamiento y la supervivencia especifica de la enfermedad, siendo el carcinoma uroterial concomitante el que marque el pronostico. El papel que desempenan las tinciones inmunohistoquimicas es fundamental, ya que nos permiten confirmar la presencia del componente epitelial. EnglishOBJECTIVE: We report two cases of patients diagnosed with lymphoepithelioma-like carcinomas of the urinary tract. We review the literature of this rare entity. The objective is to clarify the clinical and therapeutic characteristics. METHODS: We present a retrospective review of medical records of two patients diagnosed with lymphoepithelioma-like carcinomas, one in the renal pelvis and the other in the bladder. We review the epidemiology, diagnosis and therapeutic alternatives. RESULTS: Case 1: A 74-year-old women with past medical history of left radical nephrectomy and retroperitoneal lymphadenectomy six years before for renal pelvis carcinoma type pure lymphoepithelioma-like, stage pT4R0pN1cM0. She received adjuvant chemotherapy with Cisplatin and Gemcitabine. Five years later, she presented tumor recurrence in the left ureteral meatus, this lesion was resected. The pathology reported a high-grade urothelial carcinoma with marked lymphoid component, stage pT1. At follow-up, one year after the last recurrence, the patient was asymptomatic. In tomography control, no local or distant recurrences were objectified. Case 2: A 82-year-old men with diagnosis of muscle-invasive bladder cancer. The tumor caused right obstructive uropathy without extracapsular, regional or remote extension. We performed a radical cystoprostatectomy with bilateral pelvic lymphadenectomy and urinary diversion type cutaneous transureterostomy. The pathology reported a urothelial bladder carcinoma type mixed lymphoepithelioma-like, stage pT4aR1pN2cM0. At six months follow-up, the patient had liver and spleen lesions and retroperitoneal adenopathic nodes, all suggestive of metastases. He is currently receiving symptomatic treatment of their disease. CONCLUSIONS: We emphasize the clinical importance involved in the diagnosis of this entity. The diagnosis influence the aggressiveness of treatment and disease-specific survival. Therefore, concomitant transitional cell carcinoma defines the prognosis. The role of immunohistochemical staining is fundamental, allowing us to confirm the presence of the epithelial component.