Lymphoepithelioma-like variant of muscle-invasive urothelial carcinoma of the urinary bladder with complete pathological downstaging following neoadjuvant cisplatin-gemcitabine chemotherapy: A case report

ABSTRACT: Lymphoepithelioma-like carcinoma (LELC) of the urinary bladder is a rare variant of urothelial carcinoma accounting for less than 1% of all bladder malignancies, characterized by syncytially arranged tumor cells within a dense lymphoplasmacytic stroma and consistent Epstein-Barr virus (EBV) negativity. We report a male patient in his sixth decade presenting with painless gross hematuria. Cystoscopy revealed an endoscopically unresectable lateral wall bladder mass, confirmed on biopsy as muscle-invasive high-grade urothelial carcinoma, LELC variant (cT2N0M0), with moderate (2+) GATA3 positivity and negative EBER-ISH. Following three cycles of neoadjuvant cisplatin-gemcitabine chemotherapy, restaging imaging demonstrated complete clinical response (ycT0N0M0). Radical cystectomy with extended bilateral pelvic lymph node dissection and ileal conduit urinary diversion was performed. Final histopathological examination confirmed complete pathological response (ypT0N0), with fibrosis and inflammatory changes only, negative surgical margins (R0), and 10-15 tumor-free lymph nodes retrieved. This case highlights the exceptional chemosensitivity of bladder LELC to platinum-based neoadjuvant chemotherapy and underscores the necessity of proceeding with radical cystectomy despite radiological complete response.