Tumor vesical linfoepitelioma-like. Una variante infrecuente / Lymphoepithelioma-like bladder tumor. A rare variant

INTRODUCCIÓN: La diferenciaciónlinfoepitelioma-like es una variante histológica pocofrecuente del carcinoma urotelial vesical, por lo que supronóstico y tratamiento no está claramente definido.Se presenta un estudio retrospectivo de 5 casos en losúltimos 10 años en nuestro centro.DESCRIPCIÓN DE CASOS: en 4 de los casos se realizó cistectomía por ser tumores músculo-invasivosno metastásicos al diagnóstico, en el 5º RTU + BCGpor ser no músculo-invasivo. 2 pacientes recibieronquimioterapia y 1 radioterapia en adyuvancia, y 1 inmunoterapia tras recidiva. 2 presentaban un patrónlinfoepitelioma-like puro, 2 predominante y 1 focal.DISCUSIÓN: en formas predominantes o puras seha descrito buena respuesta al tratamiento con RTU yquimioterapia adyuvante, incluso superiores a cistectomía, por ser una variante con respuesta muy favorable al platino. La inmunoterapia actualmente solo estáindicada como tratamiento en segunda línea. CONCLUSIONES: el tratamiento adyuvante tiene unpapel importante por ser una variante muy quimiosensible, pero son necesarios más estudios para definir la mejor estrategia terapéutica.(AU)

INTRODUCTION: Lymphoepitheliomalike differentiation is a rare histological variant of urothelial bladder carcinoma, therefore its prognosis and treatment are not clearly defined. A retrospective study of 5cases in the last 10 years in our center was performed.CASE REPORT: cystectomy was performed in 4 of5 because they were non-metastatic muscle-invasivetumors at diagnosis, in the 5th TURB + BCG because itwas non-muscle-invasive. 2 patients received chemotherapy and 1 adjuvant radiotherapy, and 1 immunotherapy after relapse. 2 had a pure lymphoepithelioma-like pattern, 2 predominant and 1 focal.DISCUSSION: In predominant or pure forms, agood response to treatment with TURB and adjuvantchemotherapy has been described, even superior tocystectomy, as it is a variant with a very favorable response to platinum. Immunotherapy is currently onlyindicated as second-line treatment.CONCLUSIONS: adjuvant treatment plays an important role as it is a highly chemosensitive variant, but more studies are needed to define the best therapeutic strategy. (AU)

Atypical small acinar proliferation: review of a series of 64 patients.

OBJECTIVE: To study the evolution of 64 patients initially diagnosed with ASAP (atypical small acinar proliferation). MATERIAL AND METHODS: Between 1998 and the end of 2003, 64 patients were diagnosed at our centre with ASAP. RESULTS: The mean age of the patients assessed was 69 years (SD 6.4 years), the median prostate-specific antigen (PSA) level was 7.1 ng/ml (range 2-39 ng/ml) and 25% of the patients had a suspicious rectal examination. These 64 patients were subjected to re-biopsy. At re-biopsy, we diagnosed 27 patients (42%) with prostate adenocarcinoma. We classified patients into two groups depending on whether they did (n=27) or did not (n=37) have tumours. There were no significant differences in median PSA level between the two groups. The rectal examination was suspicious in 14% of patients without tumours and in 39% with tumours. Radical prostatectomy was applied to 20/28 patients (71%) diagnosed with prostate cancer. In these 20 patients, the median tumour volume was 0.4 cm3 (range 0.1-3.2 cm3) and 44% of the tumours were significant. The 37 patients with an unsuspicious histology were subjected to follow-up for a median of 12 months (range 1-30 months). The median PSA level in these patients was 5.7 ng/ml (range 0.8-28 ng/ml). A third biopsy was performed in three of these patients in view of an elevated PSA level, and one result was positive. CONCLUSIONS: In our experience, a pathological result of ASAP is associated with a definitive diagnosis of prostate cancer in 42% of cases. Moreover, a significant cancer was found in 44% of patients subjected to radical prostatectomy. We therefore systematically perform repeat biopsies on all patients with a histological result of ASAP.