A 54-year-old male with no known drug allergies or personal history of interest except smoking habit in a daily packet.
She was referred to our clinic due to monosymptomatic macroscopic hematuria with clots.
The renovesicoprostatic ultrasound showed a hyperechogenic mass of 4 cm in diameter larger on the right lateral wall.
Endoscopic transurethral resection was performed which determined that it was a bladder tumour of urothelial strain (pT2G3).
A prostatic urethra biopsy was performed during cystectomy to assess the possibility of performing an ortotopic bladder. After a positive result, Bricker-type urinary diversion and total urethrectomy were decided in the same surgical act.
The pathological study reported pure bladder lymphoepithelioma-like carcinoma with invasion of the perivesical fat (pT3a).
Immunohistochemical techniques were performed, resulting positive for CK 19 and Ki 67, confirming the epithelial tumor component; and also for CD 45, CD 43, CD 20 and bcl 2, corroborating the lymphoid tumor component.
An intense cytoplasmic positivity was also observed in 80% of Epstein-style epithelial cells.
Prostate adenocarcinoma was also found to be moderately differentiated gleason 6/10.
At 12 months of follow-up, the patient required admission to the Neurology Department due to multiple bilateral small ischemic strokes of possible cardioembolic cause.
Currently asymptomatic under anticoagulant treatment.
Non-muscle-pelvic control TAC showed several subcentimetric multiple lymph node images in relation to large retroperitoneal vessels and mesentery root.
At this time, adjuvant chemotherapy with gemcitabine and cisplatin was decided.
At present and after 20 months of follow-up the patient is asymptomatic and free of disease, pending further radiological control.
