The type of lymphocyte infiltration near urothelial carcinoma is diagnostic for chronic lymphocytic leukemia
A 62 year-old man was referred to our urology unit with a history of painless intermittent hematuria for 3 months. His occupation was long-distance driver; he had no chronic illness and a history of smoking for 45 years. In his physical examination, there were no significant findings such as hepatosplenomegaly, lymphadenopathy, fever or weight loss. Leukocytosis (15700 103/ ul) was determined in the blood cell count and thought to be related to the pyuria in the urinalysis. The left kidney was found at grade three hydronephrosis and a heterogeneous hypoechoic solid mass with irregular borders on the left side of the bladder wall were reported in the abdominal ultrasonography. All papillary masses in the left side of the bladder wall and in the prostatic urethra were resected transurethrally. The transurethral resection specimen was fixed in 10% buffered formaldehyde and routine hematoxylin and eosin preparation was performed for histological examination. Immunohistochemistry was performed on the formalin–fixed, paraffin-embedded tissue sections. Light microscopic examination revealed high grade urothelial carcinoma extending into the muscularis propria. The urothelium of the surrounding bladder mucosa showed carcinoma in situ. Diffuse small lymphocytic infiltration was found along the periphery of the tumor. Immunohistochemical studies revealed that the lymphocytes present in the region were positive for CD20, CD5 and CD43 and transitional cell carcinoma (TCC) [Figures and ]. After the pathological report the patient was investigated for hematological malignancies. Computer tomography scan of the abdomen, pelvic and chest regions demonstrated asymmetric wall thickening in the left side of the bladder and multiple lymphadenopathies in the pelvis and upper abdomen []. A peripheral blood smear and flow cytometry were performed and resulted in a diagnosis of CLL. The patient's final diagnosis was a coincidence of invasive bladder cancer and CLL. The patient received chemoradiotherapy for bladder cancer. CLL was followed conservatively. The patient died six months after diagnosis as a result of heart attack.