case_images: PMC11427362_01
case_images: Magnetic resonance (MR) urography and pathology result. MR urography shows the absence of the left kidney and ureter (A), and there is a 2 x 3 cm mass in the left posterior portion of the bladder that exhibits iso-intense T1 and extended T2 signals and a strong signal on diffusion-weighted imaging, all of which point to metastasis (B, indicated by the red circle). Additionally, the bladder is well distended, with thickening of the anterior and left lateral walls, reaching a maximum thickness of about 1 cm. It shows isointense T1 and slightly prolonged T2 signals. It exhibits high signal intensity on diffusion-weighted imaging, suggesting tumor recurrence (C, indicated by the red circle). The needle biopsy's pathology result revealed invasive urothelial carcinoma, with the malignant tissue exhibiting notable atypia, varied cell size, and a nest-like distribution (D).
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case_images: The patient was diagnosed with left-sided high-risk UTUC (T1N0M0) complicated with bladder cancer (as shown in  Supplementary Figure S1 ) and underwent robotic-assisted RNU and partial cystectomy seven months ago. Magnetic resonance (MR) urography revealed the absence of the left kidney and ureter ( Figure 1A ) and a mass of about 2x3 cm in the left posterior aspect of the bladder. T1, prolonged T2 signals, and a high signal on diffusion-weighted imaging, indicating metastasis ( Figure 1B ). The bladder's anterior and left lateral walls were thickened, the T1 signal was equally strong, and the T2 signal was slightly extended. Diffusion-weighted imaging shows high signal intensity, suggesting tumor recurrence ( Figure 1C ). Subsequently, a biopsy of the mass performed under ultrasound guidance confirmed the presence of invasive urothelial carcinoma ( Figure 1D ).
case_images: Patient's overview. The duration of treatment and the evaluation results after the administration of medication. RNU, radical nephroureterectomy; GC, gemcitabine and cisplatin.
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case_images: The histological examination revealed a low-grade, non-invasive urothelial carcinoma (as shown in  Supplementary Figure S2 ). The patient's treatment course is depicted in  Figure 2 .
case_images: Computed tomography (CT) urography and chest CT following treatment with Tislelizumab. CT urography reveals a mass in the left posterior aspect of the bladder, which has grown since the last scan. The mass is indistinctly bordered by the left posterior wall of the bladder and the left adnexa [as indicated by the red arrow, (A)]. The chest CT scan also shows several little nodules in the middle and upper lobes [as shown by the red arrow, (B)].
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case_images: After four cycles of this treatment, computed tomography (CT) results indicated disease progression (see  Figure 3 ). Supplementary Figure S3 ). Close thoracic drainage was performed (right side), and after the pleural effusion was fully drained, the drainage tube was removed. Subsequent follow-up did not reveal a recurrence of pleural effusion.
case_images: Computed tomography (CT) urography and chest CT after eight Disitamab vedotin (RC48) treatment cycles. CT urography reveals a significantly reduced mass in the left posterior bladder (indicated by the red arrow, A); Chest CT shows bilateral pleural effusion absorption, the right lung lobe is fully re-expanded, and the number of lung nodules has decreased (indicated by the red arrow, B).
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case_images: CT examination revealed that the metastatic lesions had disappeared, lung nodules had resolved, and pleural effusion had been absorbed ( Figure 4 ).