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case_images: CT scan of the abdomen, and pelvis with IV contrast in August 2023 revealed a 5.9 x 5.8 x 6.2 cm mixed cystic and solid mass in the left renal pelvis and inferior pole.
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case_images: IV contrast conducted in August 2023 revealed a 5.9 x 5.8 x 6.2 cm mixed cystic and solid mass in the left renal pelvis and inferior pole, along with newly enlarged left posterior hemi-diaphragmatic and left periaortic lymph nodes (Figure 1). In addition, a 6-mm new pulmonary nodule was noted.
case_images: Pathologic examination of the biopsy sample showed high-grade papillary urothelial carcinoma with focal inverted growth pattern.
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case_images: Biopsy of the left renal pelvis mass confirmed high-grade papillary urothelial carcinoma (Figure 2), with positive cytology findings from bladder and left renal pelvic washings, indicating high-grade urothelial carcinoma with significant degenerative changes and inflammation.
case_images: Repeat CT scan of the abdomen, and pelvis with IV contrast in February 2024 after 4 cycles of Pembro/EV revealed a resolution of the renal mass in the left renal pelvis and inferior pole.
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case_images: Pembro/EV therapy, the patient underwent a laparoscopic left radical nephroureterectomy in February 2024 (Figure 3), which showed a pathologic complete response with no residual viable tumor identified in the kidney or ureter (Figure 4).
case_images: Surgical specimen of laparoscopic left radical nephroureterectomy with pathologic complete response showing no residual viable tumor identified in the kidney or ureter.
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case_images: Pembro/EV therapy, the patient underwent a laparoscopic left radical nephroureterectomy in February 2024 (Figure 3), which showed a pathologic complete response with no residual viable tumor identified in the kidney or ureter (Figure 4).
case_images: Pathologic examination of the resected specimen revealed necrotic tissue with dense chronic inflammation involving the majority of the renal tissue surrounding the necrotic mass. No viable tumor is seen.
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case_images: Pathologic examination of the resected specimen revealed necrotic tissue with dense chronic inflammation involving the majority of the renal tissue surrounding the necrotic mass (Figure 5). Postoperatively, patient had the follow up in our clinic and last seen in March 2024, the patient is in excellent condition, with no planned adjuvant treatment.