case_images: PMC9128378_01
case_images: Timeline of the case history.
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case_images: A 33 mmx24 mm space-occupying lesion of the left renal calyx was discovered using color Doppler ultrasound (March 30, 2021) (  Figures 1 ,  2A  ). The first pathological investigation indicated that the patient had low-grade noninvasive papillary urothelial cancer (  Supplementary Figure 1A  ). The urothelial carcinoma of the bladder had penetrated into the lamina propria, according to the second pathological investigation (  Supplementary Figure 1B  ).
case_images: Color Doppler ultrasound before and after immunotherapy. (A) Before immunotherapy. Color Doppler ultrasound showed a space-occupying lesion in the upper calyx of the left kidney, approximately 33 mmx24 mm. (B) After the third immunotherapy. Color Doppler ultrasound showed that no tumor was found.
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case_images: A 33 mmx24 mm space-occupying lesion of the left renal calyx was discovered using color Doppler ultrasound (March 30, 2021) (  Figures 1 ,  2A  ). Three urine cytology results indicated a propensity for low-grade atypical urothelial cells (  Supplementary Figure 2A  ). Figure 2B  ). Following the fourth immunotherapy (June 08, 2021), computed tomography urography (CTU) revealed the space-occupying lesion in the upper calyx of the left kidney was substantially smaller than before, measuring approximately 12 mmx10 mm (  Figure 3B  ). Two urine cytology results indicated atypical urothelial cells, whereas one was negative (  Supplementary Figure 2B  ).
case_images: Imaging examination before and after immunotherapy. (A) Before immunotherapy. Enhanced CT showed the absence of the right kidney, a space-occupying lesion in the upper calyx of the left kidney, approximately 27 mmx22 mmx13 mm, uniform density, partly with the renal medulla unclearly, and the enhanced scan showed obvious continuous enhancement. (B) After the fourth immunotherapy. The space-occupying lesion in the upper calyx of the left kidney was significantly smaller than before, and the size was approximately 12 mmx10 mm. (C) After the seventh immunotherapy. The space-occupying lesion in the upper calyx of the left kidney had shrunk to 4 mmx4 mm, and the enhancement degree of the lesion was significantly lower than before. (D) After the ninth immunotherapy. The space-occupying lesion in the upper calyx of the left kidney had shrunk to 3 mmx4 mm.
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case_images: The plain scan CT value was approximately 35 HU, and the contrast CT demonstrated evident continuous enhancement (  Figure 3A  ). Figure 2B  ). Following the fourth immunotherapy (June 08, 2021), computed tomography urography (CTU) revealed the space-occupying lesion in the upper calyx of the left kidney was substantially smaller than before, measuring approximately 12 mmx10 mm (  Figure 3B  ). The CTU revealed that the lesion in the left kidney had reduced to 4 mmx4 mm, and the degree of enhancement had decreased markedly (  Figure 3C  ). CTU and color Doppler ultrasound when the patient was treated with the ninth immunotherapy (November 12, 2021). CTU revealed that the space-occupying lesion in the upper calyx of the left kidney had decreased to 3 mmx4 mm (  Figure 3D  ), and color Doppler ultrasound revealed no lesion.
case_images: The patient experienced mild cutaneous responses. Scattered gray papules formed on the skin of the patient's limb.
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case_images: Scattered gray papules formed on the skin of the patient's limb (  Figure 4  ).