case_images: PMC8337140_01
case_images: Imaging findings. (a) CT in April 2019 at diagnosis shows the extramural invasive tumor in posterior and trigonal bladder wall. (b) CT urography at diagnosis shows the leakage of contrast media because of extravasated urine. (c) MRI at diagnosis shows that the extramural invasive tumor in posterior and trigonal bladder wall is a low signal intensity on T2-weighted image. (d) CT in December 2019 at the discontinuation of pembrolizumab therapy shows growth in the primary lesion. (e) CT in June 2020 after radiotherapy shows diminished primary tumor in size. (f) CT in September 2020 three months following radiotherapy shows regrowth of the primary lesion. (g) CT in September 2020 three months following radiotherapy shows the emergency of para-aortic lymph node metastasis (arrow: para-aortic lymph node metastasis). (h) CT in February 2021 at the end of 8 doses of pembrolizumab therapy resumption shows significant reduction of the primary lesion. (i) CT in February 2021 at the end of 8 doses of pembrolizumab therapy resumption shows almost disappearance of para-aortic lymph node metastasis.
case_images: CRIU2021-9087529.001.jpg
case_images: PMC8337140_01_CRIU2021-9087529.001.jpg
case_images: fig1
case_images: Contrast-enhanced computed tomography (CT) of the thoraco-abdomino-pelvis revealed bladder cancer with extramural invasion and left hydronephrosis and left renal urine extravasation due to left ureteral obstruction of exponential growth of bladder tumor (Figures 1(a) and 1(b)). Bladder magnetic resonance imaging (MRI) revealed bladder cancer with extramural invasion (Figure 1(c)). The patient was noted to have a gastric ulcer after four courses of pembrolizumab therapy and discontinued pembrolizumab therapy due to regrowth in the primary lesion and the appearance of pelvic lymph node metastases in December 2019 (Figure 1(d)). The primary lesion and pelvic lymph node metastasis site diminished in size after the radiotherapy (Figure 1(e)). The patient subsequently resumed pembrolizumab therapy due to regrowth of the primary bladder lesion and the appearance of para-aortic lymph node metastasis on CT in September 2020 (Figures 1(f) and 1(g)). At the end of eight doses of pembrolizumab therapy in February 2021, the primary lesion and para-aortic lymph node metastasis were significantly reduced and had maintained (Figures 1(h) and 1(i)).
case_images: Pathological findings. Pathological findings revealed invasive urothelial carcinoma (UC) (luminal type UC, papillary, G2, high grade) (H&E stain (a)), CK5/6 negative (b), CK20 weak positive (c), GATA3 strong positive (d), and PD-L1 negative (red arrow: macrophage) (e).
case_images: CRIU2021-9087529.002.jpg
case_images: PMC8337140_01_CRIU2021-9087529.002.jpg
case_images: fig2
case_images: Bladder tumor biopsy revealed invasive urothelial cancer and high grade (Figure 2).