case_images: PMC10333640_01
case_images: Computed tomography (CT) at the time of admission shows a left lower ureteral tumor (a:
  arrow). A high signal intensity on diffusion-weighted imaging (b: arrow) and a low
  signal intensity on T2-weighted imaging (c: arrow) of magnetic resonance imaging show
  multiple non-muscle-invasive tumors from the posterior to right wall of the bladder and
  the muscle-invasive tumor in the lower part of the left ureter.
case_images: 10.1177_2050313X231185444-fig1.jpg
case_images: PMC10333640_01_10.1177_2050313X231185444-fig1.jpg
case_images: fig1-2050313X231185444
case_images: Computed tomography (CT) at the time of admission showed a left lower ureteral tumor (Figure 1(a)). Magnetic resonance imaging showed multiple tumors from the posterior wall to right wall of the bladder and the muscle-invasive tumor in the lower part of the left ureter (Figure 1(b) and (c)).
case_images: Pathological findings. (a) Pathological findings of bladder carcinoma show urothelial
  carcinoma, high grade, G2 > G3, pT1 (a1: hematoxylin-eosin staining), CK20 weakly
  positive (a2), CK5/6 negative (a3), GATA3 positive (a4), and PD-L1 negative (a5)
  (insert; positive control). (b) Pathological findings of left lower ureteral carcinoma
  show invasive ureteral carcinoma, high grade, G2 > G3, pT2 (b1: hematoxylin-eosin
  staining, arrow: positive-margin carcinoma in situ), CK20 positive (b2), CK5/6 weakly
  positive (b3), GATA3 positive (b4), and PD-L1 negative (b5) (insert; positive control).
  (c) The cancer tissues during the treatment courses in the present patient did not
  express PD-L1 (c1: TUR-BT in May 2020, c2: ureteral cancer in November 2020, c3: bladder
  tumor biopsy in November 2020 before BCG intravesical infusion therapy, c4: bladder
  tumor biopsy in August 2021 following four cycles of pembrolizumab).
case_images: 10.1177_2050313X231185444-fig2.jpg
case_images: PMC10333640_01_10.1177_2050313X231185444-fig2.jpg
case_images: fig2-2050313X231185444
case_images: Pathological findings were urothelial carcinoma, high grade, G2 > G3, and pT1 (Figure 2(a)). Pathological findings of the ureteral tumor following neoadjuvant chemotherapy showed invasive urothelial carcinoma, high grade, G2 > G3, ypT2, and positive-margin carcinoma in situ at bladder cuff (Figure 2(b)). Biopsy of bladder tumor in August 2021 following four cycles of pembrolizumab was performed and the histopathological findings showed urothelial carcinoma, high grade, G2 (Figure 2(c)).