case_images: PMC11806277_01
case_images: CT images of the left renal pelvic tumor, lymph node, and bone for every treatment. Orange arrowheads show a left renal pelvic tumor. Green arrowheads show lymph nodes. Red arrowheads show bone metastasis.. GC: gemcitabine and cisplatin combined chemotherapy, re-GC: rechallenged GC chemotherapy; CT: computed tomography
case_images: cureus-0017-00000077170-i01.jpg
case_images: PMC11806277_01_cureus-0017-00000077170-i01.jpg
case_images: FIG1
case_images: Computed tomography (CT) revealed a poorly enhanced left renal tumor and enlarged lymph nodes adjacent to the para-aorta (18 mm) and in the left renal pelvis (24 mm) (Figure 1A-1C). Following treatment, the renal tumor shrank, and the lymph nodes also decreased in size, with the nodes shrinking to 14 mm, resulting in a partial response (PR) (Figure 1D-1F). Although four cycles of maintenance therapy with avelumab (10 mg/kg) were administered every two weeks, the para-aortic lymph node enlarged to 20 mm and the left renal pelvis tumor grew to 22 mm, confirming progressive disease (PD) in the primary evaluation (Figure 1G-1I). The primary tumor and lymph node metastases were stable (Figure 1J, 1K). However, multiple bone metastases were unfortunately identified in the 12th thoracic vertebra and the 1st lumbar vertebra (Figure 1L). After four cycles, a reduction in the size of the primary renal pelvic tumor, the para-aortic lymph node, the renal pelvis lymph node, and bone metastases was observed, leading to a response evaluation of PR (Figure 1M-1O).
case_images: Pathological images of renal tumor tissue obtained from CT-guided biopsy at initial diagnosis. A: hematoxylin and eosin staining. B: GATA3. C: p63. D: PAX8. Bar scale is 20 mum.. CT: computed tomography
case_images: cureus-0017-00000077170-i02.jpg
case_images: PMC11806277_01_cureus-0017-00000077170-i02.jpg
case_images: FIG2
case_images: A CT-guided biopsy of the renal tumor, performed to assess the possibility of metastatic renal cancer and guide treatment planning, identified advanced invasive urothelial carcinoma, resulting in a diagnosis of mUTUC (cT3N2M0, Figure 2, Figure 3).
case_images: PD-L1 (A and B) and PD-L2 (C and D) expression in the renal tumor tissue at initial diagnosis. Retrospectively performed immunohistochemical staining for PD-L1 and PD-L2. The bar scales are 100 mum for A and C and 20 mum for B and D.. PD-L: programmed death-ligand
case_images: cureus-0017-00000077170-i03.jpg
case_images: PMC11806277_01_cureus-0017-00000077170-i03.jpg
case_images: FIG3
case_images: A CT-guided biopsy of the renal tumor, performed to assess the possibility of metastatic renal cancer and guide treatment planning, identified advanced invasive urothelial carcinoma, resulting in a diagnosis of mUTUC (cT3N2M0, Figure 2, Figure 3).
case_images: Chest X-ray after five cycles of pembrolizumab
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case_images: PMC11806277_01_cureus-0017-00000077170-i04.jpg
case_images: FIG4
case_images: After five cycles of pembrolizumab, the patient complained of dyspnea in motion, and X-ray imaging revealed ground-glass opacities (Figure 4).
case_images: CT scan four months after discontinuing pembrolizumab treatment . A: Green arrowheads show lymph nodes. B: Red arrowheads show bone metastasis.. CT: computed tomography
case_images: cureus-0017-00000077170-i05.jpg
case_images: PMC11806277_01_cureus-0017-00000077170-i05.jpg
case_images: FIG5
case_images: A CT scan four months after discontinuing pembrolizumab treatment revealed an increase in para-aortic lymph node metastasis and a worsening of thoracolumbar metastases, leading to the initiation of EV therapy (1.25 mg/kg) every 28 days (Figure 5).