case_images: PMC10587548_01
case_images: Representative radiological images of the patient. (A) Mediastinum tumor and (B) hepatic metastatic lesion on PET/CT (April 11, 2022). (C) Mediastinum tumor and (D) hepatic metastatic lesion on PET/CT (August 24, 2022). (E) PET/CT (April 11, 2022). (F) Bilateral ureters were slightly dilated on PET/CT (blue arrow, August 24, 2022). (G) Bilateral ureteral wall was slightly thickened and whole ureteral was full expanded on urinary MRU (blue arrow, August 31, 2022. (H) Right ureter expansion was improved, and ureteral exudation was absorbed on urinary MRU (September 22, 2022).
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case_images: The immunohistochemical examination of the liver mass indicated CK (Pan) (+), CD5 (+), CgA (-), SYN (-), P63 (scattered cells+), CD117 (+), GLUT-1 (+), Muc-1 (+), CD3 (-), P40 (scattered cells+), CD56 (-), CK20 (-), Ki67(+ 90%) ( Appendix Figure S1 ), which suggested that it was liver metastasis of thymic carcinoma. The boundaries between the tumor and adjacent superior vena cava, pericardium and mediastinal pleura were not clear ( Figure 1A ). The tumor had liver ( Figure 1B ), lymph nodes and bone metastasis. There was no significant increase of 18F-Fluorodeoxyglucose (FDG) fluorodeoxyglucose (FDG) metabolism in metastatic tumor at lymph nodes and liver ( Figures 1C, D ). Meanwhile, PET/CT revealed, compared to the previous images ( Figure 1E ), poor bladder filling, slightly thickened bladder wall, slightly enlarged left kidney, increased FDG metabolism in bilateral renal parenchyma, dilated bilateral ureters with smooth excretion, and no obvious ureteral calculus ( Figure 1F ). Consistent with previous findings, MRU scan showed that bilateral ureteral wall was slightly thickened and whole ureteral fully expanded ( Figure 1G ). MRU indicated that the dilation of left kidney and right ureter was improved compared to those on August 31, and the around ureteral exudation was absorbed. ( Figure 1H ). Methylprednisolone was finally discontinued about 40 days after treatment.
case_images: The timeline of the patient's symptom, diagnosis and treatments.
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case_images: Cystoscopy indicated cystitis ( Appendix Figure S2 ). The timeline of treatment course was summarized in  Figure 2 .