PMC10141313_01
Pathological and imaging examination of case 1. (A) Whole-body PET/CT showing bladder thickening, multiple nodular and mass-like soft tissue shadows in the cavity, and increased metabolism. (B) Pathological results of hematoxylin and eosin cytology staining of a tumor biopsy specimen. (C) PD-L1 expression was evaluated by immunohistochemistry. (D) Enhanced CT of the abdomen before treatment showing a 5.3 x 4.0 cm mass in the bladder with significant enhancement in the arterial phase (red arrow). (E) After two cycles of treatment, enhanced CT of the abdomen revealed that the tumor shrank to 4.1 x 3.2 cm (red arrow). (F) After 14 cycles of treatment, enhanced CT of the abdomen revealed that the size of the tumor was 1.2 x 1.0 cm (red arrow).
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The result showed bladder thickening, multiple nodular and mass-like soft tissue shadows in the cavity, and increased metabolism; there was no evidence of distant metastasis ( Figure 1A ). PD-L1 detection are shown in  Figure 1C . PD-L1 was detected using the VENTANA PD-L1 (SP263) antibody, and patients are considered PD-L1-negative if involved tumor-infiltrating immune cells (ICs) were <1%. On June 2, 2021, the patient was re-assessed by enhanced abdominal CT, and tumor size decreased from 5.3 x 4.0 cm ( Figure 1D ) to 4.1 x 3.2 cm ( Figure 1E ). On March 31, 2022, the patient underwent contrast-enhanced CT, which showed that the right anterior bladder mass was smaller than the previous (approximately 1.2 x 1.0 cm) ( Figure 1F ).
PMC10141313_02
Pathological and imaging examination of case 2. (A) Pathological results of hematoxylin and eosin cytology staining of a tumor biopsy. (B) PD-L1 expression evaluated by immunohistochemistry. (C) Abdominal enhanced CT showing a round nodule measuring 5.4 x 5.5 cm with clear boundaries at the top of the bladder (red arrow). (D) Chest CT showing a 1.7-cm nodule in the inferior lobe of the right lung (red arrow). (E) Pelvic MRI sagittal axis T2WI showing that the tumor at the base of the bladder was 6.5 x 5.5 cm, with a moderately high signal shadow. (F) After 16 cycles of treatment, enhanced CT of the abdomen revealed that the tumor was 3.8 x 3.7 cm (red arrow); (G) Chest CT showed that the size of the mass in the lower lobe of the right lung was reduced to 0.8 cm (H) Pelvic MRI, sagittal axis, and T2WI showed that the tumor in the bladder base was 5.0 x 3.8 cm, with a moderately high signal shadow (red arrow). T2WI, T2-weighted imaging.
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On April 2, 2021, he presented at our hospital with a recurrence of painless hematuria, and a biopsy confirmed bladder cancer recurrence ( Figure 2A ). Immunohistochemistry was used to assess the expression of PD-L1 as well ( Figure 2B ), and wild-type FGFR3 was discovered by NGS. The patient underwent abdominal enhanced CT ( Figure 2C ), chest CT ( Figure 2D ), and pelvic magnetic resonance imaging (MRI) (Figure F), which revealed several oval nodules of varying sizes and a maximum diameter of 1.7 cm in both lungs, as well as a round soft tissue density shadow (5.4 x 6.5 x 5.5 cm) toward the base of the bladder. The patient was admitted to our hospital and received abdominal enhanced CT ( Figure 2F ), chest enhanced CT ( Figure 2G ), and pelvic MRI ( Figure 2H ) during the most recent checkup on May 21, 2022.