PMC9899929_01
Enhanced MRI examination. (A) axial T1-weighted imging; (B) axial T1-weighted arterial phase imaging; (C) axial T2-weighted imging; (D) coronal T1-weighted arterial phase imaging.
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Infectious lesions were first considered and a short review in conjunction with clinical treatment was recommended to exclude neoplastic lesions ( Figure 1  and  Supplementary Figure 1 ).
Review of enhanced CT after nephrostomy. (A) plain scan; (B) arterial phase; (C) venous phase.
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Figure 2  and  Supplementary Figure 2 ). Following a discussion with the patient and their family, laparoscopic right nephroureterectomy with bladder-cuff resection was performed in our hospital to avoid any further delay in tumor treatment.
The gross specimen. The right middle ureter was blocked with a Hem-o-lok clip, which avoided the spread and overflow of tumor and pus into the lower urinary tract during the surgery.
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The gross specimen is shown in  Figure 3 .
Histological and immunohistochemical features. (A) HE, x40. Microscopically, the boundary of the tumor is poorly defined and invades the renal parenchyma, with remnants of renal tubules and glomeruli visible in the periphery; (B) HE, x200. The main bodies of the tumor cells are arranged in bundles, with obvious necrosis and inflammatory cell infiltration; some of the tumor cells are spindle-shaped, some are square or columnar, with a high degree of heterogeneity, high nucleoplasm ratio, obvious nucleoli, and the presence of giant tumor cells; (C) CK7 (+); (D) P63 (+); (E) GATA3 (+); (F) EMA (-).
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Immunohistochemical staining results were P63 (+), CK7 (+), GATA-3 (+), Ki-67+ (60%), P40 (+), epithelial membrane antigen (EMA) (-) and Her2 (0) ( Figure 4 ).
Treatment Timeline.
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The treatment flowchart is shown in  Figure 5 .