PMC9807337_01
(a) CT at the time of admission showed large lesions in the bladder (a1), multiple lung metastases, and GGO lesion in the inferior lobe of the right lung (a2) (arrow). (b) CT after six courses of gemcitabine and carboplatin chemotherapy revealed decreases in the sizes of bladder cancer (b1) and multiple metastases (b2); however, the GGO lesion was observed in the lower lobe of the right lung (arrow). (c) CT in January 2022 revealed that decreases in the sizes of bladder cancer (c1) and multiple metastases (c2) were maintained during pembrolizumab therapy; however, the GGO lesion in the inferior lobe of the right lung gradually increased in size (arrow). (d) Fluorodeoxyglucose-positron emission tomography showed the accumulation of fluorodeoxyglucose in the GGO lesion in the inferior lobe of the right lung (arrow).
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T4aN3M1b (Fig. 1a). The patient underwent transurethral resection for bladder tumors in August 2020. Bladder cancer and multiple metastases markedly decreased in size on CT in February 2021 (Fig. 1b). However, a GGO lesion was detected in the inferior lobe of the right lung and was gradually increasing in size; therefore, primary lung cancer was suspected (Fig. 1c). Fluorodeoxyglucose positron emission tomography revealed the accumulation of fluorodeoxyglucose in the GGO lesion in the inferior lobe of the right lung, but not in the bladder lesion or metastatic sites (Fig. 1d).
Pathological findings. The pathological findings of bladder cancer showed high-grade, G2 invasive urothelial carcinoma with squamous differentiation and cancer pearl-like findings (arrow) (a) hematoxylin-eosin staining, (b) positive for CK5/6 (c), negative for CK20 (d), positive for GATA3 (e), and negative for PD-L1 (f). The pathological findings of lung cancer showed invasive papillary adenocarcinoma (g: hematoxylin-eosin staining) that was negative for PD-L1 (h).
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Pathological findings revealed squamous differentiation-dominant, high-grade, and G2-invasive urothelial carcinoma (Fig. 2). Histopathological findings revealed ALK-negative, EGFR L858R mutation-positive invasive adenocarcinoma with a PD-L1 tumor proportion score of less than 1% (Fig. 2).