PMC9807341_01
Imaging manifestation of left renal pelvic UC in Lynch syndrome. The primary left renal pelvic cancer (a) and bone and lung metastatic lesions before and after the induction of pembrolizumab therapy (bone: b, d, lung: c, e).
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A 49-year-old Japanese woman with a medical history of uterine cervical cancer and left breast cancer was diagnosed with left renal pelvic cancer (clinical stage cT2N0M0) (Fig. 1a). Eight months later, she noticed back pain and imaging studies revealed bone (L3 lumber vertebrae: Fig. 1b) and lung metastasis (Fig. 1c). The L3-osseus and pulmonary metastases diminished on CT scan analysis (Fig. 1d,e).
Pathological manifestation of mUC in Lynch syndrome. The pathological features of bone metastatic lesion (a: hematoxylin and eosin, x400, b: anti-uroplakin-2 immunostaining, x400) and immune-histochemical presentation of the primary renal pelvic tumor (c: anti-MSH2 immunostaining, x400, d: anti-MSH6 immunostaining, x400).
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She underwent a CT-guided biopsy of the L3 lesion, which was pathologically and immunohistochemically (using anti-uroplakin-2 antibody) diagnosed as a metastasis of UC (Fig. 2a,b). Loss of MSH2 and MSH6 expression could be also confirmed by the immune histochemical study for the primary tumor (Fig. 2c,d).