Multiple cranial neuropathy is a rare manifestation of immune-related adverse events. To date, no cases have been reported during immune checkpoint blockade for metastatic renal cell carcinoma. This report describes a case of multiple cranial neuropathy that developed during lenvatinib and pembrolizumab combination therapy.
Case Presentation
A 66-year-old man with metastatic clear cell renal cell carcinoma involving the maxilla received lenvatinib and pembrolizumab. After two months, he developed a rash and facial nerve palsy that resolved with corticosteroids. Pembrolizumab rechallenge later caused diplopia due to multiple cranial neuropathies, which improved after steroid pulse therapy. Two years after treatment initiation, disease control and pembrolizumab maintenance have continued without neurological recurrence.
Conclusions
We report a rare case of multiple cranial nerve palsies that developed during lenvatinib–pembrolizumab therapy. Such neuropathies typically occur early, respond to corticosteroids, and require careful monitoring, as retreatment may lead to recurrence or new adverse events.
{"title":"Multiple Cranial Neuropathies After Lenvatinib–Pembrolizumab Therapy for Metastatic Renal Cell Carcinoma: A Case Report","authors":"Hideyuki Minagawa, Tomoyuki Kaneko, Keiichi Hokkoku, Ayano Miyashima, Inoue Hazuki, Ono Tenei, Risako Yagi, Kenjiro Kishitani, Kazuki Takei, Tohru Nakagawa","doi":"10.1002/iju5.70136","DOIUrl":"10.1002/iju5.70136","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Multiple cranial neuropathy is a rare manifestation of immune-related adverse events. To date, no cases have been reported during immune checkpoint blockade for metastatic renal cell carcinoma. This report describes a case of multiple cranial neuropathy that developed during lenvatinib and pembrolizumab combination therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 66-year-old man with metastatic clear cell renal cell carcinoma involving the maxilla received lenvatinib and pembrolizumab. After two months, he developed a rash and facial nerve palsy that resolved with corticosteroids. Pembrolizumab rechallenge later caused diplopia due to multiple cranial neuropathies, which improved after steroid pulse therapy. Two years after treatment initiation, disease control and pembrolizumab maintenance have continued without neurological recurrence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We report a rare case of multiple cranial nerve palsies that developed during lenvatinib–pembrolizumab therapy. Such neuropathies typically occur early, respond to corticosteroids, and require careful monitoring, as retreatment may lead to recurrence or new adverse events.</p>\u0000 </section>\u0000 </div>","PeriodicalId":52909,"journal":{"name":"IJU Case Reports","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12779414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145935914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vaginal pessaries are a widely used treatment for pelvic organ prolapse. They are considered minimally invasive, effective, and easy. However, pessary-related adverse events are sometimes underestimated. Here, we report on an important case of vaginal mesh exposure as a pessary complication.
Case Presentation
A patient underwent transvaginal mesh surgery for pelvic organ prolapse, and after 10 years, had a mild recurrence. Gynecologists recommended that she use a pessary. After 3 years, she had vaginal bleeding and malodor. Gynecologists detected mesh exposure, but they downplayed the finding and continued pessary use. Two years after that, she came to our hospital and underwent mesh excision surgery. She had an uneventful postoperative course with no complications in the 2 years after the surgery.
Conclusion
We propose that pessary use after mesh surgery can cause mesh exposure, which must not be ignored because it may lead to mesh infection and intra-abdominal abscess.
{"title":"Vaginal Mesh Exposure Following Pessary Use After Transvaginal Mesh Surgery: A Case Report","authors":"Yukiko Tsunoda, Kumiko Kato, Hidemori Araki, Masashi Kato, Masahiro Narushima","doi":"10.1002/iju5.70135","DOIUrl":"10.1002/iju5.70135","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Vaginal pessaries are a widely used treatment for pelvic organ prolapse. They are considered minimally invasive, effective, and easy. However, pessary-related adverse events are sometimes underestimated. Here, we report on an important case of vaginal mesh exposure as a pessary complication.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A patient underwent transvaginal mesh surgery for pelvic organ prolapse, and after 10 years, had a mild recurrence. Gynecologists recommended that she use a pessary. After 3 years, she had vaginal bleeding and malodor. Gynecologists detected mesh exposure, but they downplayed the finding and continued pessary use. Two years after that, she came to our hospital and underwent mesh excision surgery. She had an uneventful postoperative course with no complications in the 2 years after the surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We propose that pessary use after mesh surgery can cause mesh exposure, which must not be ignored because it may lead to mesh infection and intra-abdominal abscess.</p>\u0000 </section>\u0000 </div>","PeriodicalId":52909,"journal":{"name":"IJU Case Reports","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12778300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145935953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We report the case of a patient with severe uterine prolapse who underwent successful vaginal pessary removal after pelvic floor muscle training.
Case Presentation
A 63-year-old woman presented with urinary dysfunction and residual urine. She was diagnosed with stage III pelvic organ prolapse by an obstetrician-gynecologist, and a vaginal pessary was inserted. The patient underwent pelvic floor muscle training for 4 months while the vaginal pessary remained in situ. M-mode ultrasonography revealed improved pelvic floor function, necessitating vaginal pessary removal. The patient's uterine prolapse improved to pelvic organ prolapse-quantification stage II without recurrence of pelvic organ prolapse, urinary dysfunction, or residual urine after 2 years.
Conclusions
In patients with severe uterine prolapse who use a vaginal pessary, appropriate pelvic floor muscle training guided by a physical therapist may eliminate the need for continued pessary use.
{"title":"Severe Pelvic Organ Prolapse Managed Without Surgery: Pessary Discontinued After Pelvic Floor Muscle Training With M-Mode Ultrasound","authors":"Yukimasa Ide, Nobutaka Shimizu, Rio Ninomiya, Tomoko Ogawa, Tetsuya Fukumoto, Shinji Hyodo, Rie Yoshimura, Yoshitaka Kurano, Satoshi Fukata, Keiji Inoue","doi":"10.1002/iju5.70138","DOIUrl":"10.1002/iju5.70138","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>We report the case of a patient with severe uterine prolapse who underwent successful vaginal pessary removal after pelvic floor muscle training.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 63-year-old woman presented with urinary dysfunction and residual urine. She was diagnosed with stage III pelvic organ prolapse by an obstetrician-gynecologist, and a vaginal pessary was inserted. The patient underwent pelvic floor muscle training for 4 months while the vaginal pessary remained in situ. M-mode ultrasonography revealed improved pelvic floor function, necessitating vaginal pessary removal. The patient's uterine prolapse improved to pelvic organ prolapse-quantification stage II without recurrence of pelvic organ prolapse, urinary dysfunction, or residual urine after 2 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In patients with severe uterine prolapse who use a vaginal pessary, appropriate pelvic floor muscle training guided by a physical therapist may eliminate the need for continued pessary use.</p>\u0000 </section>\u0000 </div>","PeriodicalId":52909,"journal":{"name":"IJU Case Reports","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12778299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145935873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Madelung disease is a rare disorder characterized by symmetrical fat accumulation, typically around the neck, shoulders, and trunk.
Case Presentation
A 56-year-old man presented for 10-month history of dysuria and painless swelling of the lower abdomen and scrotum. A large scrotal mass completely buried the penis, and cranially displaced both testes. Contrast-enhanced magnetic resonance imaging suggested a well differentiated liposarcoma but whole-body computed tomography revealed symmetrical fat accumulation in the upper body trunk, raising suspicion of Madelung disease. Biopsy of the mass confirmed a benign lipoma. Excision of a 664 g lipoma improved the patient's penile configuration, enabling him to urinate in a standing position.
Conclusion
Madelung disease in the scrotal region is rare, only nine cases reported to date. However, it should be considered when bilateral symmetrical fat accumulation is present because a correct diagnosis has a decisive impact on treatment strategy.
{"title":"Madelung Disease of the Scrotal Region: A Case Report","authors":"Kazuki Kokura, Akihiro Kanematsu, Hideki Morisaki, Yasuhiro Shinkai, Takashi Yamasaki, Kenichiro Kawai, Masao Kakibuchi, Seiichi Hirota, Shingo Yamamoto","doi":"10.1002/iju5.70137","DOIUrl":"10.1002/iju5.70137","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Madelung disease is a rare disorder characterized by symmetrical fat accumulation, typically around the neck, shoulders, and trunk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 56-year-old man presented for 10-month history of dysuria and painless swelling of the lower abdomen and scrotum. A large scrotal mass completely buried the penis, and cranially displaced both testes. Contrast-enhanced magnetic resonance imaging suggested a well differentiated liposarcoma but whole-body computed tomography revealed symmetrical fat accumulation in the upper body trunk, raising suspicion of Madelung disease. Biopsy of the mass confirmed a benign lipoma. Excision of a 664 g lipoma improved the patient's penile configuration, enabling him to urinate in a standing position.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Madelung disease in the scrotal region is rare, only nine cases reported to date. However, it should be considered when bilateral symmetrical fat accumulation is present because a correct diagnosis has a decisive impact on treatment strategy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":52909,"journal":{"name":"IJU Case Reports","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12765589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145907369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Intravesical bacillus Calmette-Guerin (BCG) therapy is a standard treatment for intermediate to high-risk non-muscle invasive bladder cancer. While local side effects are common, systemic complications are rare and can be serious.
Case Presentation
A 69-year-old man presented with episodes of fever, headache, and impaired consciousness. He had undergone intravesical BCG therapy 3 days before presentation. He was initially diagnosed with viral encephalitis and treated with acyclovir, but showed no clinical improvement. Given the lack of response, autoimmune encephalitis was suspected, and steroid therapy was initiated, resulting in marked clinical improvement. Plasmapheresis was performed in addition to steroid therapy, and his condition improved to the level observed prior to BCG treatment. To date, he remains stable and relapse-free.
Conclusion
To our knowledge, this is the first reported case of BCG-induced autoimmune encephalitis after intravesical therapy.
{"title":"The First Case of Bacillus Calmette-Guérin-Induced Autoimmune Encephalitis","authors":"Makoto Ishii, Haruto Honda, Seigo Machiya, Hiromu Horitani, Sayaka Horii, Masao Kobayashi, Yutaka Ono","doi":"10.1002/iju5.70134","DOIUrl":"10.1002/iju5.70134","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Intravesical bacillus Calmette-Guerin (BCG) therapy is a standard treatment for intermediate to high-risk non-muscle invasive bladder cancer. While local side effects are common, systemic complications are rare and can be serious.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 69-year-old man presented with episodes of fever, headache, and impaired consciousness. He had undergone intravesical BCG therapy 3 days before presentation. He was initially diagnosed with viral encephalitis and treated with acyclovir, but showed no clinical improvement. Given the lack of response, autoimmune encephalitis was suspected, and steroid therapy was initiated, resulting in marked clinical improvement. Plasmapheresis was performed in addition to steroid therapy, and his condition improved to the level observed prior to BCG treatment. To date, he remains stable and relapse-free.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>To our knowledge, this is the first reported case of BCG-induced autoimmune encephalitis after intravesical therapy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":52909,"journal":{"name":"IJU Case Reports","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12765590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145907397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Small renal masses account for 48%–66% of renal cell carcinoma diagnoses, influencing management decisions for low-stage kidney disease. This report presents a case of cancer recurrence and tumor progression into the renal pelvis postcryoablation, managed with radical nephrectomy.
Case Presentation
A 70-year-old woman with a history of cryoablation for T1b renal cell carcinoma in the right kidney presented with persistent hematuria. Imaging revealed local recurrence and carcinoma invasion of the renal pelvis. The patient underwent open radical nephrectomy. Intraoperatively, the kidney was found adhered to the peritoneum and vena cava. The remaining elements of renal, hilar and adrenal anatomy showed no abnormalities. The postoperative course was uneventful.
Conclusion
While local recurrences following cryoablation can often be safely retreated with cryoablation, progression involving the renal pelvis is rare and demands heightened vigilance and expertise. Tailored approaches, including radical nephrectomy and technical adaptability, are essential for achieving optimal oncological and functional outcomes.
{"title":"Radical Nephrectomy Following Prior Cryoablation for Renal Cell Carcinoma: A Case Report and Literature Review","authors":"Spyridon Mitsios, Panagiotis Balaxis, Athanasios Klampatsas, Anastasia Nikolaidou, Gkatzos Stergios, Panagiotis Kousidis, Evangelos Petsatodis, George Moustakas","doi":"10.1002/iju5.70127","DOIUrl":"10.1002/iju5.70127","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Small renal masses account for 48%–66% of renal cell carcinoma diagnoses, influencing management decisions for low-stage kidney disease. This report presents a case of cancer recurrence and tumor progression into the renal pelvis postcryoablation, managed with radical nephrectomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 70-year-old woman with a history of cryoablation for T1<sub>b</sub> renal cell carcinoma in the right kidney presented with persistent hematuria. Imaging revealed local recurrence and carcinoma invasion of the renal pelvis. The patient underwent open radical nephrectomy. Intraoperatively, the kidney was found adhered to the peritoneum and vena cava. The remaining elements of renal, hilar and adrenal anatomy showed no abnormalities. The postoperative course was uneventful.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>While local recurrences following cryoablation can often be safely retreated with cryoablation, progression involving the renal pelvis is rare and demands heightened vigilance and expertise. Tailored approaches, including radical nephrectomy and technical adaptability, are essential for achieving optimal oncological and functional outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":52909,"journal":{"name":"IJU Case Reports","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12755053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145890246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bladder amyloidosis is a rare condition characterized by amyloid fibril deposition in the bladder, often mimicking bladder cancer. Diagnosis requires histological analysis of the examination, and treatment typically involves transurethral resection.
Case Presentation
An 80-year-old male presented with gross hematuria. Computed tomography suggested bladder cancer with pulmonary metastases. However, due to the extent of the bladder tumor, complete resection was not feasible, and only a limited transurethral resection was performed for diagnostic purposes. Pathological examination revealed bladder amyloid λ amyloidosis. Remarkably, five months post-surgery, both bladder and pulmonary lesions resolved spontaneously. No recurrence was observed during six years of follow-up.
Conclusions
This case highlights a rare instance of spontaneous remission in bladder amyloidosis. However, such occurrences were exceedingly uncommon, and systemic amyloidosis can progress to a life-threatening condition. Therefore, careful follow-up, surgical removal, or systemic therapy is essential for bladder amyloidosis.
{"title":"Bladder Amyloidosis With Pulmonary Lesions: A Case of Spontaneous Remission After Transurethral Resection","authors":"Suguru Ito, Takuma Suzuki, Ryo Sato, Kunihiko Maeda, Shinta Suenaga, Hidenori Kanno, Sadanobu Sato, Shigemitsu Horie, Sei Naito, Norihiko Tsuchiya","doi":"10.1002/iju5.70123","DOIUrl":"10.1002/iju5.70123","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Bladder amyloidosis is a rare condition characterized by amyloid fibril deposition in the bladder, often mimicking bladder cancer. Diagnosis requires histological analysis of the examination, and treatment typically involves transurethral resection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>An 80-year-old male presented with gross hematuria. Computed tomography suggested bladder cancer with pulmonary metastases. However, due to the extent of the bladder tumor, complete resection was not feasible, and only a limited transurethral resection was performed for diagnostic purposes. Pathological examination revealed bladder amyloid λ amyloidosis. Remarkably, five months post-surgery, both bladder and pulmonary lesions resolved spontaneously. No recurrence was observed during six years of follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This case highlights a rare instance of spontaneous remission in bladder amyloidosis. However, such occurrences were exceedingly uncommon, and systemic amyloidosis can progress to a life-threatening condition. Therefore, careful follow-up, surgical removal, or systemic therapy is essential for bladder amyloidosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":52909,"journal":{"name":"IJU Case Reports","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12744878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145859000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We report a case in which combination therapy with enfortumab vedotin (EV) and pembrolizumab proved effective in treating non-muscle-invasive bladder cancer (NMIBC) accompanied by multiple bone metastases.
Case Presentation
A 61-year-old man with NMIBC underwent eight transurethral resections of bladder tumor (TURBTs) at another hospital over 4 years. During the eighth TURBT, carcinoma in situ was detected, and the patient was treated with intravesical Bacillus Calmette-Guérin (BCG) therapy. A computed tomography scan performed at our hospital 1.5 years after BCG therapy revealed multiple osteosclerotic lesions. Cystoscopy and bladder magnetic resonance imaging revealed no obvious tumorous lesions. An incisional biopsy of the sternum confirmed the diagnosis of multiple bone metastases originating from NMIBC. The patient was started on combination therapy with EV and pembrolizumab. After 5 months, bone scintigraphy revealed decreased accumulation.
Conclusion
Combination therapy with EV and pembrolizumab was also effective in treating NMIBC with multiple bone metastases.
{"title":"Multiple Bone Metastases From Non-Muscle Invasive Bladder Cancer Responding to Combination Therapy With Enfortumab Vedotin and Pembrolizumab: A Case Report","authors":"Shin Kanemoto, Shinkuro Yamamoto, Kosuke Hino, Kazuma Tsuboi, Mototsune Kakizaki, Yasuhiro Nishiyama, Satoshi Fukata, Ryoji Arata, Keiji Inoue, Noriaki Ono","doi":"10.1002/iju5.70119","DOIUrl":"10.1002/iju5.70119","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>We report a case in which combination therapy with enfortumab vedotin (EV) and pembrolizumab proved effective in treating non-muscle-invasive bladder cancer (NMIBC) accompanied by multiple bone metastases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 61-year-old man with NMIBC underwent eight transurethral resections of bladder tumor (TURBTs) at another hospital over 4 years. During the eighth TURBT, carcinoma in situ was detected, and the patient was treated with intravesical Bacillus Calmette-Guérin (BCG) therapy. A computed tomography scan performed at our hospital 1.5 years after BCG therapy revealed multiple osteosclerotic lesions. Cystoscopy and bladder magnetic resonance imaging revealed no obvious tumorous lesions. An incisional biopsy of the sternum confirmed the diagnosis of multiple bone metastases originating from NMIBC. The patient was started on combination therapy with EV and pembrolizumab. After 5 months, bone scintigraphy revealed decreased accumulation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Combination therapy with EV and pembrolizumab was also effective in treating NMIBC with multiple bone metastases.</p>\u0000 </section>\u0000 </div>","PeriodicalId":52909,"journal":{"name":"IJU Case Reports","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12740398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145851486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Intramural ureteral urothelial carcinoma can be difficult to diagnose, especially when presenting without mucosal abnormalities or positive cytology. In such cases, percutaneous biopsy may provide an alternative diagnostic approach.
Case Presentation
A 74-year-old man presented with acute renal failure caused by bilateral hydronephrosis. Cystoscopy showed no mucosal abnormality. Retrograde pyeloureterography revealed bilateral distal ureteral strictures, but urine cytology from ureteral catheters was negative. Imaging revealed a submucosal mass on the right dorsal bladder wall. Urothelial carcinoma was diagnosed on a computed tomography-guided percutaneous trans-extraperitoneal and transvesical biopsy. Neoadjuvant chemotherapy was administered and radical cystectomy performed. Pathology confirmed invasive urothelial carcinoma originating from the right intramural ureter at the ureterovesical junction with bladder muscle invasion.
Conclusion
This case highlights the diagnostic challenges of intramural ureteral urothelial carcinoma presenting as a submucosal bladder tumor. Computed tomography-guided percutaneous biopsy can be a safe and effective diagnostic option in such challenging cases.
{"title":"Computed Tomography-Guided Biopsy of a Ureteral Urothelial Carcinoma Mimicking a Submucosal Bladder Tumor at the Ureterovesical Junction","authors":"Akira Ohtsu, Yuji Fujizuka, Seiji Arai, Masakazu Yamaguchi, Hiroyuki Tokue, Tatsuro Maehara, Takanori Shimizu, Yoshitaka Sekine, Hayato Ikota, Kazuhiro Suzuki","doi":"10.1002/iju5.70132","DOIUrl":"10.1002/iju5.70132","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Intramural ureteral urothelial carcinoma can be difficult to diagnose, especially when presenting without mucosal abnormalities or positive cytology. In such cases, percutaneous biopsy may provide an alternative diagnostic approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 74-year-old man presented with acute renal failure caused by bilateral hydronephrosis. Cystoscopy showed no mucosal abnormality. Retrograde pyeloureterography revealed bilateral distal ureteral strictures, but urine cytology from ureteral catheters was negative. Imaging revealed a submucosal mass on the right dorsal bladder wall. Urothelial carcinoma was diagnosed on a computed tomography-guided percutaneous trans-extraperitoneal and transvesical biopsy. Neoadjuvant chemotherapy was administered and radical cystectomy performed. Pathology confirmed invasive urothelial carcinoma originating from the right intramural ureter at the ureterovesical junction with bladder muscle invasion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This case highlights the diagnostic challenges of intramural ureteral urothelial carcinoma presenting as a submucosal bladder tumor. Computed tomography-guided percutaneous biopsy can be a safe and effective diagnostic option in such challenging cases.</p>\u0000 </section>\u0000 </div>","PeriodicalId":52909,"journal":{"name":"IJU Case Reports","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12719012/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145812252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Metastatic urothelial carcinoma (UC) of the renal pelvis is an aggressive malignancy with a poor prognosis. Although avelumab maintenance therapy is a standard of care for advanced UC, long-term durable remission after treatment cessation is rare.
Case Presentation
We report the case of a 71-year-old female with metastatic UC of the renal pelvis who achieved a partial response to gemcitabine and cisplatin chemotherapy. She subsequently underwent 40 courses of avelumab maintenance therapy, which she later chose to discontinue. The partial response initially achieved with gemcitabine and cisplatin chemotherapy has been maintained for over 2 years without further intervention following the cessation of avelumab maintenance therapy.
Conclusion
This case highlights avelumab's potential to induce a profound and durable antitumor immune response, suggesting the possibility of a “functional cure” in a subset of patients. This provides valuable data for guiding clinical decisions on the optimal duration of therapy.
{"title":"Long-Term Response to Avelumab Maintenance Therapy and Durable Remission After Cessation in a Patient With Metastatic Urothelial Carcinoma of the Renal Pelvis: A Case Report","authors":"Hiroyuki Fujinami, Shinro Hata, Toru Inoue, Tadasuke Ando, Toshitaka Shin","doi":"10.1002/iju5.70117","DOIUrl":"10.1002/iju5.70117","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Metastatic urothelial carcinoma (UC) of the renal pelvis is an aggressive malignancy with a poor prognosis. Although avelumab maintenance therapy is a standard of care for advanced UC, long-term durable remission after treatment cessation is rare.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>We report the case of a 71-year-old female with metastatic UC of the renal pelvis who achieved a partial response to gemcitabine and cisplatin chemotherapy. She subsequently underwent 40 courses of avelumab maintenance therapy, which she later chose to discontinue. The partial response initially achieved with gemcitabine and cisplatin chemotherapy has been maintained for over 2 years without further intervention following the cessation of avelumab maintenance therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This case highlights avelumab's potential to induce a profound and durable antitumor immune response, suggesting the possibility of a “functional cure” in a subset of patients. This provides valuable data for guiding clinical decisions on the optimal duration of therapy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":52909,"journal":{"name":"IJU Case Reports","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12704228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145769939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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