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Case Presentation: High-Grade Urothelial Carcinoma With Deep Muscle Invasion Case Presentation
Patient Case:
The patient is a 68-year-old man with a 30 pack-year history of cigarette smoking. He presents with gross hematuria. A CT scan of the abdomen and pelvis reveals a bladder mass. A CT scan of the chest is unrevealing. He is referred to a urologist and undergoes a cystoscopy, confirming the bladder mass. A transurethral resection of bladder tumor (TURBT) reveals high-grade urothelial cancer with invasion of the muscularis propria. His creatinine level is 1.1 and he has no history of neuropathy or hearing loss.
He is recommended to receive neoadjuvant chemotherapy and completes 4 cycles of gemcitabine plus cisplatin. He tolerates chemotherapy reasonably well but develops grade 1 sensory peripheral neuropathy. He subsequently undergoes a radical cystectomy, which reveals ypT3N0 urothelial cancer. The PD-L1 expression (via 22C3 antibody clone) is found to have a combined positive score of 20. He undergoes circulating tumor DNA testing to assess for molecular residual disease and ctDNA is undetectable.
