[A CASE OF UNRESECTABLE METASTATIC RENAL CARCINOMA SUCCESSFULLY TREATED BY COMBINED MODALITY THERAPY WITH NIVOLUMAB AND SURGERY].

The patient was a 65-year-old male who was referred with right renal mass (8 × 6.7 cm) and swelling of para-aortic lymph nodes in CT in April, 20XX. Additional examinations revealed inferior vena cava invasion, multiple lung metastases and left iliac bone metastasis and he was diagnosed with a renal cell carcinoma (cT4N1M1b). Pazopanib was administered as the first line treatment for an unresectable renal cancer. Nivolumab was then administrated as the 2nd line therapy due to the disease progression evaluated in (late) June, 20XX. However, immediately after the first administration of nivolumab, the patient have a difficulty in walking resulting from low-back pain, and MRI showed multiple lumbar vertebral metastases and L2 compression fracture. He was transferred to another hospital for combined modality therapy including right femoral head replacement and palliative radiotherapy in August, 20XX. Nivolumab was resumed since he had stable disease after his return to our hospital, and a total of 20 cycles of nivolumab treatment was performed. A follow-up CT showed 70% decrease in an initial primary tumor and tumor decrease or disappear in metastatic lung and bone tumors. The primary tumor was considered surgically resectable, and a radical nephrectomy was performed in August 20XX +1. Histopathological examination showed with a marked effect of neoadjuvant therapy and no evidence of viable tumor cells. We report a case of unresectable carcinoma that was successfully treated with nivolumab.

[Ureteral Cancer Occuring in an Adult Megaureter : A Case Report].

A 86-year-old man visited our hospital to undergo a careful examination for asymptomatic gross hematuria. First, we performed cystoscopy and found a tumor projecting from the right ureteral orifice. We therefore performed computed tomography, which revealed right ureteral cancer projecting into the lower ureter and severe megaureter on bothsides. To evaluate the left megaureter, we performed retrograde pyelography, but were unable to insert a guide-wire. We therefore performed magnetic resonance-urography, which revealed an expanded left lower ureter, but no findings of hydronephrosis or any tumor lesions. Based on the findings of these examinations, we diagnosed the patient with right ureteral cancer with megaureter. Right nephroureterectomy and partial cystectomy were performed in April 2017. The pathological findings resulted in a diagnosis of invasive urothelial carcinoma. The patient experienced recurrence in his bladder at 3 months follow-up cystoscopy and underwent transurethral resection of bladder tumor.