40M history of a right upper tract transitional cell carcinoma status post nephroureterectomy 11 years ago with subsequent recurrent TA low grade bladder cancer. Recent cystoscopy in the office revealed a recurrence of several small 1 cm or less papillary lesions.
BLADDER TUMOR, BIOPSY:
PAPILLARY UROTHELIAL CARCINOMA (EXTENSIVELY CAUTERIZED), NON-INVASIVE, LOW-GRADE.
Patient has stage IV urothelial cancer with diffuse metastasis with a very long treatment history. He has had metastatic urothelial cancer since 8 years ago and he is heavily treated with chemotherapy and immunotherapy until he finished 27 cycles of nivolumab 4years ago when he did not return until 1 year ago when he presented to the ER with a rapidly growing left neck mass and found to have Cspine involvement (bx proven, FGFR3+), requiring radiation and ultimately systemic therapy with Nivolumab. He completed 3rd cycle (1/4/2022). . This admission, pt now presenting with worsening metastasis with epidural metastatic spinal cord compression. Pt currently DNR/DNI, however still wishes to pursue chemotherapy.
There is a filling defect in the collecting system of the inter polar region of the right kidney
he filling defect measures 1.2 x 1.8 cm and demonstrate approximate enhancement from 40HU (from prior non enhanced CT) to 78 HU on portal venous phase on current study. Distal to the filling defect there is calyectasis
Lungs and large airways: Innumerable lung metastases have continued to grow, some of which demonstrate cavitation. For example, a 7.5 cm rightlower lobe nodule previously measured 6.3 cm. 6.7 cm left lower lobe nodule previously measured 5.7 cm. Debris is noted in the trachea.