Abstract
A 67-year-old man was referred to our hospital with chief complaints of macrohematuria and anemia. He was diagnosed with muscle-invasive bladder cancer (MIBC) with right external iliac lymph node (LN) involvement and received two courses of gemcitabine and carboplatin. After chemotherapy, left external iliac LN involvement was identified as a new lesion, even though the bladder cancer (BCa) and right external iliac LN decreased in size. Therefore, pembrolizumab was administered as a second-line treatment. The bladder tumor and positive LNs subsequently shrunk. Open radical cystectomy and bilateral ureterocutaneostomy were also performed. The pathological examination of the surgical specimen indicated urothelial carcinoma, pathological stage Tis, and negative LN involvement. The patient was followed up for 30 months without evidence of local recurrence or distant metastasis.