A 79-year-old woman underwent radical cystectomy after neoadjuvant chemotherapy for urothelial carcinoma of bladder (high grade, pT3aN0M0). Six months later, a computed tomography scan revealed multiple lung metastases. Salvage treatment with chemotherapy and pembrolizumab was administered, and a complete response was achieved. Two years after surgery, however, a left adrenal mass appeared, and positron emission tomography／computed tomography showed significant solitary uptake in the left adrenal gland. She underwent left adrenalectomy and histological findings revealed that the adrenal tumor was a metastatic urothelial carcinoma. No new lesion was observed over one year after surgery. Surgical resection should be considered in cases with solitary metastasis who responded systemic treatment.
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