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Primary signet ring cell carcinoma of the bladder is a rare tumor and it has a poor prognosis and is more mortal than the urothelial cell carnioma. However, most patients apply with painless macroscopic hematuria; rarely do they could apply with urinary tract infection or lower urinary tract symptoms. In this study; a 47-yearold male was referred to our clinic with dysuria, which was antibiotic therapy and symptomatic treatment. In ultrasonography, bladder wall thickening has been seen then patient underwent with cystoscopy. After atypical lesions were seen on the bladder mucosa, random punch biopsies were taken. A pathological examination revealed infiltrative urothelial carcinoma with a poorly differentiated signet ring cell component. As in this case report, patients with signet ring cell bladder cancer, which is rare and has an aggressive course, might only present with non-specific complaints such as dysuria. If atypical lesions are observed during the diagnostic cystoscopy procedure, the threshold should be kept low to decide on biopsy.

Aim: To evaluate the ex vivo efficacy of chemotherapy, immunotherapy and targeted agents with the oncogram method in patients with bladder cancer and determine the most appropriate personalized treatment agent using immune markers. Materials & methods: Bladder cancer tissues were obtained from each patient. After cultivation, cell cultures were divided into 12 groups for each patient and 11 drugs were administered. Cell viability and immunohistochemistry expression were examined. Results: A good response rate was determined to be a 23% viability drop. The nivolumab good response rate was slightly better in PD-L1-positive patients and the ipilimumab good response rate was slightly better in tumoral CTLA-4-positive cases. Interestingly, the cetuximab response was worse in EGFR-positive cases. Conclusion: Although good responses of drug groups after their ex vivo application by using oncogram were found to be higher than control group, this outcome differed on a per patient basis.

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