case_images: PMC6398041_01
case_images: Hematoxylin and eosin staining (original magnification x400): poorly differentiated with signet ring colon adenocarcinoma with extracellular mucin.
case_images: CRIONM2019-4767019.001.jpg
case_images: PMC6398041_01_CRIONM2019-4767019.001.jpg
case_images: fig1
case_images: Pathology report was consistent with poorly differentiated mucinous adenocarcinoma with signet ring cells (Figure 1), pT4N2bM1, with 14 positive lymph nodes out of the 40 retrieved.
case_images: CT scan that shows liver lesions (a) before starting 1st line chemotherapy and (b) before starting immunotherapy. (c) Last CT scan showing continuous PR.
case_images: CRIONM2019-4767019.002.jpg
case_images: PMC6398041_01_CRIONM2019-4767019.002.jpg
case_images: fig2
case_images: CT of the chest/abdomen and pelvis (CAP) showed multiple enlarged abdominal lymph nodes, at least seven liver lesions (Figure 2(a)), metastasis to the left adrenal gland, multiple peritoneal metastases, and a block of supraclavicular lymph nodes measuring 1.9 cm. CT CAP revealed progression of disease (PD) (Figure 2(b)) with increasing abdominal lymph nodes and peritoneal metastases by more than 30% (based on RECIST criteria). She is still continuing pembrolizumab every 3 weeks and her most recent CT scans from late September 2018 showed further decrease in liver lesions (Figure 2(c)) and supraclavicular lymph nodes measuring 7 mm (1.9 cm at the start of treatment) and decrease by more than 20% in abdominal lymph nodes while peritoneal masses have totally disappeared.