case_images: PMC10061108_01
case_images: Computed tomography of the abdomen showing the upper abdominal mass with an unclear boundary with the surrounding intestinal canal, obvious enhancement can be observed on enhanced scanning (the red arrow shows the location of the package).
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case_images: PMC10061108_01_fonc-13-1028179-g001.jpg
case_images: f1
case_images: The abdominal CT scan depicted an unclear boundary between the middle abdomen and ascending colon, local invasion of the head of the pancreas, and an enhanced scan displayed significant enhancement ( Figure 1 ).
case_images: (A) The boundary between the mass and the surrounding intestine was unclear, and the central necrosis of the tumor was the flesh of fish-like. (B, C) Medium-differentiated adenocarcinoma on histopathological assessment of the resected specimen (Both are hematoxylin-eosin staining).
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case_images: PMC10061108_01_fonc-13-1028179-g002.jpg
case_images: f2
case_images: During the operation, a 0.5x0.5 cm fistula was found at the colon anastomosis, and a 10x10 cm bossing could be touched in the ascending colon and invaded the head of the pancreas, making it difficult to move the fixation ( Figure 2A ).
case_images: Tumor chromosome copy number map. The red dots display APC germline mutations on chromosome 5 and POLE mutation on chromosome 12.
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case_images: PMC10061108_01_fonc-13-1028179-g003.jpg
case_images: f3
case_images: Next-generation sequencing (NGS) applying the Illnuina NovaSeq6000 (ACCB Biotech) using the patient's archival tumor tissue and blood showed RAS wild-type, POLE mutation, tumor mutation load 119.9 mutation/MB ( Figure 3 ).
case_images: (A) CT showed that the abdominal mass decreased gradually after using treprizumab and remained stable for a long time (the red arrow displaysthe package's location). (B) Significant decrease of tumor markers of metastasized cancer under therapy with terriprizumab at 240 mg and bevacizumab at 500 mg every three weeks. Significant decrease of tumor markers of metastasized cancer under therapy with terriprizumab at 240 mg and bevacizumab at 500 mg every 3 weeks.
case_images: fonc-13-1028179-g004.jpg
case_images: PMC10061108_01_fonc-13-1028179-g004.jpg
case_images: f4
case_images: After two cycles of treatment, the patient's disease to was assessed partially responded (PR) by CT ( Figure 4A ), and the carcinoembryonic antigen, carbohydrate antigen 19-9, and carbohydrate antigen 50 levels returned to normal ( Figure 4B ).
case_images: The case lifetime.
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case_images: PMC10061108_01_fonc-13-1028179-g005.jpg
case_images: f5
case_images: The case timeline is presented in  Figure 5 .