case_images: PMC11347344_01
case_images: The CT examination findings. (A-C) CT images in January 2022. (A) The metastasis invaded the duodenum and right ureter, resulting in right hydronephrosis. (B) Multiple low-density lesions in the liver which were considered to be metastatic in nature. (C) Metastasis in the retroperitoneal lymph node. (D-F) CT images in April 2022 after 4 cycles of immunotherapy. (D) Duodenal lesions were significantly reduced and hydronephrosis was relieved. (E) The number of liver lesions was reduced. (F) Metastasis in the retroperitoneal lymph node was reduced.
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case_images: In December 2021, she experienced tumor recurrence and metastasis, leading to duodenal obstruction, right hydronephrosis, and severe malnutrition. ( Figures 1A-C ,  2A, B ). April 2022, the patient continued to receive immunotherapy of pembrolizumab. After four cycles, a follow-up CT scan showed a reduction in duodenal lesions, retroperitoneal metastatic lymph nodes, and liver lesions ( Figures 1D-F ).
case_images: Gastroduodenoscopy examination findings. (A, B) Proliferative lesions and intestinal stenosis of duodenum on January 24, 2022. (C, D) Stenosis of the duodenal descending part was improved after 4 cycles of immunotherapy in April 2022. (E) Edema and ulcerative lesions in intestinal mucosa on March 2, 2023.
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case_images: In December 2021, she experienced tumor recurrence and metastasis, leading to duodenal obstruction, right hydronephrosis, and severe malnutrition. ( Figures 1A-C ,  2A, B ). Electronic gastroduodenoscopy revealed improvement in the duodenal descending segment stenosis ( Figures 2C, D ) and the naso-jejunal feeding tube was removed. Colonoscopy results showed mucosal edema and ulceration of the small intestine ( Figure 2E ), with biopsy revealing adenocarcinoma.
case_images: (A) Representative image shows the presence of spherical cells on peripheral blood smears. (B) Cabot ring in the bone marrow; (C) Nuclear egress in the bone marrow; (D) Trinuclear erythrocyte in the bone marrow; (E) Stippling erythrocyte in the bone marrow.
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case_images: Bone marrow (BM) aspiration analysis confirmed hemolytic anemia and the presence of spherocytes on peripheral blood smears ( Figures 3A-E ).