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case_images: (A) The pathological findings of colonoscopy biopsy. It shows that atypical cells are arranged in an irregular glandular tube-like arrangement, with large and deeply stained nuclei and obvious mitosis (H&E, 40x). (B) The microscopic findings of the resected specimen. There is only mucus but no exact cancer cells were found (H&E, 40x).
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case_images: He then underwent colonoscopy biopsy, which revealed adenocarcinoma (Figure 1A). Microscopic examination found only mucus but no viable cancer cells in the whole intestinal layer, perianal fat, fibrous tissue around the ureter, and lymph nodes around the vena cava (Figure 1B).
case_images: The intestinal and kidney mass treatment effect images of patient at baseline, after pembrolizumab and after surgery, respectively. The red arrow indicates the lesion.
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case_images: Abdominal contrast-enhanced computed tomography (CT) revealed that ascending colon cancer had broken through the serosa with multiple mesenteric and retroperitoneal lymph node metastases, inferior vena cava and right ureter involvement, and right kidney and right renal arteriovenous invasion (July 4, 2019) (Figure 2). CT scanning revealed that the patient had robust partial remission (PR) (Figure 2). CEA also declined to the normal range (Figure 5).
case_images: Immunohistochemical staining for MLH1, MSH2, MSH6, and PMS2 on the intestinal biopsy samples reveal loss of MLH1 and PMS2 protein expression (40x).
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case_images: Immunohistochemical staining for MLH1, MSH2, MSH6, and PMS2 on the patient's archival intestinal biopsy samples revealed loss of MLH1 and PMS2 expression (Figure 3).
case_images: The irradiated gross tumor volume and the radiation dose plan.
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case_images: Dynamic change curves of CEA in peripheral blood during the whole treatment process.
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case_images: CT scanning revealed that the patient had robust partial remission (PR) (Figure 2). CEA also declined to the normal range (Figure 5).
case_images: Resection samples of intestines and kidneys.
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case_images: Thus, the patient was treated with expansive radical right hemicolectomy + right nephrectomy + retroperitoneal lymphadenectomy on March 19, 2020 (Figure 6).