PMC10336539_01
FDG PET/CT and pathological changes (A-C) PET/CT cross sectional view. A mass shadow with increased glucose metabolism can be seen near the anastomotic site. Its maximum SUV value is 18.18 and its size is about 49.5 x 42.5 mm. It is nodular with strip-shaped calcification and the boundary with the left ureter is unclear. (D) 18F-FDG PET/CT maximum density projection (MIP). Hypermetabolic nodules are visible in the left neck and lumpy lesions with increased glucose metabolism are visible in the abdomen. (E) Moderately differentiated adenocarcinoma (H&E staining, 400x). (F-H) Immunohistochemical staining showed that cells were positive for MLH1 (F) and negative for MSH2 (G) and MSH6 (H) (400x).
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F1
F-fluorodeoxyglucose positron emission tomography computed tomography detected a large mass with elevated glucose metabolism near the anastomosis (Figures 1A-D), as well as multiple retroperitoneal lymph node metastases. The mass was diagnosed as moderately differentiated adenocarcinoma by biopsy pathology and was considered to originate from the intestine (Figure 1E). Immunohistochemical staining showed that cells were positive for MLH1 (Figure 1F) and negative for MSH2 (Figure 1G) and MSH6 (Figure 1H).
Imaging studies and the treatment time axis. Follow-up imaging of the abdominal mass. (A) After four cycles of pembrolizumab. (B) After local DT4600cGy/23f/32d radiotherapy. (C) Three months (D) 12 months (E)18 months, and (F) 30 months after the start of fruquintinib administration. (G) The treatment time axis. SD, stable disease; PR, partial response.
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F2
The response to treatment, as evaluated by imaging, was stable disease (Figure 2A). However, imaging follow-up showed no changes in the abdominal mass (Figure 2B). The abdominal mass showed continuous shrinkage in the imaging follow-up starting on the third month of fruquintinib treatment (Figures 2C-E). The last imaging follow-up was at 30 months, and the focus remains obtaining a continuous partial response, as determined using the RECIST1.1 guidelines (Figures 2F, G).