PMC9969135_01
Abdomen CT scans and histological findings. (A) Abdomen CT scans suggested emerging mass in the vermiform appendix (red arrow), surrounded by multiple abscesses on 26/08/2019. (B) Histological finding with hematoxylin and eosin staining from the first surgery in September 2019. (C). Abdomen CT scans suggested an emerging occupation behind the uterus (red arrow), along with multiple nodes on the omentum suggesting recurrence on 10/07/2020. (D) Histological finding with the hematoxylin and eosin-stained biopsy specimen from the second cytoreductive surgery on 20/07/2020.
fonc-13-1010871-g001.jpg
PMC9969135_01_fonc-13-1010871-g001.jpg
f1
Pelvic CT showed an emerging mass in the vermiform appendix, surrounded by multiple abscesses ( Figure 1A ). Subsequently, the patient received radical appendectomy for tumors, histological findings of which suggested appendiceal mucinous adenocarcinoma, without invasion to the surrounding nerves or vessels ( Figure 1B ). Repeated abdomen CT revealed an emerging occupation behind the uterus, along with multiple nodes on the omentum, suggesting recurrence ( Figure 1C ). Histological findings implied recurrence of appendiceal mucinous adenocarcinoma ( Figure 1D ).
Abdomen CT scan presentations suggested the emerging occupation behind the uterus (A, C, E, G, I, K, red arrow) and thickened peritoneum (B, D, F, H, J, L, red arrow) from October 2020 to March 2022. (A, B). October 2020. (C, D). December 2020. (E, F). January 2021. (G, H). May 2021. (I, J). September 2021. (K, L). March 2022.
fonc-13-1010871-g002.jpg
PMC9969135_01_fonc-13-1010871-g002.jpg
f2
After three cycles' exposure, emerging occupation behind the uterus ( Figure 2A ) as well as the emergence of thickened peritoneum ( Figure 2B ) was presented by repeated abdomen CT scans, which suggested progressive disease (PD). However, efficacy evaluation by regular CT scans still resulted in PD again ( Figures 2C, D ). Beyond that, subsequent monotherapy with anlotinib, a multiple-target agent, failed to control the disease either ( Figures 2E, F ). ADP-ribose polymerase inhibitor (PARPi) in castration-resistant prostate cancer harboring ATM mutations, a combination treatment of niraparib and anlotinib was administrated as salvage regimen. After 3 months' exposure, the target lesion as well as the multiple nodes was suggested as stable disease (reduction by 15.8%,  Figures 2G, H ) according to the CT scans in May 2021. Regular abdomen CT scans suggested persistent stable disease for efficacy evaluation ( Figures 2I-L ).
The variations of tumor marker CEA (normal range 0 to 5 ng/mL) from June 2020 to March 2022.
fonc-13-1010871-g003.jpg
PMC9969135_01_fonc-13-1010871-g003.jpg
f3
In addition, tumor markers of CEA (normal range, 0 to 5 ng/ml) decreased significantly during the combination treatment ( Figure 3 ). The variation of CEA during the whole treatment is presented in the  Figure 3 .