PMC9403738_01
(A) Endoscope images showing rectal neoplasm. (B) In July 2019, pretreatment CT-scan showed the thickened colorectal wall and multiple liver and distant lymph nodes metastases. (C) CT-scan after 6 cycles of immunotherapy showed the tumor regression achieved partial response. (D) Timeline of diagnosis, detailed treatment protocol from July 2019 till date.
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A 51-year-old man was admitted to the hospital with his electronic colonoscopy showing rectal neoplasm and pathological diagnosis revealing severe dysplasia of the glandular epithelium in July 2019 ( Figure 1A ). CT evaluation showed multiple liver and distant lymph node metastases ( Figure 1B ). Since 4 July 2019, he was receiving antitumor treatment, including chemotherapy, targeted therapy, and interventional embolization for primary and liver metastatic cancer focus ( Figure 1D  shows detailed treatment protocol from July 2019 till date). After six cycles of pembrolizumab injection, the patient did not experience any discomfort and CT scan showed partial response (PR) ( Figure 1C ). ACTH level, consistent with the diagnosis, and the cortisol level normalized (396.1 nmol/l). Abdominal CT evaluation was maintained at PR ( Figure 1C ).
PMC9403738_02
(A) Endoscope images showing esophageal neoplasm. (B) In February 2021, pretreatment CT-scan showed multiple livermetastases and supraclavicular and subcarinal lymph node metastases. (C) In June 2021, posttreatment CT-scan showed the tumor regression. (D) Timeline of diagnosis, detailed treatment protocols since February 2021 till date.
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Therefore, he received prednisone (5 mg/day orally) as replacement therapy and pembrolizumab was discontinued for one cycle ( Figure 2D  shows detailed treatment protocols since February 2021 till date). In outpatient endocrinology, he received hydrocortisone acetate (20 and 10 mg orally in the morning and evening, respectively) as replacement therapy after discharge and CT scan evaluation showed no tumor progression ( Figure 2C ).