PMC10185440_01
Basal CT scan. Multiple and bilobar hepatic metastases are observed
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F1
Abdominal ultrasounds showed liver lesions and the computerized tomography (CT) thoracoabdominal-pelvic scan showed an irregular thickening of the cecum wall with locoregional adenopathies in both the hepatic hilum and in the gastroduodenal ligament and multiple hepatic metastases (Figure 1).
Urgent CT scan showed pseudonodular hypodense image depending on the lateral wall of the second duodenal portion (blue arrow) that causes distension of the gastric chamber
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F2
CT scan showed distension of the gastric chamber and, more strikingly, of the first and second duodenal portion with abundant content, with a pseudonodular hypodense image depending on the lateral wall of the second duodenal portion, in addition to bilateral pulmonary thromboembolism and a single pulmonary metastasis in the right lower lobe of 9 mm (Figure 2).
CT prior to the start of treatment with TAS-102. Pulmonary metastasis (blue arrow) and retroperitoneal lymph node involvement are observed. Complete hepatic response is maintained. R: right side of the patient
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F3
CT after 3 cycles of TAS-102. Complete response of pulmonary metastasis and retroperitoneal lymph node involvement was observed (blue arrows)
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F4
After the third cycle, a complete response of lymph node involvement and pulmonary metastasis response was observed (Figure 4).
PET/CT showing no pathological uptake of 18-fluoro-deoxy-glucose. Complete biometabolic response is confirmed. Left of the figure is the corresponding CT image. Right of the figure is the image corresponding to the PET, with absence of pathologi-cal uptake
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F5
A positron emission tomography-CT (PET-CT) scan (Figure 5) and colonoscopy performed at this time revealed the absence of disease, accompanied by a biochemical response with the tumor marker carcinoembryonic antigen decreased to less than 0.5 mug/L.