PMC8631449_01
Contrast enhanced CT scan demonstrating descending colon cancer at baseline (A) and liver metastasis at baseline (B) and at progression (C).
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F1
The chest and abdominal CT scan showed a metastatic disease, in particular a lesion on the left lobe of the liver of about 107 x 67 x 94 mm and six lesions on the right lobe, the bigger of which was about 21 mm (Figure 1A,B). After four cycles of treatment, CT scan evaluation showed disease progression, in particular on the left lobe of the liver where the bigger metastasis was 180 mm (Figure 1C), while there was an improvement on the primary tumor because the colorectal cancer step from 96 x 89 mm to 61 x 54 mm.
PMC8631449_02
CT scan showing left lung metastases (A,B).
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F2
In early 2017 disease relapse was shown, with bilaterally pulmonary metastases at CT scan and CEA increased to 8.7 mug/L (Figure 2).
PMC8631449_03
Contrast enhanced CT scan showing liver metastasis at baseline (A) and at progression (C); MRI rectal cancer at baseline (B) and after treatment (D).
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F3
In early 2018, a 55 to 60-years-old patient with persistent constipation and bleeding underwent colonoscopy, with a diagnosis of distal rectal adenocarcinoma with a single synchronous hepatic metastasis (about 25 mm) on IV-VIII segment (Figure 3A). A pelvic NMR described a rectal cancer extended from 2 cm above the anal opening to 10 cm, which was defined as cT3N1M1 (Figure 3B). At the end of chemoradiotherapy, an abdominal and chest CT scan showed a progression of the liver disease on the IV-VIII segment from 24 x 20 mm to 42 x 36 mm (Figure 3C) while the pelvic NMR described a regression of the primary tumor (Figure 3D).
PMC8631449_04
Contrast enhanced MRI showing metastases of the cerebellum (A) and metastases of the left temporal lobe (B).
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F4
After surgery, post-operative chemotherapy with FOLFOX6 was administered. After 4 cycles of treatment an abdominal and chest CT scan did not describe metastatic disease, whereas a brain CT scan performed for referred headache, photophobia and dizziness unfortunately showed a cerebellar lesion about 35 mm on the right (Figure 4A) and another lesion about 20 x 20 mm on temporal left site (Figure 4B).