PMC8821913_01
Contrast-enhanced CT of the whole abdomen and pelvic cavity of the patient in different periods. Enhanced scanning was performed using Omnipaque (300 mg/ml) with an injection rate of 3 ml/s. The arterial phase was scanned 28-30 s after injection, the portal phase 48-50 s, and the delayed phase 60-70 s. (A) Primary tumor: from left to right are preoperative, after chemotherapy, and after targeted treatment (the following sequence is from left to right). (B) No metastases before surgery, new metastases after chemotherapy, and metastases disappeared after target therapy. (C) Preoperative metastases, metastases increased after chemotherapy and decreased after targeted therapy. (D) Preoperative metastases, new metastases after chemotherapy and disappeared after targeted therapy. (E) No metastasis here before surgery, no metastasis here after chemotherapy, and new recurrence after targeted therapy.
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Enhanced CT scan showed that the enhancement degree was lower than normal pancreatic parenchyma ( Figure 1 , left). At the same time, multiple nodular low-density masses ( Figure 1C , left) were detected in the liver. At this time, whole abdominal enhanced CT showed the progression of liver metastasis (70 days after the operation) ( Figure 1B , middle). At this time, we evaluated the tumor and found that the primary tumor was enlarged ( Figure 1 , right) and the liver had a new metastatic nodule ( Figure 1 ), so the therapy was stopped.
Hematoxylin-eosin staining image of metastases from the abdominal cavity (x100) of the patient, showing adenocarcinoma derived from pancreatic ducts.
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Rapid pathology revealed that the metastatic nodule was adenocarcinoma, and further immunohistochemistry showed pancreatic ductal adenocarcinoma ( Figure 2 ).
Changes in the tumor markers (CA19-9 and CA125) of the patient.
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The patient was still in follow-up, and the tumor marker test results are shown in  Figure 3 .