PMC9530329_01
Timeline outlining clinical events.
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The timeline of events is presented  Figure 1 . Figure 1 ). Follow-up abdominal enhanced CT scan was done every 6 months and showed no tumor recurrence.
Diagnosis of gastric carcinoma. (A) Endoscopic images showing gastric cancer. (B) Gastric cancer (indicated by yellow arrow), specific enhancement pattern on multiphasic contrast-enhanced computed tomography (CT). (C) Representative histopathological image of gastric cancer.
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According to the Chinese Society of Clinical Oncology (CSCO) guidelines, a gastroscopy was first performed where a tumor was found at the angular notch of the stomach ( Figure 2A ). To further determine the cause of increased AFP and CEA levels, contrast-enhanced computed tomography (CT) was performed that showed a primary tumor in the left lobe of the liver ( Figures 3A, B ), with possible existing carcinomas in the stomach ( Figure 2B ) and the rectum ( Figure 4B ). During the operation, the samples from the lesion sites of stomach and liver were biopsied, both pathological examinations show malignant tumors ( Figures 2C ,  3C ).
Diagnosis of primary liver cancer. (A) Liver cancer seen on contrast-enhanced CT (arterial phase), indicated by yellow arrow. (B) Liver cancer seen on contrast-enhanced CT (venous phase), indicated by arrow. (C) Representative histopathological image of liver cancer.
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To further determine the cause of increased AFP and CEA levels, contrast-enhanced computed tomography (CT) was performed that showed a primary tumor in the left lobe of the liver ( Figures 3A, B ), with possible existing carcinomas in the stomach ( Figure 2B ) and the rectum ( Figure 4B ). During the operation, the samples from the lesion sites of stomach and liver were biopsied, both pathological examinations show malignant tumors ( Figures 2C ,  3C ).
Diagnosis of rectal carcinoma. (A) Endoscopic images indicating rectal carcinoma (yellow arrow). (B) Contrast-enhanced CT showing rectal cancer. (C) Representative histopathological image of rectal carcinoma.
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To further determine the cause of increased AFP and CEA levels, contrast-enhanced computed tomography (CT) was performed that showed a primary tumor in the left lobe of the liver ( Figures 3A, B ), with possible existing carcinomas in the stomach ( Figure 2B ) and the rectum ( Figure 4B ). A biopsy indicated that the mass was a rectal adenocarcinoma which was prone to bleeding ( Figure 4A ). Pathological analysis showed a rectal ulcerative type of moderately differentiated adenocarcinoma (size: 7 x 4.5 x 1.5 cm) infiltrating the outer membrane with the presence of lymphovascular emboli and absence of perineural invasion ( Figure 4C ).