PMC10382127_01
(A) The baseline electronic fiber colonoscopy of the patient. (B) After 2 cycles of immunotherapy, there was no significant change in the size of the tumor, but the surface was congested. (C) Showed that the rectal mass has disappeared and fibrosis can be seen in the area of the original area.
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Electronic fiber colonoscopy showed that the rectal mucosa was rough, the tumor protruding into the rectum, 5-10 cm from the anus, and the lower pole of the mass was located 1cm above the dentate line ( Figure 1A ). Re-examination of electronic sigmoidoscopy revealed a protuberant mass 5-10cm from the anus, with surface congestion ( Figure 1B ). Re-examination by electronic sigmoidoscopy showed that the tumor was 5cm from the anus with scar changes after radiotherapy, the mucosa was smooth, and no obvious new organisms were observed ( Figure 1C ).
(A)The biopsy indicated squamous cell carcinoma. (B) The immunohistochemical PD-L1 detection.
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Biopsy of the lesion is SCC ( Figure 2A ). The results of immunohistochemistry showed that AE1/AE3 (+), P40 (+), CK5/6 (+), Ki-67 (70%), MLH1 (+), FMS2 (+), MSH2 (+), MSH6 (+), PD-L1 (VENTANA SP263) (CPS:60), PD-L1 (DAKO 22C3) (CPS:50) ( Figure 2B ).
(A) The baseline abdominal MRI of the patient. (B) After 2 cycles of immunotherapy, the size and shape of the tumor did not change significantly. (C) After a series of comprehensive treatment, the original mass disappeared. (D) After 1 year of follow-up, the disease was stable and had no recurrence.
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Abdominal MRI found that carcinoma invaded the posterior wall of the uterus, and the distance between the distal end of the tumor and the anal margin was 6.3 cm ( Figure 3A ). After received 2 cycles of Pembrolizumab immunotherapy, the patient's symptoms did not significantly relieve and the size of the tumor has not shrunk in imaging ( Figure 3B ). No occupying lesions were found in abdominal and pelvic MRI scans ( Figure 3C ). Within 12 months after the end of the overall treatment regimens, four follow-up visits for the patient were conducted and no recurrence lesions were found ( Figure 3D ).
(A) The baseline PET/CT of the patient. (B) Showed that most of the abnormal lymph nodes founded on the baseline scan had disappeared, but the rectal mass and para-aortic lymph nodes at the level of the second lumbar spine has not changed significantly. (C) Showed that the patient achieved NED status eventually.
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Of these suspected lymph nodes, para-aortic lymph nodes at the level of the second lumbar spine had the strongest uptake capacity for 18F-FDG, with a SUVmax of 8.0 ( Figure 4A ). Although most of the abnormal lymph nodes founded on the baseline scan had disappeared, the para-aortic lymph nodes at the level of the second lumbar spine has not changed and with SUVmax of 4.1 ( Figure 4B ). PET/CT showed mild uptake of 18F-FDG at the primary tumor site with SUVmax of 1.6, and all abnormal uptake of 18F-FDG in lymph nodes seen at baseline scans disappeared ( Figure 4C ).