PMC6398041_01
Hematoxylin and eosin staining (original magnification x400): poorly differentiated with signet ring colon adenocarcinoma with extracellular mucin.
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Pathology report was consistent with poorly differentiated mucinous adenocarcinoma with signet ring cells (Figure 1), pT4N2bM1, with 14 positive lymph nodes out of the 40 retrieved.
CT scan that shows liver lesions (a) before starting 1st line chemotherapy and (b) before starting immunotherapy. (c) Last CT scan showing continuous PR.
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CT of the chest/abdomen and pelvis (CAP) showed multiple enlarged abdominal lymph nodes, at least seven liver lesions (Figure 2(a)), metastasis to the left adrenal gland, multiple peritoneal metastases, and a block of supraclavicular lymph nodes measuring 1.9 cm. CT CAP revealed progression of disease (PD) (Figure 2(b)) with increasing abdominal lymph nodes and peritoneal metastases by more than 30% (based on RECIST criteria). She is still continuing pembrolizumab every 3 weeks and her most recent CT scans from late September 2018 showed further decrease in liver lesions (Figure 2(c)) and supraclavicular lymph nodes measuring 7 mm (1.9 cm at the start of treatment) and decrease by more than 20% in abdominal lymph nodes while peritoneal masses have totally disappeared.