PMC9706189_01
(A) One segment of intestinal canal, 21.5 cm long, 7.5-11 cm circumferential diameter, 2.5 cm tangential margin at one end, one ulcerated mass visible at 11.5 cm at the other end, 4.5x4x2.3 cm in size, grayish white cut surface. (B, C) Microscopic observation: the tumor cells were arranged in adenoid or sieve shape, infiltrated and broke through the plasma membrane layer, intravascular cancer thrombus and nerve invasion were seen, the tumor cells had abundant red stained cytoplasm, large and deep stained nuclei, obvious nucleoli, easy to see nuclear fission, and focal necrosis. (D) Immunohistochemistry showed tumor cells: CK(+), CK7 (-), CK20(+), CDX-2(+), MLH-1(+), MSH2(+), MSH6(+), PMS2(+), P53(+), Ki67 about 90%(+).
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After a comprehensive evaluation, the rectal cancer resection (Dixon surgery) and colostomy were performed and postoperative pathological examination revealed moderately differentiated colorectal adenocarcinoma (pT4bN2M1 stage IVc) ( Figure 1 ).
The patient underwent two surgeries (Dixon and sigmoidostomy conducted in December 2018 and para-stomal hernia repair, sigmoidostomy repair and ileostomy conducted in October 2019). The patient received 28 chemotherapies (XELOX for sessions 1-4, XELOX plus bevacizumab for sessions 5-7, FORFIRI plus bevacizumab for sessions 8-23, nivolumab plus regorafenib for sessions 24-28).
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So far, the patient underwent 2 operations and 28 times of chemotherapy ( Figure 2 ).
(A, B): The right eye slit-lamp examination and anterior segment photography. There are mixed eyelid congestion and oval ulceration (3*5mm) in the central cornea. The opacity of the corneal lesions, edema around the lesions, and mild opacity of the other peripheral cornea can be observed. (D, E): The left eye slit-lamp examination and anterior segment photography. The size of the ulceration is 3*6mm, other characteristics are the same as the right eye. (C, F): Lamellar staining of the corneal epithelium in the ulceration of both eyes with fluorescent, and punctate staining and positive seidel test were seen in the rest of the cornea.
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Slit-lamp examination and anterior segment photography showed evident ulceration in both eyes, and fluorescent(FL) showed lamellar corneal epithelial staining and a positive seidel test ( Figure 3 ).
In-vivo histology of the cornea (zeiss63X, FOV400mum). (A, B) Below the cornea of the left eye, the epithelial layer of the lesion was found to be defective. Many streak-like hyper-reflections and no normal epithelial cells were observed. (C, D) Deep structures were not imaged. Epithelial cells of the corneal epithelium in the clear zone above the lesion were swollen, and subepithelial nerve fibers were not observed. (E, F) The superficial stromal layer was slightly turbid, and the deep stromal cells were activated. The shape of endothelial cells was good, and there were a large number of punctate hyper-reflections observed in the endothelial layer.
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In-vivo histology of the cornea suggested that the patient developed corneal ulceration with perforation (Figure 4).