Fig. 1.

Radiology images showing response over time in the chest, abdomen, and pelvis A-C: Pretreatment 18F-FDG PET/CT imaging at initial workup: Metastatic disease seen as avid pulmonary nodules (A, circle); partially necrotic infrahilar mass (A, white closed arrow); peritoneal mass along abdominal wall (B, white open arrow); external iliac node (C, black arrowhead); and patchy areas of avidity within confluent thickening of the rectus abdominis muscles, where there are also dystrophic calcifications (B and C, white arrowheads). D-F: Axial post-contrast CT imaging eight months later: Progression after EMA/EP seen as continued pulmonary nodules (D, circle); enlarging infrahilar mass (D, white closed arrow; 4 cm, previously 3.4 cm); peritoneal mass (E, white open arrow; 4.1 cm, previously 2.8 cm); external iliac node (F, black arrowhead; measuring 3.9 cm, previously 2.7 cm); and continued rectus abdominis thickening (E and F, white arrowheads). Note also tumoral and bland pulmonary emboli (D, black closed arrow) and deep venous thrombosis (F, black closed arrow) from invasion of the right external iliac vein at the level of the external iliac node. G-I: Axial post-contrast CT imaging an additional five months later: Response with pembrolizumab with decreased pulmonary nodules (G, circle); infrahilar mass (G, white closed arrow; 2.3 cm, previously 4 cm); peritoneal mass (H, white open arrow; 1 cm, previously 3.9 cm); right inguinal node (I, black arrowhead; measuring 1.5 cm, previously 3.9 cm); and rectus abdominis thickening (H and I, white arrowheads).