2022年 · 第37卷第05期

A 71-year-old female was admitted with "red patches on the skin of the right breast for 15 years, aggravated for 1 year". Physical examination: There were red eczema-like changes in the skin on the inner side of the right breast and the middle of the chest, with a suture incision in the center (Figure 1), and no swollen lymph nodes were palpable in the ipsilateral axilla. Pathological biopsy suggests that Paget's disease (skin in the breast area) may be possible. Immunohistochemistry showed: CK7 (+), CK8 (+), CK10/13 (-), CEA (partial +), S100 (-), ER (partial +), PR (-), CK20 (-), AR (+), Her-2 (+ + +), Ki67 (30% ~60% +). Ultrasonography showed that there was no obvious space-occupying echo in the breast gland. MR findings of breast enhancement: No clear abnormal enhanced space occupying foci were found. Excision of right breast skin lesion + large V-shaped flap transfer of abdomen were performed. Cryopathological examination revealed: (right breast) cutaneous Paget's disease, upper, lower, medial, external and basal margin (-). Postoperative pathological report: The right breast with skin tissue, one piece of gray-yellow and gray-red breast tissue, size 9 cm ×8 cm ×3.2 cm, skin size 8 cm ×8 cm, a rough skin area, size 3.5 cm ×1.3 cm, gray-white, solid, hard in texture, with unclear boundary, was seen at the upper margin 3.2 cm, lower margin 4 cm, inner margin 3 cm, and outer margin 1.5 cm. Light microscopy: The right breast tissue showed that the tumor was located in the epidermis. The tumor cells were large, round, rich in cytoplasm, large nuclei, and obvious abnormalities, showing small clusters, nests or scattered in the skin epidermis (Figure 2). No infiltration of breast parenchyma and no intraductal carcinoma components were observed. The upper, lower, inner, outer and basal margin were all (-). Cutaneous Paget's disease (right breast) was diagnosed. Follow-up for 2 months showed no local recurrence, no distant metastasis and no complications.

A 61-year-old male was admitted with "intermittent upper abdominal pain for 1 month". Physical examination: soft abdomen, mild deep tenderness in the upper abdomen, no muscle tension and rebound pain, and no obvious abdominal mass. Deny history of trauma, surgery, pancreatitis, etc. Abdominal enhanced CT showed a massive high-density shadow on the body of the pancreas, about 5.2 cm ×4.1 cm in size, with uneven enhancement on the enhanced scan (Figure 1). The lesion surrounded the splenic artery and was unclear from the adjacent gastric wall, which was considered as pancreatic cystadenocarcinoma. Selective pancreatectomy and splenectomy were performed. During the operation, the tumor was found to be located in the body of the pancreas, with irregular shape and slightly tough texture. Suspected metastatic nodules were seen on the surface of omentum and hepatic round ligament. The resection and freezing were performed for rapid pathology. The result was fibrous tissue hyperplasia with necrosis and acute and chronic inflammatory cell infiltration, so the operation was completed according to the established surgical procedure. The postoperative pathology showed that the tumor was gray-white and light brown, solid, slightly tough and translucent. Microscopically, the tumor consists of thick collagen fibers and spindle-shaped fibroblasts (Figure 2). Immunohistochemistry: SMA (+), Vimentin (+) (Figure 3), β-catenin (a little nuclear +) (Figure 4), Desmin (focal +), CK-pan (-), S-100 (-), CD117 (-), CD34 (-), Ki-67 (+8%), Dog-1 (-), SDHB (+), STAT6 (-), H3K27me3 (+). According to the pathology, the final diagnosis was aggressive fibromatosis of the pancreas (AF). The patient was discharged from the hospital on the 5th day after surgery, recovered well, without complications such as bleeding and pancreatic leakage, and did not receive other drug treatment or radiotherapy or chemotherapy. The outpatient follow-up has reached half a year, and the current condition is stable without recurrence.

The patient was a 56-year-old male with the main complaint of "abdominal pain in the right upper abdomen and abdominal distension for more than three months". The tumor markers CEA, AFP and CA199 were all normal. He had previous gallbladder and bile duct stones, and underwent "laparoscopic cholecystectomy + exploratory lithotomy of bile duct incision" without a history of malignant tumor. MRI examination: A round-like cystic-solid lesion was found in the left inner lobe of the liver, with a slightly longer T in the solid part₂Eq T₁Signal, DWI showed an inhomogeneous slightly higher signal with clear boundaries and a diameter of about 15 mm (Fig. 1). Contrast-enhanced ultrasound showed abnormal perfusion of the solid part of mixed echoes in the S4 segment of the liver. The rapid enhancement of the solid part showed high enhancement in the arterial phase, began to resolve in the portal phase, and showed low enhancement in the delayed phase (Figure 2). There was no contrast medium perfusion in the cystic part at all stages, and mucinous cystadenocarcinoma of the liver was considered. Radical surgical resection was performed to completely remove the left liver. Postoperative pathology: mucinous cystadenocarcinoma of the liver，No intravascular tumor thrombus and nerve invasion were observed (Figure 3).

A 55-year-old male was admitted to hospital for more than 1 month due to yellow skin and sclera staining all over his body. Physical examination: The abdomen was flat and soft, with mild tenderness and rebound pain in the left upper abdomen, palpable mass, and a recent weight loss of 4 kg. Laboratory test: Hb 134 g/L, white blood cells 5.23×10⁹/L, total bilirubin 282.7 μ mol/L, and tumor markers were normal. Ultrasound: Dilation of intrahepatic and extrahepatic bile ducts, main pancreatic duct, hypoechoic mass in the head of the pancreas. No abnormalities were found on chest CT. Abdominal CT: A soft tissue mass was seen on the head of the pancreas, about 3.5 cm ×3.6 cm ×5.1 cm in size, with mild enhancement in the arterial phase, and no abnormalities were found on CT angiography (Figure 1). Percutaneous hepatic puncture biliary drainage and puncture biopsy were performed under B-ultrasound guidance. Pathology: diffuse large B-cell lymphoma (DLBCL), non-germinal center source; Immunohistochemistry (Figure 2): CD20, CD79, and Bcl-6 positive, CD10, CD30, and Bcl-2 negative, Ki-67 80%. The patient started to receive R-Chop (rituximab + cyclophosphamide + vinorelbine + doxorubicin + methylprednisolone) regimen after the bilirubin level dropped to normal after reducing yellow treatment. He has completed 7 cycles of treatment. After six months, no obvious mass was found on CT reexamination, and the patient does not have any discomfort at present.

Organ transplantation is currently the most effective treatment for end-stage organ failure. Organ shortage is a global problem restricting organ transplantation^［1］。 Donor organ harvesting, preservation and ischemic reperfusion injury (IRI) after transplantation are important factors affecting prognosis of transplantation. Since the development of organ transplantation technology in the 20th century, organ protection technology has been the research hotspot in this field. Organ preservation solutions such as Collins solution, the University of Wisconsin solution (UW solution), histidine-tryptophan-ketoglutarate solution (HTK solution) have been introduced one after another, which has promoted the rapid development of static cold storage (SCS) technology of organs^［2］。 With the deepening of understanding of transplanted organ IRI, the requirements for organ preservation quality and time limit are constantly increasing. In order to adapt to the increasing demand of donor organs and accept the expansion of standard donor organs, special preservation solutions for different organs such as: HTK-N solution^［3］Lung preservation fluid (e.g. Steen's fluid)^［4］Renal perfusion (e.g. KPS1 solution)^［5］And so on have been developed and applied one after another. Currently, SCS is still the standard preservation technique for organ transplantation^［2］However, SCS can cause cold ischemic damage to organs and cannot effectively assess organ function during cold preservation. Mechanical perfusion (MP) organ preservation techniques include normothermic machine perfusion (NMP, 32℃ ~37℃), subnormothermic machine perfusion (SNMP, 20℃ ~32℃), hypothermic oxygenated perfusion (HOPE, 0℃ ~12℃) and hypothermic machine perfusion (HMP, 0℃ ~12℃). In addition, such as supercooling preservation (-4℃ ~6℃)^［6］And other new preservation technologies have also appeared one after another. In vitro perfusion system can remove metabolic waste and provide basic substances to meet the metabolic needs of organs in the process of organ preservation under different temperature control conditions, which can not only prolong the organ preservation time, but also evaluate the function of isolated organs, improve organ quality, reduce the occurrence of related complications after operation, and improve the utilization rate of marginal organs. Results of multiple clinical randomized controlled trials (RCTs) published in multiple high-quality journals^［7-11］It is also confirmed that MP can significantly repair the quality of donor organs and reduce the incidence of related complications after transplantation, and it is expected to strongly promote the progress of organ transplantation in the future.