2022年 · 第37卷第08期

The patient, 55 years old, a postmenopausal woman, was admitted to the hospital for "finding a left breast mass for more than 1 month". Breast ultrasonography showed that two hypoechoic nodules were seen in the left breast, the sizes were: 2.6 cm ×0.9 cm ×1.1 cm (2:30 direction), 0.7 cm ×0.5 cm ×0.7 cm (2:00 direction), and several lymph node echoes were seen in the left axilla. (Primary breast tumor and axillary lymph node) Pathological results of puncture: Immunohistochemical examination of left breast at 2 o'clock and 2: 30 o'clock: invasive breast carcinoma (non-special type), and cancerous tissue was seen in left axillary lymph node examination; (Primary breast tumor and axillary lymph nodes) Immunohistochemical examination: ER (3+, 90%), PR (3+, 90%), HER-2 (2+, uncertain positive), Ki-67 (+, about 30%). FISH test results: HER-2 gene amplification (FIG. 1). Systemic assessment showed no distant metastasis, according to EC (HP) -T (HP) protocol: doxorubicin liposomes 35 mg/m²+ Cyclophosphamide 600 mg/m²(trastuzumab first 8 mg/kg, then 6 mg/kg + pertuzumab first 840 mg, then 420 mg) -docetaxel 80 mg/m²(trastuzumab + pertuzumab) were treated with neoadjuvant chemotherapy combined with targeted therapy. Overall evaluation of 8 cycles of chemotherapy: partial response (PR). Followed by modified radical mastectomy for breast cancer, postoperative pathological examination showed: (after neoadjuvant chemotherapy, left side) invasive breast cancer (non-special type, WHO grade II, 6 points), peripheral fibrostromal hyperplasia with more foam cell aggregation and inflammatory cell infiltration, which was in line with the changes after chemotherapy; Cancer metastasis was found in the ipsilateral axillary lymph nodes (5/20) (the maximum diameter of metastasis was about 2.5 mm), and 3 of them showed treatment response. Evaluation of response to neoadjuvant therapy in breast cancer: RCB system grade II, tumors showed unifocal distribution, the largest bidiameter of residual tumors was 7 mm ×2 mm, and the cancer cell density was 10%. Postoperative pathological stage: yp T1bN2aM0. (Primary breast tumor and axillary lymph nodes) Immunohistochemical examination results showed: ER (3+), PR (3+), HER-2 (2+, uncertain positive), Ki-67 (+, 1%), and postoperative FISH examination detected: HER-2 amplification was not observed (Figure 2). Emmetrutuzumab (T-DM1) was started 3 weeks after surgery for 14 cycles, and radiotherapy was completed at the same time during the treatment period. Endocrine therapy was administered with anastrozole (1 mg, once/day) + abecilib tablets (150 mg, twice/day), with follow-up every 3 months. Follow-up included survival, imaging and hematology. Follow-up as of January 1, 2022, no tumor recurrence was observed.

A 53-year-old female was admitted mainly for "epigastric pain for 10 d". Enhanced CT examination of the whole abdomen revealed: huge cystic-solid mass occupied at the back of the stomach (long diameter about 13.4 cm); Multilocular cystic lesion of the lower pole of the left kidney (long diameter approximately 2.2 cm), multilocular cystic renal carcinoma? (Figure 1). Gastroscopy showed that the posterior wall of the fundus of the stomach was swollen and the mucosa was ulcerated (Figure 2). Immunohistochemical examination showed: CD34 (+), CD117 (+), DOG-1 (+), SDHB (+), Ki67 (30% of positive cells), consistent with gastrointestinal stromal tumor (GIST). Gene detection: C-kit 11 exons 1679-1681 deletion mutation. The patient underwent preoperative treatment with imatinib mesylate 400 mg/d for 6 months. Enhanced CT examination of the whole abdomen revealed a cystic-solid mass in the gastric body (long diameter about 5.2 cm) and a lower multilocular cystic lesion in the left kidney (long diameter about 2.2 cm) (Figure 3). Gastroscopy showed that a spherical bulge was visible on the fundus of the stomach, and the surface mucosa was intact (Figure 4). The patient's gastric GIST was significantly reduced, and the renal mass did not change significantly, so it was decided to be surgically removed at the same time. Intraoperative exploration: There was no metastasis, GIST was located in the posterior wall of the stomach body, and renal mass was located in the lower pole of the left kidney. Partial left nephrectomy was followed by gastric stromal tumor and wedge resection of part of the stomach wall. The operation time was 120 min, and the intraoperative bleeding was about 100 ml. The patient was discharged 6 days after operation. Postoperative pathological examination revealed that the size of the (stomach) mass was 5.4 cm ×4 cm ×3 cm, and hemorrhagic necrosis and cystic degeneration were seen in the central area (moderate effect) (Figure 5); The renal mass size was 1.5 cm ×1 cm ×1 cm, clear cell carcinoma (Figure 6). The patient continued to take oral imatinib mesylate 400 mg/d after surgery, and no tumor recurrence or metastasis was observed after 9 months of follow-up.

A 76-year-old male was admitted to hospital for "intermittent blood in the stool for more than 2 years". The patient complained of aggravation of blood in the stool 5 months ago, and went to a local hospital for electronic colonoscopy, which showed: (1) colon polyps; (2) Proctitis. No special treatment was given. Two months ago, I went to the local hospital again for abdominal enhanced CT examination, which showed that an oval mass shadow could be seen on the right side of the bladder, and the medial edge was close to the rectal wall, which was considered a benign lesion. One week ago, the patient's symptoms worsened again, so he went to our hospital for whole abdominal enhanced MRI examination, which showed: space-occupying lesions on the right side of the rectum, which were considered benign lesions (Figure 1). Laparoscopic abdominal cavity exploration + pelvic tumor resection was performed. Intraoperative exploration showed that the tumor was located in the peritoneum between the rectum and bladder, about 5 cm ×6 cm in size, with good mobility, no obvious adhesion to the surrounding tissues, and the ultrasonic scalpel could completely dissect the tumor (Figure 2). The sectional view of the postoperative tumor is shown in Figure 3. Pathological examination revealed: (pelvic cavity, abdominal wall) fibronecrotic nodules with extensive hyaline degeneration and calcium salt deposition (Figure 4). calcifying fibrous tumor (CFT) was diagnosed.

The patient was a 45-year-old female. He was admitted to hospital for more than 2 months due to dull pain in the left groin. Two months ago, the patient developed dull pain in the left groin without obvious inducement, no mass was touched, and no limb movement impairment. Color ultrasound showed that the wall of the initial segment of the left great saphenous vein was obviously unevenly thickened, the wall structure was unclear, the echo was thickened and reduced, and the distribution was uneven. A mixed echo mass with a range of 24 mm ×20 mm ×29 mm was formed locally, and the venous cavity was irregular. The blood flow signal in the mixed echo mass was rich and the blood flow signal in the venous cavity was unobstructed. MRI of left hip joint showed a round-like abnormal signal shadow in the left groin with clear boundary and a size of 2.8 cm ×2.4 cm. T1WI showed low signal, T2WI showed high signal, and obvious enhancement was seen after enhancement. The lesion was closely related to the left femoral vein (Figure 1). Excision of left inguinal mass was performed. Intraoperatively, the mass was located at the point where the great saphenous vein merged into the femoral vein, about 3 cm ×3 cm in size, involving the great saphenous vein and growing into the femoral vein cavity. Postoperative pathology: (inguinal) complex hemangioendothelioma, immunohistochemical staining: CD31 (+), CD34 (+), D2-40 (-), S-100 (-), Desmin (-), CGA (-), SYN (-), CD56 (-), P53 (-), Ki-67 (+20%) (Figure 2). After 3 months follow-up, no recurrence and distant metastasis were observed.