2023年 · 第38卷第05期

Pancreatic cancer has a high degree of malignancy and poor prognosis. Most patients have no chance of surgery at first diagnosis, and the surgical resection rate is only about 20% ~30%. For patients with unresectable locally advanced and distant metastases, systemic treatment plays an important role in improving their prognosis. However, the objective response rate of the first-line chemotherapy regimen represented by gemcitabine/albumin paclitaxel or oxaliplatin/irinotecan/calcium leucovorin/5-fluorouracil (oxaliplatin, irinotecan, 5-FU/LV, FOLFIRINOX) is less than 40%, targeting the target therapy of kirsten rat sarcoma viral oncogene (KRAS) G12C, poly-ADP ribose polymerase pathway potential benefit population<10%, with limited prognostic improvement. In recent years, immunotherapy has been applied to a variety of solid tumors and has made great progress, which has significantly improved the prognosis of patients. However, based on the tumor microenvironment (TME) in which pancreatic cancer is immunosuppressed, simple immunotherapy mostly ends in failure. Recently, aiming at the abnormally abundant tumor stroma of pancreatic cancer, the related research on transforming "cold" tumors into "hot" tumors through immune microenvironment remodeling has become a hot topic. New combinations and methods such as immunotherapy combined with chemotherapy, targeted therapy, chimeric antigen receptor T-cell (CAT-T) technology and tumor vaccine have shown good safety in early clinical research and are expected to lead the direction of comprehensive treatment of pancreatic cancer in the future.

A 59-year-old female was seen for "perianal pain during defecation for 7 days". Digital rectal diagnosis: The tumor can be palpable on the posterior wall of the rectum from about 5 cm to the anal margin, with a size of about 4.5 cm ×4.0 cm. It is soft to touch, the mucosa is smooth, and the mobility is acceptable. Abdominal CT examination showed that the intestinal wall of the lower rectum was unevenly thickened, about 4.4 cm at the thickest part, and patchy low-density shadows were seen in the thickened intestinal wall. The enhanced scan was obviously unevenly enhanced, and the corresponding segmental intestinal lumen was narrowed, which was acceptable in relation to the surrounding tissues (Figure 1). Colonoscopy showed that the rectum was about 5 cm from the anal margin to a wide base flat bulge of the anal margin, with a size of about 5 cm ×4 cm. The surface was still smooth and the mucosa was not invaded. Preliminary diagnosis: Presacral cyst. Transanal presacral cyst resection was performed. The whole thickness of the rectum was incised at the protuberance and directly reached the presacral to see a cystic mass. The mass was completely removed along the cyst wall of the mass. After confirming that there was no residue, the whole thickness of the rectum was intermittently sutured with absorbable thread. Pathological examination showed that (anterior sacral mass) was consistent with a caileum cyst, and the cyst wall was lined with squamous epithelium and cubic epithelium, with local chronic inflammation and foam cells (Figure 2).