2026年 · 第41卷第04期

I have treasured this photograph for over forty years, and it will open the floodgates of my memory. Standing at the entrance, I can see the light that illuminated me, and some who will never be seen again! On that day, Professor Yang Yinmo sent me two essays, "Mountains Under the Banner" and "After Dispersing", suggesting that I restore the scene of the defense meeting at that time. I agreed, not only because the defense made me see my own strength clearly, but also because it was the key scale for me to become who I am today, but also an inheritance of medical spiritual bloodline, and it should be passed on endlessly and forever. These values surpass the coronation of academics.

Red cloth banner with large white letters.

A 71-year-old male was admitted due to the discovery of "esophageal lesions for 2 weeks". Aug 2023 Gastroscopy revealed early esophageal cancer and ultrasound gastroscopy revealed esophageal cancer (T1bN0M0). CT examination of thorax and abdomen showed changes in the middle esophageal wall and multiple cysts in the liver. Endoscopic submucosal dissection of esophageal lesions was performed (Figure 1). Pathological examination revealed differentiated squamous cell carcinoma in the esophagus with negative margins. Retrospective gastroscopy 4 months after surgery revealed that the fundus of the stomach showed type ⅡA + Ⅱc lesions with a diameter of about 3 cm (Figure 2). Pathological examination revealed that the glandular epithelium of "fundus of stomach" showed moderate to severe dysplasia and carcinoma (adenocarcinoma). Abdominal enhanced CT examination revealed abnormal density shadow in the left lateral lobe of the liver, metastasis? Lymphoma? (Figure 3). PET-CT examination showed a slightly low density shadow in the left lateral lobe of the liver, and no abnormal hypermetabolism of glucose was observed. After multidisciplinary discussion, the left lobe of the liver occupies space and grows indolently, the primary hepatic lymphoma is highly likely, and the diagnosis of fundus adenocarcinoma is definite. In January 2024, laparoscopic left lateral lobectomy of the liver + microwave ablation of liver lesions + radical proximal gastrectomy was performed (Figure 4). Pathological examination revealed lymphoma in the marginal zone of the left lateral lobe of the liver; Differentiated adenocarcinoma in gastric fundus 60% + neuroendocrine carcinoma 40%, no lymph node metastasis. Genetic testing revealed p.l 195F variant in TP53 gene, and IP regimen (irinotecan combined with cisplatin) chemotherapy was given. Follow-up PET-CT examination in December 2024 showed multiple low-density shadows in the right lobe of the liver, multiple small nodules in the right lung, bone destruction in the right scapula, and varying degrees of increased glucose metabolism in each lesion, so multiple metastases were considered. Pathological examination of liver puncture showed that abnormal cells were found in liver tissue, and the immunophenotype supports neuroendocrine carcinoma.

The patient was a 36-year-old male. Admitted for "5 d of anal swelling and pain after mixed hemorrhoid surgery". Physical examination: the left perianal and perineal skin is blue-purple, with an isolated rash beside it, and there are blisters and ulcers in the center; Posterior hemorrhoid tissue edema and erosion (Figure 1). Laboratory test: Routine blood test: RBC 2.65×10¹²/L, HB78 g/L, WBC 3.6×10⁹/L; Serum CRP 204 mg/L. Rectal color ultrasound examination: the perianal area is more obvious inflammatory, involving the superficial subcutaneous space. Pelvic MRI examination: Inflammatory changes of anal canal and perianal involved the perineum, scrotal root and bilateral buttocks subcutaneously, and necrotizing fasciitis changes were not excluded. Preoperative diagnosis: necrotizing fasciitis after mixed hemorrhoid surgery? Debridement and drainage + negative pressure closed drainage were performed in the emergency department. A small amount of pus in the lesion was seen during the operation, accompanied by foul odor; Subcutaneous tissue edema, fascial necrosis. The isolated rash was completely removed and sent to pathology. After operation, anti-infection and supportive treatment were given, and the condition was further aggravated. On the 4th day of admission, debridement and drainage and transverse colostomy were performed again. Postoperatively, the patient had persistent fever with a maximum body temperature of 39.0 ℃, herpes-like changes in the skin at the edge of the incision, severe pain, and gradually expanded; Ulcer-like changes were observed in the intestinal mucosa at the stoma (Figures 2, 3). Since the onset of the disease, the peripheral blood white blood cell count has not increased significantly, and the hemoglobin has progressively decreased. Pathological findings: A large amount of neutrophil infiltration was seen in the connective tissue (Figure 4). Colonoscopy was performed on the 10th day of admission, and the intestinal mucosa was smooth, excluding inflammatory bowel disease. On the 12th day of admission, after consultation with dermatologist of Peking University People's Hospital, he was diagnosed as pyoderma gangrenosum (PG). Methylprednisolone 80 mg was administered intravenously once a day; Thalidomide 50 mg orally once nightly; Compound betamethasone 1ml + lidocaine hydrochloride injection 0.1g was locally blocked once. On the second day after medication, the patient's body temperature returned to normal, the wound pain was relieved, and the wound necrosis expansion stopped. After that, the dosage of drugs was gradually adjusted, and the condition was stable and discharged. After 3 months of follow-up, the perianal wound healed and the ulcer at the stoma disappeared (Figures 5, 6).