2018年 · 第56卷第10期

The patient was a 62-year-old female. Seven years after pancreaticoduodenectomy (PD), he was admitted to hospital on March 22, 2017 because of repeated episodes of upper abdominal pain for more than 4 years and aggravation for 5 days. The patient underwent PD in our center in April 2010 due to obstructive jaundice and occupation of the lower common bile duct. Preoperative CA19-9 was 83.53 U/ml. Ultrasound and CT imaging results showed that the lower end of the common bile duct occupied space, secondary intrahepatic and extrahepatic bile duct dilatation, but no pancreatic duct dilatation. Intraoperative pancreaticojejunal mucosal anastomosis was performed with full-thickness continuous suture with 4-0 non-absorbable line, and pancreatic juice drainage tube was built into the pancreatic duct for drainage. The results of postoperative pathological examination showed high-moderately differentiated invasive adenocarcinoma of the lower common bile duct with negative biliary margin; CA19-9 decreased to normal after surgery; No adjuvant therapy was performed after surgery. The patient did not complain of discomfort at 6 months and 1 year postoperative follow-up, and no abnormalities were found on imaging. In August 2012, the patient underwent left hemihepatic and caudate lobectomy due to differentiated papillary adenocarcinoma in the left hepatic duct in an external hospital. The preoperative CA19-9 was 152.6 U/ml, and it decreased to normal after operation. After the second operation, the patient reported recurrent epigastric pain. Because the pain was mild, it improved after symptomatic treatment such as anti-inflammatory, acid inhibition and enzyme inhibition in the local clinic, so no further examination was performed. In November 2016, the patient's pain intensified, and an abdominal CT examination was performed in our hospital. The results showed multiple pancreatic calcifications, pancreatic duct stones and mild dilatation of the pancreatic duct. The patient refused surgical treatment due to economic and self-related factors, and was discharged after symptomatic treatment. Before this admission, the patient showed persistent sharp pain in the upper abdomen, forced position, bent and bent knees on the side. Physical examination at admission: temperature 36.3 ℃, pulse 95 beats/min, breathing 18 beats/min, blood pressure 103/79 mmHg (1 mmHg =0.133 kPa). A median surgical incision scar around the umbilicus was seen in the upper abdomen, about 20 cm long, positive upper abdominal tenderness, and a hard mass about 5 cm ×5 cm in size was palpable under the xiphoid process, positive tenderness and poor mobility. After admission, blood amylase was 211 U/L and urinary amylase was 1 210 U/L. Abdominal CT images showed high density in the pancreatic head area with dilatation of the pancreatic duct (FIG. 1A)。 Laboratory tests: 32.2 U/ml for CA19-9 and 1.12 μ g/L for carcinoembryonic antigen. magnetic resonance cholangiopancreatography (MRCP) showed no obvious dilatation of the right intrahepatic bile duct, and the pancreatic duct showed poorly due to multiple operations. Multiphase dynamic enhanced MRI of the liver (FIG. 1B) The scan showed the morphology of the liver, the proportion of each lobe was acceptable, and the signal in the right lobe of the liver was abnormal. Small cyst and pancreatic duct dilation were considered. Based on the patient's medical history, physical examination and the above examination results, it is considered that the patient's recurrent abdominal pain is due to the long-term complicated pancreaticojejunostomy stenosis and pancreatic duct stone formation after pancreaticoduodenectomy, which leads to recurrent acute attacks of chronic pancreatitis.

The patient was a 38-year-old female who was admitted to the hospital on 26 January 2018 due to "right axillary mass for 5 years". The mass increased gradually within 5 years without any treatment. Physical examination: A local skin bulge under the right axillary palpated with a mass of 9.0 cm ×6.0 cm in size, soft cystic in texture, smooth in surface and good mobility. Bilateral breast glands without palpable mass (Figure 1)。 No obvious enlarged lymph nodes were palpable in bilateral axillary and supraclavicular. Ultrasonography of the breast: a liquid dark area was visible under the right axilla with a fibrous septum in the middle, with a maximum depth of 23.8 mm, and fluid flow was visible after squeezing (Figure 2)。 Mammography: Multiple high-density tumor shadows fused into a mass under the right axillary, extending to the tail of the right mammary axillary, with a size of about 10.0 cm ×4.0 cm, clear border and regular shape (Figure 3)。 Chest CT examination: Multiple low-density nodules were seen in the right axilla, partially fused, and the CT value was 11 HU. No obvious enhancement was seen after enhancement scan; Examination conclusion: There are multiple nodules in the right axilla, but lymphatic cyst is not excluded (Figure 4)。 After 40 ml of nearly colorless transparent liquid was extracted by fine needle puncture, the tumor shrank slightly. Cytological examination showed a large number of lymphocytes, but no malignant tumor cells. Because no clear solid components were found in the tumor, no thick needle biopsy was performed.

In the paper "2018 Chinese Expert Consensus on the Diagnosis and Treatment of Metastatic Prostate Cancer" published in Volume 56, Issue 9, 2018, on page 650 "Experts Participating in the Discussion and Approval of this Consensus", Professor Zhu Gang's work unit should be "Beijing United Family Hospital"; "Androgen deprivation therapy is the basic treatment for metastatic prostate cancer" should be added to the annotation of Figures 1 and 2. Corrections are hereby made.