2019年 · 第57卷第01期

Zhang Yuhua

A 61-year-old male was admitted to the hospital on December 6, 2017 due to "abdominal distension, vomiting with wasting for 15 days". The patient developed postprandial abdominal distension with vomiting 15 days before admission. Visited a local hospital, gastroscopy showed gastric retention and duodenal stenosis; Enhanced abdominopelvic CT examination showed thickened intestinal wall, narrow lumen and gastric retention in the descending duodenum. Consider duodenal mass occupation (nature to be investigated), gastric retention. After receiving treatment such as fasting water, gastrointestinal decompression, anti-infection and nutritional support, the patient lost about 7.5 kg in weight in 10 days, and was later transferred to our hospital. Past history: No history of chronic disease, no history of infectious disease, no history of allergy, appendectomy 20 years ago. Physical examination in hospital: thin body and clear consciousness; Body temperature 36.2 ℃, pulse 76 beats/min, breathing 17 beats/min, blood pressure 102/68 mmHg (1 mmHg =0.133 kPa); The skin and mucosa of the whole body were not yellowed, and the superficial lymph nodes were not palpable and obviously swollen. The bilateral pupils are equal in size and round, and they are sensitive to light reflection. No dry and wet rales and pleural friction were heard in both lungs, the heart rhythm was uniform, and no pathological murmur was heard in the auscultation area of each valve; Soft abdomen, no tenderness and rebound pain in the whole abdomen, subcostal and subsword of liver and spleen, Murphy sign (-); Physiological reflexes are present, but pathological reflexes are not elicited. Admission auxiliary examination: blood routine: white blood cell count 5.12×10⁹/L, neutrophil percentage 66.6%, hemoglobin 141 g/L; Blood biochemistry: ALT 22 U/L, albumin 36 g/L, total bilirubin 15.8 μ mol/L, creatinine 98 μ mol/L. procalcitonin (PCT) (using Thermo Fisher B.R.A.H.M.S PCT antibody kit or VIDAS B.R.A.H.M.S PCT antibody kit of Mérieux, France)<0.5 μ g/L, Positive fecal occult blood. Coagulation function and tumor markers were normal. PET-CT examination showed abnormally increased metabolic mass in the descending duodenum with a SUVmax of 6.1, which was consistent with malignant lesion. Electronic gastroscopy: irregular mass after the duodenal bulb. Biopsy pathology revealed moderately differentiated adenocarcinoma.

Female, 58 years old. He was admitted to the hospital on January 28, 2018 due to "sudden lower abdominal pain for 6 h". The patient had sudden lower abdominal pain without obvious trigger, which later spread to the whole abdomen, accompanied by chills and fever. The body temperature reached 39 ℃, and the anus stopped exhausting and defecating. Physical examination: painful face, plate-shaped abdomen, tenderness and rebound pain in the whole abdomen, heavy lower abdomen, no intestinal sounds. Enhanced CT of the whole abdomen revealed that the upper rectum occupied mass with perforated fecal borrhea (FIG. 1A）。

There are slight differences in the definition of early lung adenocarcinoma in different countries and different medical centers. According to the 8th edition of lung cancer staging system promulgated by AJCC, early lung cancer is limited to stage I non-small cell lung cancer. Based on the existing literature at home and abroad and the related experience accumulated in our hospital, the diagnosis of early lung adenocarcinoma depends on multidisciplinary evaluation before operation, intraoperative and postoperative pathological diagnosis. Its treatment is mainly surgical, and the surgical mode is selected according to the preoperative evaluation and intraoperative cryopathological examination results. According to the final postoperative pathological diagnosis and staging, the patients were guided to follow-up or corresponding adjuvant therapy^[1]。 In early lung adenocarcinoma, the incidence of lung adenocarcinoma with ground-glass opacity (GGO) as imaging manifestation is increasing year by year. Although pathological diagnosis plays an important role in guiding the intraoperative and postoperative treatment of these cases, there are still many differences and controversies in the pathology community. We discussed the current problems in order to jointly improve the consistency and reproducibility of pathological diagnosis of early lung adenocarcinoma in GGO.

A 56-year-old male patient was diagnosed with "primary liver cancer and hepatitis B cirrhosis" before operation; Hepatic artery chemoembolization was performed in an external hospital 1 month before operation. Preoperative abdominal enhanced MRI revealed that tumor in the right posterior lobe of the liver (Figure 1）。 No extrahepatic metastases were found on PET-CT. Preoperative liver function was Child-Pugh grade A, ICG 15 min retention was 15%. Laparoscopic resection of tumor in the right posterior lobe of the liver was proposed.