2025年 · 第63卷第02期

immune checkpoint inhibitor (ICI) not only improves the long-term survival of patients with advanced non-small cell lung cancer (NSCLC)^{［1, 2, 3］}In patients with early NSCLC, neoadjuvant ICI therapy has also been shown to improve pathological response rates and prognosis^{［4, 5, 6, 7］}。 It is worth noting that some patients with NSCLC have other lesions including ground glass nodule (GGN) in addition to the main lesion, most of which are precancerous lesions or minimally invasive adenocarcinoma, so they are also known as multiple primary lung cancer (MPLC)^［8］。 Because the main lesion and GGN may be located in different lung lobes, considering the factors such as lung function protection and patient tolerance, GGN outside the main lesion will not be resected^［9］It is therefore important to assess the response of GGN to non-surgical treatments, including immunotherapy. Previous studies have preliminarily reported the therapeutic effect of immunotherapy on advanced NSCLC combined with GGN^［10］However, there are few reports on the therapeutic effect of neoadjuvant immunotherapy on NSCLC combined with GGN.

The patient, a 29-year-old female, went to the basic surgery department of Peking Union Medical College Hospital on November 5, 2020 because of "multiple bilateral thyroid nodules found in physical examination for more than 2 years". In September 2020, the patient underwent thyroid function examination in another hospital and no obvious abnormalities were found. The thyroid ultrasound examination results showed hypoechoic nodules with calcification in the middle and upper left lobe of the thyroid gland, with a size of about 0.8 cm ×0.7 cm ×0.8 cm, and a high possibility of malignancy. On 15 Oct 2020, the patient underwent fine needle thyroid biopsy in a foreign hospital. No clear follicular epithelial cells were found in the puncture smear, and genetic test showedBRAF（+）； The liquid-based cytology smear showed that a large number of thyroid follicular epithelial cells were arranged in small nests, crowded, the nucleus was enlarged and lightly stained, the nuclear membrane was thickened and irregular, fine nucleoli and nuclear grooves were visible, a few pseudo-inclusions were visible in the nucleus, a few lymphocytes and a few multinucleated giant cells were visible in the background, and the possibility of papillary thyroid carcinoma was considered. Ultrasound examination of thyroid gland in our hospital showed hypoechoic nodules in the middle and upper left lobe of thyroid gland, about 0.7 cm ×0.6 cm ×0.6 cm in size, irregular, unclear boundary, aspect ratio>1, punctate strong echo inside, and color Doppler flow imaging (CDFI) showed punctate blood flow signal inside the edge; Multiple anechoic nodules were found in the remaining thyroid gland, the larger one was located in the middle of the right lobe, about 0.8 cm ×0.3 cm in size, with punctate strong echoes inside, accompanied by comet shadows behind, and no clear blood flow signal was seen in CDFI; No clear abnormal enlarged lymph nodes were observed in bilateral necks. He has a history of menstrual disorders and acne in the past, and has been taking drospirenone and ethinyl estradiol orally for a long time (the specific dose is unknown). Since 2016, he has been taking minocycline orally (100 mg, twice/d), and has been taken as needed after regular oral administration for 1 month.

The 69-year-old male patient was admitted to the Department of Infection and Immunology of our hospital from the outpatient clinic on May 29, 2024 due to "repeated chest tightness for more than 1 year". Admission physical examination: heart rate 70 beats/min, 18 breaths/min, blood pressure 122/80 mmHg (1 mmHg =0.133 kPa), body temperature 36.7 ℃, no obvious abnormalities in cardiopulmonary auscultation. The patient had a history of hypertension for more than 20 years and was treated with oral antihypertensive drugs; 10 years ago, he underwent left coronary artery stenting for coronary heart disease, and was treated with oral double antiplatelet drugs after operation; A history of chronic obstructive pulmonary disease for years; Diagnosis of AIDS for 5 years, oral lamivudine dolutegravir tablets 350 mg, once a day. No cerebrovascular disease, diabetes, etc. The electrocardiogram was normal at admission, and the results of aortic CT angiography (CTA) showed a huge cystic aneurysm in the anterior wall of the aortic arch, with a maximum diameter of about 63 mm, involving the innominate artery, left common carotid artery, left subclavian artery opening, a penetrating ulcer in the middle descending aorta, and an aneurysm in the lower abdominal aorta, after left coronary artery stenting (Figure 1). Other laboratory results were basically normal. Preliminary diagnosis: (1) Aortic arch aneurysm; (2) penetrating descending aortic ulcer; (3) Lower abdominal aortic aneurysm; (4) Coronary artery stent placement state; (5) hypertension; (6) chronic obstructive pulmonary disease; (7) AIDS. He was transferred to the Department of Vascular Surgery of our hospital for further treatment.

Comrade Wang Zhengguo, an outstanding member of the Communist Party of China, an academician of the Chinese Academy of Engineering, one of the main founders of impact injury, trauma ballistics and traffic medicine research in China, an academic leader of the national key discipline "Field Surgery", and a former researcher of the Third Affiliated Hospital (Institute of Field Surgery) of the Third Military Medical University, died in Shanghai at 9: 26 on January 5, 2025 at the age of 89.