Gastrointestinal bleeding after pancreatoduodenectomy:Report of four cases

BACKGROUND Postpancreatectomy hemorrhage is one of the most severe and life-threatening complications after pancreaticoduodenectomy.We present four cases of gastrointestinal bleeding patients to clarify its appropriate treatment and prevention.CASE SUMMARY The main symptoms included black stool,hematochezia,haematemesis,blood in the nasogastric tube,and hemorrhagic shock.The mean age was 66.25 years old and the median onset time was 340 d after the surgery.The bleeding location comprised gastrointestinal anastomosis,bile duct-jejunum anastomosis,and extraluminal bleeding.The possible causes included marginal ulcer,jejunal varix,and abdominal infection.Endoscopic hemostatic clips,as well as a covered stent using angiography,were utilized to stop the bleeding and three patients survived.Only one patient died of gastrointestinal bleeding,abdominal bleeding,abdominal infection,hypovolemic shock,and disseminated intravascular coagulation.CONCLUSION Early and effective endoscopic intervention is the key to successful hemostasis in patients with gastrointestinal bleeding after pancreatoduodenectomy.

Traditional Chinese Medical Cases and Its Role in Pedagogy:A Narrative Analysis

Narrative medicine has gained significant attention in recent decades.The similarities between“parallel charts”and“medical cases”in traditional Chinese medicine(TCM)primarily lie in their authenticity.However,they differ in structure and narrative methods.Furthermore,medical case teaching is a prevalent pedagogical approach in TCM education that practitioners must master.This study explores the connection between TCM medical case teaching and narrative medicine,and concludes that the evolution of modern TCM case teaching aligns with the international standards of narrative medicine while integrating key TCM characteristics to enhance its value.This approach is essential for fostering humanistic sentiments,empathy,and reflective capabilities among future well-rounded TCM practitioners.

Borderline resectable giant hepatic cavernous hemangioma and coexisting hemangiomatosis should be a new indication for living donor liver transplantation:A report of two cases

To the Editor:Hemangioma is a benign liver tumor that rarely requires treatment if the patient is asymptomatic[1].However,great cavernous hemangioma(GCH)can lead to symptoms due to its mass effect and Kasabach-Merritt syndrome(KMS)[2].GCH treatment options vary;therefore,tailoring treatment to individual patients according to their condition,such as symptoms,tumor location,and liver function,is important.Occasionally,GCH is associated with hemangiomatosis,and its boundaries with normal tissue are unclear[3],leading to a lack of consensus on the initial therapeutic approach,with literature primarily comprising case reports or series[4].This study presented two cases of GCH and coexisting hemangiomatosis;the patients underwent liver resection of the main mass to relieve symptoms but ultimately required liver transplantation(LT).We aimed to describe the role of LT in these patients.

Using clinical cases to guide healthcare

Evidence-based practice(EBP)has been the gold standard in healthcare for nearly three centuries and aims to assist physicians in providing the safest and most effective healthcare for their patients.The well-established hierarchy of evidence lists systematic reviews and meta-analyses at the top however these methodologies are not always appropriate or possible and in these instances case-control studies,case series and case reports are utilised to support EBP.Case-control studies allow simultaneous study of multiple risk factors and can be performed rapidly and relatively cheaply.A recent example was during the Coronavirus pandemic where case-control studies were used to assess the efficacy of personal protective equipment for healthcare workers.Case series and case reports also play a role in EBP and are particularly useful to study rare diseases such as inflammatory bowel disease in transgender and gender non-conforming individuals.They are also vital in generating and disseminating early signals and encouraging further research.Whilst these methodologies have weaknesses,particularly with regards to bias and loss of patient confidentiality for rare pathologies,they have an important part to play in EBP and when appropriately utilised can significantly impact upon clinical practice.

C-CORE:Clustering by Code Representation to Prioritize Test Cases in Compiler Testing

Edge devices,due to their limited computational and storage resources,often require the use of compilers for program optimization.Therefore,ensuring the security and reliability of these compilers is of paramount importance in the emerging field of edge AI.One widely used testing method for this purpose is fuzz testing,which detects bugs by inputting random test cases into the target program.However,this process consumes significant time and resources.To improve the efficiency of compiler fuzz testing,it is common practice to utilize test case prioritization techniques.Some researchers use machine learning to predict the code coverage of test cases,aiming to maximize the test capability for the target compiler by increasing the overall predicted coverage of the test cases.Nevertheless,these methods can only forecast the code coverage of the compiler at a specific optimization level,potentially missing many optimization-related bugs.In this paper,we introduce C-CORE(short for Clustering by Code Representation),the first framework to prioritize test cases according to their code representations,which are derived directly from the source codes.This approach avoids being limited to specific compiler states and extends to a broader range of compiler bugs.Specifically,we first train a scaled pre-trained programming language model to capture as many common features as possible from the test cases generated by a fuzzer.Using this pre-trained model,we then train two downstream models:one for predicting the likelihood of triggering a bug and another for identifying code representations associated with bugs.Subsequently,we cluster the test cases according to their code representations and select the highest-scoring test case from each cluster as the high-quality test case.This reduction in redundant testing cases leads to time savings.Comprehensive evaluation results reveal that code representations are better at distinguishing test capabilities,and C-CORE significantly enhances testing efficiency.Across four datasets,C-CORE increases the average of the percentage of faults detected(APFD)value by 0.16 to 0.31 and reduces test time by over 50% in 46% of cases.When compared to the best results from approaches using predicted code coverage,C-CORE improves the APFD value by 1.1% to 12.3% and achieves an overall time-saving of 159.1%.

An Investigation on Open-RAN Specifications:Use Cases,Security Threats,Requirements,Discussions

The emergence of various technologies such as terahertz communications,Reconfigurable Intelligent Surfaces(RIS),and AI-powered communication services will burden network operators with rising infrastructure costs.Recently,the Open Radio Access Network(O-RAN)has been introduced as a solution for growing financial and operational burdens in Beyond 5G(B5G)and 6G networks.O-RAN promotes openness and intelligence to overcome the limitations of traditional RANs.By disaggregating conventional Base Band Units(BBUs)into O-RAN Distributed Units(O-DU)and O-RAN Centralized Units(O-CU),O-RAN offers greater flexibility for upgrades and network automation.However,this openness introduces new security challenges compared to traditional RANs.Many existing studies overlook these security requirements of the O-RAN networks.To gain deeper insights into the O-RAN system and security,this paper first provides an overview of the general O-RAN architecture and its diverse use cases relevant to B5G and 6G applications.We then delve into specifications of O-RAN security threats and requirements,aiming to mitigate security vulnerabilities effectively.By providing a comprehensive understanding of O-RAN architecture,use cases,and security considerations,thisworkserves as a valuable resource for future research in O-RAN and its security.

Successful management of severe hypoglycemia induced by total parenteral nutrition in patients with hepatocellular injury: Three cases reports

BACKGROUND Glucose imbalance is common in total parenteral nutrition(TPN).Hypoglycemia seems to be less frequent than hyperglycemia,but it influences the clinical outcome to a greater extent.Therefore,it should be effectively prevented and treated.However,there is no relevant report on how to treat hypoglycemia caused by TPN in patients with liver cell injury.CASE SUMMARY We present three patients with liver cell injury who developed severe hypo-glycemia during or after TPN infusion.The causes of severe hypoglycemia and glucose-raising strategies were discussed.According to the physiological charac-teristics of the hepatocellular injury,the ratio of nutrition components prescribed in TPN was appropriately adjusted for the three cases.We simultaneously reduced the dose of insulin and fat emulsion,and increased the dose of glucose in TPN.The blood glucose level was restored to normal range and clinical symptoms were eliminated.CONCLUSION When hypoglycemia occurs during or after TPN in patients with hepatocellular injury,physicians need to simultaneously reduce insulin and fat emulsion,and increase glucose,and correct severe hypoglycemia in time to reduce its adverse consequences.

Changes in macrophage infiltration and podocyte injury in lupus nephritis patients with repeated renal biopsy: Report of three cases

BACKGROUND In this study,we retrospectively analysed macrophage infiltration and podocyte injury in three patients with diffuse proliferative lupus nephritis(LN)who un-derwent repeated renal biopsy.CASE SUMMARY Clinical data of three diffuse proliferative LN patients with different pathological characteristics(case 1 was LN IV-G(A),case 2 was LN IV-G(A)+V,and case 3 was LN IV-G(A)+thrombotic microangiopathy)were reviewed.All patients underwent repeated renal biopsies 6 mo later,and renal biopsy specimens were studied.Macrophage infiltration was assessed by CD68 expression detected by immunohistochemical staining,and an immunofluorescence assay was used to detect podocin expression to assess podocyte damage.After treatment,Case 1 changed to LN III-(A),Case 2 remained as type V LN lesions,and Case 3,which changed to LN IV-S(A),had the worst prognosis.We observed reduced macro-phage infiltration after therapy.However,two of the patients with active lesions after treatment still showed macrophage infiltration in the renal interstitium.Before treatment,the three patients showed discontinuous expression of podocin.Notably,the integrity of podocin was restored after treatment in Case 1.CONCLUSION It may be possible to reverse podocyte damage and decrease the infiltrating ma-crophages in LN patients through effective treatment.

Application of Digital Evidence in Criminal Cases: Dilemma and Optimization

The judicial application of digital evidence in criminal cases(criminal digital evidence)is an inevitable trend for the digital transformation of criminal proceedings in the macro context of the digital economy.It is characterized by digitization,diversification,and traceability.The application of criminal digital evidence can be divided into two main scenarios:the vertical scenario involving phases such as filing,prosecution,and trial;the horizontal scenario related to specific types of crimes.Criminal digital evidence is primarily applied to handling non-contact crimes,such as cybercrimes.However,the application of such evidence may infringe upon the basic rights of suspects,including their rights to privacy,rights to know,and rights to defense.Furthermore,the diversified and non-systematic nature of digital evidence may lead to challenges in applying the law,particularly with algorithmic“black boxes,”which can result in judicial discrimination and other drawbacks.Therefore,it is necessary to formulate or improve the regulatory framework for criminal digital evidence to ensure its lawful and standardized application.Additionally,judicial authorities must strengthen collaboration in case handling to ensure smooth coordination in collecting and applying digital evidence,thereby realizing its efficient litigation value.Furthermore,it is essential to check and balance the algorithm-based conviction and sentencing to protect the legitimate rights and interests of the parties involved,achieving high-quality human rights protection.

Classical Medical Cases of Doubt Narrative Foreclosure and Mediation in Traditional Chinese Medicine

Narrative foreclosure is a phenomenon highlighted within the Chinese narrative medicine system, characterized by a state in which individuals become overly suspicious due to certain events in their development, leading to profound concerns about their health and safety. This article employs the logical discourse framework of Chinese narrative medicine to illustrate the experiences of various patients exhibiting typical instances of narrative foreclosure in traditional Chinese medicine(TCM) cases, such as Bei Gong She Ying(杯弓蛇影 to see a bow reflected in a cup as a snake), Wu Qiu Zhi Chong(吴球治虫 Wu Qiu treats worms), and Fa Jing Qu She(法靖驱蛇 Fajing drives away snakes). It explores how TCM practitioners leverage narrative wisdom to facilitate patients in dispelling their internal doubts through the concept of Bu Yao Wei Yao(不药为药 healing diseases without medicine). Through these medical cases, the article advocates for the significance of narrative competencies among medical practitioners in diagnosing and treating patients, alongside the use of pharmaceuticals and surgical interventions. Additionally, it outlines the prospects for the future development of narrative approaches in TCM.

Narrative Thinking of Healthcare Providers in Medical Cases and Its Implications for Modern Medical Education

In the realm of Chinese narrative medicine, narrative thinking holds equal significance to evidence-based thinking within clinical practice, making substantial contributions to patient safety and medical quality. Ancient Chinese medical theories advocate forging a narrative bond with patients, urging healthcare practitioners to utilize Dao Shu Jie He(道术结合 integration of Dao and techniques) and Yi Dao Yu Shu(以道驭术 guiding techniques with Dao) during diagnosis, treatment, and rehabilitation. In this context, Dao(道) in traditional Chinese medicine(TCM) corresponds to narrative thinking(叙事思维) while Shu(术) aligns with scientific thinking(科学思维) in evidence-based medicine. This study adopts “narrative Chinese medicine” within the “discourse system of Chinese narrative medicine” as its framework, centering on medical stories that exemplify the application of narrative thinking in ancient Chinese diagnosis and treatment. It delves into the narrative thinking encapsulated in Chinese medicine, such as Guan Wu Qu Xiang(观物取象 observing things and extracting information), Can He Er Xing(参合而行 final examination and decision by integrating the four diagnoses), Xing Shen Bing Zhi(形神并治 body-spirit treatment), Xin Shen Jian Li(心身兼理 mind-body balance) and Bian Zheng Lun Zhi(辨证论治 treatment based on pattern differentiation). The study endeavors to inspire contemporary medical educators and clinicians to acknowledge the value of narrative thinking in TCM and fully incorporate it into daily medical practice.

Gestational diabetes mellitus combined with fulminant type 1 diabetes mellitus, four cases of double diabetes: A case report

BACKGROUND Fulminant type 1 diabetes mellitus(FT1DM)that occurs during pregnancy or the perinatal period is known as pregnancy-related FT1DM(PF),always without history of abnormal glucose metabolism.Here,we present four patients who developed FT1DM during treatment but were first diagnosed with gestational diabetes mellitus(GDM).CASE SUMMARY The clinical data of four patients with GDM combined with FT1DM admitted to our hospital between July 2018 and April 2021 were collected,and the patients and their infants were followed up.All patients were diagnosed with GDM during the second trimester and were treated.The blood glucose level elevated suddenly during the third trimester and then were diagnosed with FT1DM.Two patients had an insulin allergy,and two had symptoms of upper respiratory tract infection before onset.One patient developed ketoacidosis,and three developed ketosis.Two patients had cesarean section deliveries,and two had vaginal deliveries.The growth and development of the infants were normal.C-peptide levels were lower than those at onset,suggesting progressive impairment of islet function.The frequencies of the DRB109:01,DQB103:03,DQA103:02,DPA101:03,DPA102:02,DPB105:01,DRB401:03,G 01:01,and G 01:04 human leukocyte antigen(HLA)-G alleles were high in the present study.CONCLUSION In comparison with pregnancy-associated FT1DM(PF),patients with GDM combined with FT1DM had an older age of onset,higher body mass index,slower onset,fewer prodromal symptoms,and less acidosis.The pathogenesis may be due to various factors affecting the already fragileβ-cells of GDM patients with genetically susceptible class II HLA genotypes.We speculate that GDM combined with FT1DM during pregnancy,referred to as“double diabetes,”is a subtype of PF with its own unique characteristics that should be investigated further.

Clinical Thoughts and Cases of Jianpi Yishen Sechang Decoction Combined with Acupuncture in the Treatment of Functional Diarrhea

Functional diarrhea(FDr)accounts for a relatively high proportion of digestive diseases.It is an infection that is not accompanied by abdominal pain and shows negative results in laboratory tests for bacteria and viruses.The main symptoms are persistent or recurrent discharge of watery and soft stools.The course of the disease is prolonged and recurring,and the treatment cost is higher and greatly affects the patient’s daily life.The incidence rate has a gradual increase in the trend.Its pathogenesis is complex where Western medicine is mostly used in symptomatic drug treatment.The treatment can be fast-acting and effective in relieving diarrhea.However,the long-term use of Western medicine poses a high risk in terms of side effects and a high chance of recurring upon stopping medication.At the same time,some diarrhea patients show the existence of drug-resistant strains of bacteria,and the overall efficacy of the drug is limited.Chinese medicine is mild and able to provide excellent treatment of diarrhea.With its lower price and cost,most families can afford it.Fengliang Tian,director of traditional Chinese medicine,implemented the“needle and medicine”method,which combines medicine and acupuncture,involving the usage of Jianpi Yishen Sechang Decoction and acupuncture in the treatment of functional diarrhea.The method has a low price,fewer side effects,is easy to accept,and can significantly reduce the recurrence rate with high efficacy.The study would like to share the clinical thinking and cases as follows to provide ideas and methods for the treatment of functional diarrhea by traditional Chinese medicine.

Lipomatous ependymoma with ZFTA:RELA fusion-positive:A case report

BACKGROUND Ependymoma with lipomatous differentiation is a rare type of ependymoma.The ZFTA fusion-positive supratentorial ependymoma is a novel tumor type in the 2021 World Health Organization classification of central nervous system tumors.ZFTA fusion-positive lipomatous ependymoma has not been reported to date.CASE SUMMARY We reported a case of a 15-year-old Chinese male who had a sudden convulsion lasting approximately six minutes.Magnetic resonance imaging showed a round cystic shadow of approximately 1.9 cm×1.5 cm×1.9 cm under the right parieto-occipital cortex.Microscopic examination showed characteristic perivascular pseudorosettes and adipose differentiation in the cytoplasm.Immunohisto-chemical staining showed that the tumor cells were negative for cytokeratin,NeuN,Syn and p53,but positive for GFAP,vimentin and S-100 protein.Signi-ficant punctate intracytoplasmic EMA immunoreactivity was observed.The level of Ki-67 was about 5%.Genetic analysis revealed ZFTA:RELA fusion.A cranio-tomy with total excision of the tumor was performed.The follow-up time was 36 months,no evidence of disease recurrence was found in magnetic resonance imaging.CONCLUSION Based on these findings,the patient was diagnosed as a ependymoma with ZFTA fusion and lipomatous differentiation.This case report provides information on the microscopic morphological features of ependymoma with ZFTA fusion and lipomatous differentiation,which can help pathologists to make a definitive diagnosis of this tumor.

Wilson's disease in two siblings from Ecuador:Two case reports

BACKGROUND Wilson's disease(WD)is a rare metabolic disorder of copper accumulation in organs such as liver,brain,and cornea.Diagnoses and treatments are challenging in settings,where advanced diagnostic tests are unavailable,copper chelating agents are frequently scarce,healthcare professionals lack disease awareness,and medical follow-ups are limited.Prompt diagnoses and treatments help prevent complications,improve patients’quality of life,and ensure a normal life expectancy.The clinical presentations and outcomes of WD can vary within a single family.CASE SUMMARY We present the cases of two siblings(19 and 27 years)from a consanguineous family in rural Ecuador,diagnosed as having WD during a family screening.The male patient,diagnosed at age 19 after his brother’s death from acute liver failure,presented with compensated cirrhosis,neurological symptoms,and bilateral Kayser-Fleischer rings.He developed progressive neurological deterioration during an irregular treatment with D-penicillamine due to medication shortages.His condition improved upon switching to trientine tetrahydrochloride,and his neurological symptoms improved over an 8-year period of follow-ups.The female patient,diagnosed at age 10,exhibited only biochemical alterations.Her treatment history was similar;however,she remained asymptomatic without disease progression over the same follow-up period.We discuss the potential influence of epigenetic mechanisms and modifier genes on the various phenotypes,emphasizing the need for research in these areas to optimize therapeutic strategies.CONCLUSION Our patients’medical histories show how early diagnosis and treatment can prevent disease progression;and,how suboptimal treatments impact disease outcomes.

Bullous pemphigoid associated with acquired hemophilia A: A case report

BACKGROUND Acquired hemophilia A (AHA) is a rare and potentially severe bleeding disordercaused by circulating autoantibodies against factor Ⅷ (FⅧ). In approximately50% of the patients, the condition is associated with autoimmune diseases,cancers, medication use, pregnancy, and the post-partum period. Bullous pemphigoid(BP) is a chronic autoimmune subepidermal blistering disease associatedwith tissue-bound and circulating autoantibodies against BP antigens 180 (BP180)and 230 (BP230). AHA-associated BP has a high mortality rate;hence, the understandingof this disease must improve.CASE SUMMARY A 69-year-old man presented with erythema, blisters, blood blisters, and crustsaccompanied by severe pruritus for more than 20 days, and ecchymosis andswelling on his left upper arm for 3 days. Pathological examination revealed asubepidermal blister that contained eosinophils. Laboratory tests showed that theBP180 autoantibody levels had increased, isolated activated partial thromboplastintime was notably prolonged (115.6 s), and coagulation FⅧ activity wasextremely low (< 1.0%). Furthermore, the FⅧ inhibitor titer had greatlyincreased (59.2 Bethesda units). Therefore, the patient was diagnosed as having BP associated with AHA, prescribed 0.05% topical halometasone cream, and transferred to a higher-level hospitalfor effective treatment;however, he died after 2 days.CONCLUSION AHA associated BP is rare, dangerous, and has a high mortality rate. Therefore, its timely diagnosis and effectivetreatment are necessary.

Extramedullary plasmacytoma with the uvula as first affected site:A case report

BACKGROUND Extramedullary plasmacytoma(EMP)represents one of the rarer forms of plasma cell malignancies,capable of impacting a variety of tissues and organs throughout the body.The majority of EMP cases are predominantly found in the head and neck region,especially within the laryngopharynx,as well as in the gastrointestinal tract.While there have been documented instances of oropharyngeal involvement in EMP cases in the academic literature,it is important to note that EMP specifically affecting the uvula is exceedingly uncommon.Furthermore,it is noteworthy that over 60% of epithelial carcinomas in the upper respiratory tract and oropharynx tend to metastasize to the cervical lymph nodes,indicating a propensity for regional spread in these types of cancers.In this context,we present a rare case of extramedullary plasmacytoma where the uvula served as the initially affected site.This case emphasizes the need for heightened awareness among clinicians regarding such unusual comorbidities,as early recognition and diagnosis can significantly influence patient management and treatment outcomes.In addition,a review of the relevant literature is included to further educate and inform healthcare professionals about this rare presentation,ultimately aiming to enhance clinical understanding and improve patient care in similar situations.CASE SUMMARY A 51-year-old man was admitted to our hospital because of a slowly enlarging neck mass.A physical examination revealed a palpable left lymph node,and magnetic resonance imaging(MRI)of the oropharynx and the neck showed a soft tissue mass in the oropharynx and enlargement of multiple lymph nodes in the neck.The soft tissue mass was diagnosed as plasmacytoma by immunohistochemical analysis.Monoclonal immunoglobulins and bone marrow biopsy showed normal results.Therefore,we diagnosed that as EMP of the uvula.After four cycles of adjuvant chemotherapy dominated by bortezomib,MRI reexamination showed a significant reduction of the mass in the oropharynx and the cervical lymph nodes.Afterwards,the λ light chain returned to normal levels.There was no evidence of evolution to multiple myeloma.CONCLUSION We have reported a rare case of extramedullary plasmacytoma with the uvula as the first affected site and the relevant literature is reviewed to improve clinicians'awareness of such rare comorbidities.

Cerebral fat embolism following autologous fat injection in facial reconstruction:A case report

BACKGROUND Autologous fat injection in facial reconstruction is a common cosmetic surgery.Although cerebral fat embolism(CFE)as a complication is rare,it carries serious health risks.CASE SUMMARY We present a case of a 29-year-old female patient who developed acute CFE following facial fat filling surgery.After the surgery,the patient experienced symptoms including headache,nausea,vomiting,and difficulty breathing,which was followed by neurological symptoms such as slurred speech and left-sided weakness.Comprehensive physical examination and auxiliary investigations,including blood tests,head and neck computed tomography angiography,and cranial magnetic resonance diffusion-weighted imaging,were performed upon admission.The clinical diagnosis was acute cerebral embolism following facial fat filling surgery.Treatment included measures to improve cerebral circulation,dehydration for intracranial pressure reduction,nutritional support,and rehabilitation therapy for left limb function.The patient showed a significant improvement in symptoms after 2 weeks of treatment.She recovered left limb muscle strength to grade 5,had clear speech,and experienced complete relief of headache.CONCLUSION Our case highlights the potential occurrence of severe complications in patients undergoing fat injection in facial reconstruction.To prevent these complications,plastic surgeons should enhance their professional knowledge and skills.

Refractory lipoatrophy treated with autologous whole blood injection:A case report

BACKGROUND Intramuscular corticosteroid injection may cause adverse effects such as dermal and/or subcutaneous atrophy,alopecia,hypopigmentation,and hyperpigmentation.Although cutaneous atrophy can spontaneously resolve,several treatment options have been suggested for this condition.CASE SUMMARY In this paper,we report a case of corticosteroid injection induced lipoatrophy treated with autologous whole blood(AWB)injection,as the condition had been unresponsive to fractional laser therapy.A 29-year-old female patient visited the dermatology clinic complaining of skin depression on her right buttock area,which had appeared six months earlier.There had been only subtle improvement at the margins after fractional CO_(2) laser treatment;therefore,after obtaining informed consent from the patient,AWB treatment was initiated.One month after the first AWB injection,the size and depth of the lesion had noticeably improved,and a slight improvement was also observed in discoloration.CONCLUSION Close observation is the initial treatment of choice for steroid induced skin atrophy;however,for patients in need of immediate cosmetic improvement,AWB injection may be a safe and cost-effective alternative.

Primary parenchymal squamous cell carcinoma of the kidney:A case report

BACKGROUND Primary squamous cell carcinoma(SCC)of the renal parenchyma is extremely rare,with only nine cases reported.CASE SUMMARY This study reports a 51-year-old man with primary SCC of the renal parenchyma.The patient was admitted with recurrent dull pain and discomfort in the right lumbar region,which had worsened over 2 weeks,accompanied by painful gross hematuria.SCC antigen(SCCA)levels were elevated,and imaging revealed a renal mass with associated calculi.The patient underwent laparoscopic unilateral nephrectomy and lymph node dissection.Postoperative pathology confirmed highly differentiated SCC with necrosis in the right renal parenchyma,with negative renal pelvis and ureter.The pathological stage was Pt3aN1M0.Four months after surgery,the tumor recurred with involvement of the liver,right psoas major muscle,and inferior vena cava.The patient refused chemotherapy and succumbed to the disease 6 months postoperatively due to disease progression.CONCLUSION We report a case of primary SCC of the renal parenchyma,a rare renal malignancy.The clinical symptoms,laboratory tests,and imaging findings are nonspecific,making accurate and timely diagnosis challenging.According to the literature,for patients with renal calculi accompanied by a renal mass,elevated serum SCCA levels,and magnetic resonance imaging showing cystic or cystic-solid masses within the kidney with pseudocapsules and heterogeneous mild enhancement,the possibility of this disease should be considered.