case reports

病例报告
  • 文章类型: Case Reports
    肾损伤是腹部创伤的常见和相关并发症。尽管人们一致认为大多数高级损伤需要手术探查,非手术管理仍然是一种可行的方法。我们的目的是报告4例成人非手术孤立性高级别钝性肾损伤的病例报告,随后是文献综述。
    方法:一名22岁女性因间歇性发热和肾损伤相关症状出现急诊室(ER),包括持续的左翼疼痛,恶心,和呕吐。三周前被诊断为左肾损伤AASTIV级。她被建议去医院,但被拒绝入院。然后她来了间歇性发烧,第二次腹部计算机断层扫描(CT)扫描显示尿路瘤。患者接受双J(DJ)支架和经皮引流。
    保守管理是治疗AASTI至III级肾损伤的血流动力学稳定患者的标准,不管效率的机制。如果尽管进行了输尿管支架置入术或经皮肾穿刺造瘘引流等干预措施,但仍持续收集肾周积液,经皮引流可以促进愈合,预防或治疗脓肿。
    结论:微创治疗DJ支架置入和经皮引流可用于治疗未经治疗的高级别肾损伤和尿路瘤。
    UNASSIGNED: Renal trauma is a common and associated complication of abdominal trauma. Although there is consensus that most high-grade injuries require surgical exploration, nonoperative management remains a viable approach. We aim to report case reports of four cases of nonoperative isolated high-grade blunt renal trauma in adults, followed by a literature review.
    METHODS: A 22-year-old female presented to the emergency room (ER) with intermittent fever and associated symptoms of renal trauma, including persistent left flank pain, nausea, and vomiting. Three weeks earlier was diagnosed with left renal trauma AAST Grade IV. She was advised to go to the hospital but was refused admission. Then she came with intermittent fever, and a second abdominal computed tomography (CT) scan showed urinoma. The patient was managed with a Double J (DJ) stent and percutaneous drainage.
    UNASSIGNED: Conservative management is the standard of care for hemodynamically stable patients with AAST grade I to III renal injury, regardless of the mechanism of efficiency. If perinephric fluid collection persists despite interventions such as ureteral stenting or percutaneous nephrostomy drainage, percutaneous drainage may facilitate healing and prevent or treat abscesses.
    CONCLUSIONS: Minimal invasive management DJ stent insertion and percutaneous drainage can be used as a treatment for untreated high-grade renal trauma and urinoma as its complication.
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  • 文章类型: Case Reports
    甲醛在2006年被国际癌症研究机构(IARC)列为第一类致癌物质。虽然IARC指出,缺乏证据表明甲醛会导致脑癌,三项荟萃分析一致报道,暴露于高浓度甲醛的工人患脑癌的风险显著增高.因此,我们报告了一例工人在造纸工业使用甲醛树脂时暴露于高浓度的甲醛后被诊断为胶质母细胞瘤。
    一名40岁的男性患者加入了一家浸渍纸制造商,并使用甲醛树脂进行了10年零2个月的浸渍工作。2017年,患者出现严重头痛,到医院进行脑部磁共振成像,这揭示了一个质量。同年,患者接受了开颅手术切除脑肿瘤,并被诊断为颞叶胶质母细胞瘤。2019年,由于脑肿瘤复发,进行了开颅手术,但他在2020年去世了.对工作环境的暴露评估确定,患者在超过10年的时间内连续暴露于高于0.3ppm暴露阈值的甲醛,并且通过在不戴呼吸器或防护手套的情况下进行工作,他有高呼吸和皮肤暴露。
    本病例报告是韩国职业安全与健康研究所的流行病学调查和评估委员会首次认识到由于长期暴露于高浓度甲醛浸渍文书工作而导致的与工作有关的脑肿瘤的科学证据。这个案例突出了正确的工作场所管理的重要性,告知工人在浸渍工作中长时间暴露于甲醛会导致脑瘤,并在类似过程中尽量减少暴露。
    UNASSIGNED: Formaldehyde was classified as a Group I Carcinogen by the International Agency for Research on Cancer (IARC) in 2006. While the IARC has stated that there is a lack of evidence that formaldehyde causes brain cancer, three meta-analyses have consistently reported a significantly higher risk of brain cancer in workers exposed to high levels of formaldehyde. Therefore, we report a case of a worker who was diagnosed with glioblastoma after being exposed to high concentrations of formaldehyde while working with formaldehyde resin in the paper industry.
    UNASSIGNED: A 40-year-old male patient joined an impregnated paper manufacturer and performed impregnation work using formaldehyde resin for 10 years and 2 months. In 2017, the patient experienced a severe headache and visited the hospital for brain magnetic resonance imaging, which revealed a mass. In the same year, the patient underwent a craniotomy for brain tumor resection and was diagnosed with glioblastoma of the temporal lobe. In 2019, a craniotomy was performed owing to the recurrence of the brain tumor, but he died in 2020. An exposure assessment of the work environment determined that the patient was exposed to formaldehyde above the exposure threshold of 0.3 ppm continuously for more than 10 years and that he had high respiratory and dermal exposure through performing work without wearing a respirator or protective gloves.
    UNASSIGNED: This case report represents the first instance where the epidemiological investigation and evaluation committee of the Occupational Safety and Health Research Institute in Korea recognized the scientific evidence of work-related brain tumors due to long-term exposure to high concentrations of formaldehyde during impregnated paperwork. This case highlights the importance of proper workplace management, informing workers that prolonged exposure to formaldehyde in impregnation work can cause brain tumors and minimizing exposure in similar processes.
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  • 文章类型: Case Reports
    关于2019年冠状病毒病(COVID-19)疫苗的不良反应有许多研究,但COVID-19疫苗接种后的尿失禁很少见。这里,我们报告了一个8岁的男孩去门诊部,泰国平医学院医院,泰语Binh,越南在过去2周内抱怨尿失禁,在第一剂信使RNA疫苗之后。他在临床和实验室检查中没有其他异常。这种临床情况表明疫苗有副作用。在没有厕所和膀胱训练的情况下,诊断后没有给予特异性治疗。随后的监测显示症状在2个月内逐渐减轻,从症状开始的第14周完全康复,不需要任何医疗干预。该案例强调需要对疫苗接种后的潜在不良反应进行全面评估和评估。包括不常见的介绍。
    There have been many studies on the adverse effects of coronavirus disease 2019 (COVID-19) vaccines but the urinary incontinence after COVID-19 vaccination is rare. Here, we report an 8-year-old boy presented to outpatient department, Thai Binh University of Medicine Hospital, Thai Binh, Vietnam with complaints of urinary incontinence for the past 2 weeks, following the first dose of the messenger RNA vaccine. He had no other abnormalities in clinical and laboratory exams. This clinical situation suggested vaccine side effects. No specific treatment was administered upon diagnosis without toilet and bladder training. Subsequent monitoring revealed a gradual reduction in symptoms over 2 months, with complete recovery achieved at the 14th week from the onset of symptoms, without necessitating any medical intervention. This case highlights the need for thorough evaluation and assessment of potential adverse effects following vaccination, including uncommon presentations.
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  • 文章类型: Journal Article
    大多数关于依库珠单抗的安全性数据来自临床试验,而其在现实世界中的安全信息仍然有限。
    收集并分析了依库珠单抗在FDA不良事件报告系统(FAERS)数据库中的数据(从2007年第一季度到2023年第一季度)。PubMed中与依库珠单抗相关的药物不良反应(ADR)的病例报告,对2023年5月之前的Embase和WebofScience进行了系统审查。
    在FAERS数据库中确定了总共464例依库珠单抗的ADR。比例报告比率(PRR)最高的前五名ADR是总补体活性下降,血管外溶血,血红蛋白尿症,总补体活性增加和突破性溶血。从44篇出版物中发现51例与依库珠单抗相关的ADR。观察到病例报告中依库珠单抗相关淋病奈瑟菌感染病例数与脑膜炎奈瑟菌感染病例数相当。
    临床医生必须密切关注接受eculizumab的患者的感染风险,包括严重的脑膜炎奈瑟氏球菌感染和其他可能致命的感染,如淋病奈瑟氏球菌感染。此外,临床用药时应警惕可能出现的新的ADR。
    UNASSIGNED: Most of the safety data regarding eculizumab came from clinical trials, while its safety information in the real world is still limited.
    UNASSIGNED: The data of eculizumab in the FDA Adverse Event Reporting System (FAERS) database (from the first quarter of 2007 to the first quarter of 2023) was collected and analyzed. The case reports of adverse drug reactions (ADRs) related to eculizumab in PubMed, Embase and Web of Science before May 2023 were systematically reviewed.
    UNASSIGNED: A total of 464 ADRs of eculizumab were identified in the FAERS database. The top five ADRs with the highest proportional reporting ratio (PRR) are total complement activity decreased, extravascular hemolysis, hemoglobinuria, total complement activity increased and breakthrough hemolysis. Fifty-one cases of ADR related to eculizumab were identified from 44 publications. The number of reported cases of eculizumab associated Neisseria gonorrhoeae infection in case reports was observed to be comparable to the number of cases of Neisseria meningitidi infection.
    UNASSIGNED: Clinicians must pay close attention to the risk of infections in patients receiving eculizumab, including severe N. meningitidis infection and other potentially fatal infections such as N. gonorrhoeae infection. In addition, The possible emergence of new ADRs should be vigilant during clinical medication.
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  • 文章类型: Journal Article
    心外膜连接为双心房折返回路提供了解剖学基础。右心房和右肺静脉之间的连接被称为“腔静脉束”,”,很少有与此束相关的房扑报告。我们介绍了一个双房性心动过速的病例,涉及腔间束。
    Epicardial connections provided the anatomical substrate for the biatrial reentry circuit. The connections between the right atrium and right pulmonary vein were called \"intercaval bundle,\" and there are few reports of atrial flutter related to this bundle. We present a case of a biatrial tachycardia, involving the intercaval bundle.
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  • 文章类型: Case Reports
    绝经前妇女的冠状动脉痉挛性心绞痛(CSA)并不常见,但也被认为与月经周期中雌激素下降有关,有时变得难治且难以控制。我们经历了两名绝经前妇女的CSA,表现出月经周期的参与。
    病例1:41岁女性在尿脓毒血症期间出现ST段抬高和胸痛,月经刚开始2天后。根据月经周期进行乙酰胆碱应激试验,并诱发多发性冠状动脉痉挛。病例2:40岁女性难治性胸痛是经前综合征(PMS)的症状。最大剂量药物的冠状动脉造影显示自发性多发性冠状动脉痉挛。血雌激素水平正常,这表明可能涉及荷尔蒙的变化,以及引入无心绞痛的低剂量药丸和减少药物剂量。
    在绝经前女性心绞痛中,雌激素可能起作用;询问月经周期和PMS病史很重要。此外,对于怀疑有CSA的绝经前女性,应考虑导管插入的时机.低剂量药丸在某些情况下可能有效,与妇科等其他部门的积极医疗合作是可取的。.
    UNASSIGNED: Coronary spastic angina (CSA) in premenopausal women is not frequent but has also been suggested to be associated with oestrogen decline during the menstrual cycle and sometimes becomes refractory and difficult to control. We experienced two premenopausal women with CSA that showed the involvement of the menstrual cycle.
    UNASSIGNED: Case 1: 41-year-old-woman had ST-segment elevation and chest pain during urosepsis, just 2 days after the onset of menstruation. The acetylcholine stress test was performed according to the menstrual cycle, and multiple coronary spasms were induced. Case 2: 40-year-old-woman had refractory chest pain as a symptom of premenstrual syndrome (PMS). Coronary angiography on drugs at the maximum dose revealed spontaneous multiple coronary spasms. Blood levels of oestrogen were normal, suggesting that hormonal change may be involved, and the introduction of low-dose pills made free from angina and the reduction of drug dose.
    UNASSIGNED: In premenopausal female angina pectoris, oestrogen may play a role; it is important to ask about the menstrual cycle and history of PMS. Besides, the timing of catheterization in premenopausal women with suspected CSA should be considered. Low-dose pills may be effective in some cases, and active medical collaboration with other departments such as gynaecology is desirable. .
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  • 文章类型: Case Reports
    我们报告了一例12岁男孩,该男孩接受了前交叉韧带(ACL)重建和外侧半月板修复。全phy骨,全内技术,由于开放的身体,使用股四头肌腱自体移植和可调节的悬吊纽扣固定。术中透视检查确认按钮的最佳位置,而关节镜评估移植物显示适当的张力,全方位的运动和膝盖的稳定性。然而,膝关节的常规影像学评估,术后6小时,发现胫骨纽扣通过隧道迁移到膝关节,而膝关节在临床检查中不稳定。移除移植物并用延伸的按钮重新加载。在翻修手术中保留了股骨接受腔,同时使用透明密封技术(全内技术)钻了新的胫骨接受腔。术后病程顺利。患者在翻修手术后12个月恢复无限制活动,并在术后两年保持完全活跃。这是文献报道的第一例胫骨纽扣迁移,手术后立即迁移,按钮的关节内位置和对移植物张力的负面影响。未能识别和治疗这种有害的并发症对膝盖来说可能是灾难性的。还描述了手术治疗的技术。外科医生应该意识到这种罕见的并发症,这可能会对临床结果产生不利影响。
    We report a case of a 12 years old boy that underwent Anterior Cruciate Ligament (ACL) reconstruction and lateral meniscus repair. The all-epiphyseal, all-inside technique, with quadriceps tendon autograft and adjustable suspensory button fixation was utilized due to the open physes. Intraoperative fluoroscopy confirmed optimal position of the buttons, while arthroscopic evaluation of the graft showed proper tension, with full range of motion and knee stability. Nevertheless, routine radiographic evaluation of the knee, six hours postoperatively, revealed tibial button migration through the tunnel into the knee joint, while the knee was unstable in clinical examination. The graft was removed and reloaded with extended buttons. The femoral socket was retained in the revision surgery while a new tibial socket was drilled with the transphyseal technique (all-inside technique). The postoperative course was uneventful. The patient returned to unrestricted activities at twelve months after revision surgery and remains fully active two years postoperatively. This is the first case of tibial button migration reported in the literature, with immediate migration after surgery, intra-articular position of the button and negative impact on graft tension. Failure to recognize and treat this detrimental complication could be catastrophic for the knee. The technique of the surgical treatment is also described. Surgeons should be aware of this rare complication, that could adversely affect the clinical outcome.
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  • 文章类型: Case Reports
    此病例报告着重于发生神经系统创伤并导致重症监护(ICU)谵妄时患者和家庭成员可能会经历的情况。它是患者(A.B.)和配偶(R.G.B.)观点的个人账户,当患者(A.B)在ICU中22天后出现椎动脉动脉瘤和出血,并经历了重症监护病房(ICU)谵妄。本病例报告提供了患者和配偶关于谵妄的观点,即,A.B.无法辨别现实,失去记忆,妄想症和幻觉,代理和恢复,ICU后综合征,和创伤后应激障碍(PTSD)。神经外科医生的临床诊断为谵妄,治疗包括睡眠镇静和不间断睡眠。A.B.能够恢复意识,但经历了长达一年的创伤后应激障碍。家庭一致参与患者的谵妄护理至关重要。家庭成员护理和以家庭为中心的策略对未来的研究和医疗保健具有重要意义。
    This case report focuses on what patients and family members may experience when a neurological trauma transpires and resultant intensive care (ICU) delirium occurs. It is the personal account of the patient (A.B.) and spouse\'s (R.G.B.) perspectives when the patient (A.B) suffered a vertebral artery aneurysm and hemorrhage and experienced intensive care unit (ICU) delirium after being in the ICU for 22 days. This case report provides the patient\'s and spouse\'s perspectives regarding delirium, i.e., A.B.\'s inability to discern reality, loss of memory, paranoia and hallucinations, agency and recovery, post-ICU syndrome, and post-traumatic stress disorder (PTSD). Clinical diagnosis by the neurosurgeon indicated delirium, with treatment consisting of sleep sedation and uninterrupted sleep. A.B. was able to regain consciousness yet experienced post-traumatic stress disorder up to one year afterward. Consistent family participation in the patient\'s delirium care is crucial. Family member care and family-centered strategies are provided with implications for future research and health care.
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  • 文章类型: Case Reports
    背景:种植体周围炎在临床实践中提出了重大挑战,需要有效的治疗策略。该病例报告提出了治疗种植体周围炎的综合治疗方法,专注于切除手术,包括植入成形术和长期维持。
    方法:我们描述了一例50岁女性种植体周围炎影响上颌全弓种植体支持康复的病例。治疗策略包括切除手术与植入成形术,一个新的上颌覆盖义齿,以及每年三到四次的定期维护护理时间表。在10年的随访期内进行了临床和影像学评估。
    结果:治疗后,所有上颌骨植入物均未显示超过4mm的探测深度,探查或化脓时没有出血,最小的斑块积累,没有进一步的骨质流失.植入成形术的切除手术似乎有效地提供了粘膜下净化,并创造了有利于口腔卫生的粘膜上植入物表面。尽管有定期维护,一些下颌骨植入物在随访期间出现骨丢失,并采用与上颌骨植入物相同的方法进行治疗.
    结论:综合治疗方法取得了良好的长期临床和影像学结果,强调联合策略在治疗种植体周围炎方面的有效性。然而,在新的植入物中复发或种植体周围炎的可能性,即使经过十年的成功治疗和严格的维护,强调了持续的重要性,勤勉关怀和定期评估,以及时诊断和解决这些问题。
    结论:为什么这个病例是新信息?种植体周围炎治疗的长期有效性,特别是涉及植入成形术,仍然记录不足。该病例提供了10年随访的见解,以了解治疗种植体周围炎的综合方法的有效性。此外,这些发现说明了新的种植体周围炎发展的潜力,无论持续的种植体周围的健康和严格的维护。这一发现强调了持续监测对表现出种植体周围炎的新植入物的早期诊断和治疗的关键作用。成功处理此病例的关键是什么?此病例的成功取决于综合治疗方法,该方法结合了与植入成形术相关的手术干预以去除植入线,从而创造更光滑的表面,对斑块积累的保留较少。这种方法的一个关键方面也是假体组件的重新设计,以提高卫生可达性,连续监测,和一致的维护保养。在这种情况下,成功的主要限制是什么?尽管患者一贯坚持维护计划。此外,对植入物特性的关键评估,特别是他们对机械故障的敏感性,在进行植入成形术时是最重要的。此外,使患者的期望与治疗的现实美学和功能结果相一致通常具有挑战性.
    结论:种植体周围炎,一种影响种植牙的炎症性疾病,治疗相当具有挑战性。该病例报告描述了患有这种疾病的50岁妇女如何成功治疗和维持10年以上。该方法包括一种称为切除手术的手术方法,其中涉及重塑骨缺损(骨成形术)和平滑植入物表面(植入成形术)。此外,她安装了一个新的上义齿,每年定期随访三到四次。十年后,她的上部植入物稳定,没有感染或进一步骨质流失的迹象,它们很容易保持清洁。在这段时间里,她的一些下部植入物确实经历了进行性骨丢失的炎症,但是他们使用与她的上植入物相同的外科手术进行管理。这份为期10年的病例报告强调了切除手术治疗种植体周围炎的积极和稳定的临床结果,以及跨学科方法和定期检查维护的重要性。早期诊断,以及长期种植周围炎的管理。
    BACKGROUND: Peri-implantitis poses significant challenges in clinical practice, necessitating effective therapeutic strategies. This case report presents a comprehensive treatment approach for managing peri-implantitis, focusing on resective surgery, including implantoplasty and long-term maintenance.
    METHODS: We describe the case of a 50-year-old female patient with peri-implantitis affecting a maxillary full-arch implant-supported rehabilitation. The treatment strategy involved resective surgery with implantoplasty, a new maxillary overdenture, and a regular maintenance care schedule of three to four visits per year. Clinical and radiographic assessments were performed over a 10-year follow-up period.
    RESULTS: Post-treatment, all maxillary implants demonstrated no probing depths exceeding 4 mm, absence of bleeding on probing or suppuration, minimal plaque accumulation, and no further bone loss. Resective surgery with implantoplasty seems to have effectively provided submucosal decontamination and created a supra-mucosal implant surface conducive to oral hygiene. Despite regular maintenance, some mandibular implants exhibited bone loss during the follow-up period and were managed using the same approach as for the maxillary implants.
    CONCLUSIONS: The comprehensive treatment approach yielded favorable long-term clinical and radiographic outcomes, underscoring the effectiveness of the combined strategies in managing peri-implantitis. Nevertheless, the potential for recurrence or the development of peri-implantitis in new implants, even after a decade of successful treatment and strict maintenance, highlights the importance of ongoing, diligent care and regular evaluations to promptly diagnose and address these issues.
    CONCLUSIONS: Why is this case new information? The long-term effectiveness of peri-implantitis treatments, particularly involving implantoplasty, remains under-documented. This case provides insights from a 10-year follow-up on the efficacy of a comprehensive approach for managing peri-implantitis. Furthermore, these findings illustrate the potential for new peri-implantitis to develop, regardless of sustained peri-implant health and rigorous maintenance. This finding highlights the critical role of continuous monitoring for the early diagnosis and treatment of new implants exhibiting peri-implantitis. What are the keys to the successful management of this case? The success of this case hinged on a comprehensive treatment approach that combines surgical intervention associated with implantoplasty to remove implant threads, thereby creating smoother surfaces, less retentive for plaque accumulation. A critical aspect of this approach was also the redesign of prosthetic components to improve hygiene accessibility, continuous monitoring, and consistent maintenance care. What are the primary limitations to success in this case? The primary challenge in achieving success in this case was the prevention of new implants with peri-implantitis, despite the patient\'s consistent adherence to the maintenance program. Moreover, a critical evaluation of implant characteristics, particularly their susceptibility to mechanical failures, is paramount when performing implantoplasty. Furthermore, aligning patient expectations with the realistic esthetic and functional outcomes of the treatment is often challenging.
    CONCLUSIONS: Peri-implantitis, an inflammatory disease affecting dental implants, is quite challenging to treat. This case report describes how a 50-year-old woman with this condition was successfully treated and maintained over 10 years. The approach included a surgical method called resective surgery, which involved reshaping the bone defect (osteoplasty) and smoothing the implant surface (implantoplasty). Additionally, she was fitted with a new upper denture and had regular follow-up visits three to four times a year. After ten years, her upper implants were stable with no signs of infection or further bone loss, and they were easy to keep clean. Some of her lower implants did experience inflammation with progressive bone loss during this time, but they were managed using the same surgical procedure as for her upper implants. This 10-year case report highlights positive and stable clinical results after resective surgery for treating peri-implantitis and the importance of an interdisciplinary approach and regular check-ups for maintenance, early diagnosis, and management of peri-implantitis over the long term.
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  • 文章类型: Case Reports
    肺鳞状细胞癌(LUSC)的特点是转移和复发率高,导致患者预后不良。LUSC肠转移是临床罕见的发生。LUSC肠转移患者的治疗选择有限,并且没有管理这些病例的标准治疗指南。在这次审查中,我们讨论临床特征,诊断,并治疗LUSC肠转移患者,目前罕见的LUSC肠转移病例。我们描述了一名患有严重咳嗽和胸痛并被诊断患有LUSC和骨肿瘤的患者。最初,原发性LUSC和骨肿瘤通过标准治疗得到控制.然而,原发性LUSC在治疗后不久复发,这次是肠道转移,缺乏有效的治疗方法。我们从该病例的观察表明,LUSC转移到肠道与预后较差有关。
    Lung squamous cell carcinoma (LUSC) is characterized by a high rate of metastasis and recurrence, leading to a poor prognosis for affected patients. Intestinal metastasis of LUSC is a rare clinical occurrence. Treatment options for LUSC patients with intestinal metastasis are limited, and no standard therapy guidelines exist for managing these cases. In this review, we discuss the clinical features, diagnosis, and treatment of LUSC patients with intestinal metastasis and present a rare case of LUSC with intestinal metastasis. We describe a patient who presented with a severe cough and chest pain and diagnosed with LUSC and bone tumor. Initially, the primary LUSC and bone tumor were controlled with standard treatments. However, the primary LUSC reoccurred shortly after treatment, this time with intestinal metastasis, for which effective treatments are lacking. Our observation from the case suggests that LUSC metastasizing to intestinal tract is associated with a poorer prognosis.
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