World Journal of Clinical Cases最新文献

The paradigm-shifting efficacy of immune checkpoint inhibitors in microsatellite instability-high colorectal cancer demands a critical appraisal of their long-term tissue effects. This editorial is a landmark case report revealing spontaneous colonic transection following pathological complete response to pembrolizumab - a first-in-medicine finding. Despite radiological resolution of disease, profound immune-mediated tissue remodeling resulted in catastrophic structural failure at the tumor site. This phenomenon exposes critical limitations in current imaging modalities to detect immunotherapy-induced bowel wall fragility and necessitates heightened awareness among surgeons. As immune checkpoint inhibitors move into neoadjuvant settings with rising complete response rates, we must reassess surgical planning, consider prophylactic interventions for high-risk anatomy, and develop biomarkers for tissue integrity. This case underscores that tumor regression does not equate to restored organ function, urging multidisciplinary vigilance against delayed structural toxicity.

Background: Psoriasis is a chronic inflammatory condition related to an increased atherosclerotic cardiovascular disease (ASCVD) risk.

Aim: To investigate whether lipoprotein (a) [Lp(a)] levels are increased in patients with psoriasis.

Methods: A comprehensive literature search up to January 30, 2025 was conducted utilizing PubMed and Cochrane Library databases. A qualitative synthesis and a meta-analysis on Lp(a) mean differences (MD) between psoriasis cases and healthy controls (HC) was performed. The protocol of this meta-analysis has been registered to PROSPERO (No. CRD420250652465).

Results: Eighteen studies with 1650 psoriasis patients and 1621 HC were eligible for qualitative synthesis. Pooled analysis from 16 studies (1401 psoriasis patients and 1320 HC) demonstrated that psoriasis patients had significantly higher Lp(a) levels compared with the HC group (MD: 6.72 mg/dL, 95%CI: 4.32-9.12, P < 0.00001, I ² = 71%). Sensitivity analyses according to the region of origin was also performed. The pooled analysis of the European sub-population showed a pronounced increase in Lp(a) levels in 189 patients with psoriasis vs 178 HC (MD: 15.86 mg/dL, 95%CI: 5.79-25.92, P < 0.002, I ² = 79%), while the pooled analysis on the Asian sub-population demonstrated a smaller but still significant difference in Lp(a) levels between 1177 psoriasis patients and 1127 HC (MD: 4.95 mg/dL, 95%CI: 2.99-6.92, P < 0.00001, I ² = 58%).

Conclusion: Our findings suggest that Lp(a) levels are significantly elevated in psoriasis patients, further adding to their ASCVD risk.

Background: Submucosal tumors arise from the subepithelial layer anywhere along the gastrointestinal tract, most commonly in the stomach. A wide range of lesions, from benign to malignant, may present as gastric submucosal tumors. However, the gastric involvement of Crohn's disease (CD) is generally not considered in the differential diagnosis of such lesions.

Case summary: A 23-year-old male patient presented with a gastric subepithelial tumor. The medical history included CD. Diagnostic workup revealed a 3-cm mucosal lesion with a central ulceration on the posterior wall of the distal antrum. The patient underwent laparoscopic wedge resection of stomach, and the postoperative course was uneventful. Histopathological analysis confirmed a diagnosis of gastric CD presenting as a subepithelial tumor.

Conclusion: Despite its rarity, upper gastrointestinal CD can present as a gastric subepithelial tumor, warranting consideration in young patients with CD.

Background: Mesonephric-like adenocarcinoma (MLA) is a rare and highly malignant disease that occurs in the uterine body or ovaries. We report a case of a MLA that was considered to have originated in the fallopian tube and presented with malignant peritonitis.

Case summary: A 57-year-old female presented with a chief complaint of abdominal pain that began 2 months prior. Cancerous peritonitis was suspected. During exploratory laparoscopy, the right fallopian tube was found to be enlarged, with widespread disseminated lesions extending from the pelvic cavity to the upper abdomen. Histopathological examination of the peritoneal tissue obtained by biopsy showed tumor cells with a high nuclear/cellular ratio and proliferation of papillary tubular to pedunculated solid nests. Immunohistochemical testing was positive for GATA-binding protein 3, thyroid transcription factor 1, cluster of differentiation 10, and paired box protein-8, and negative for estrogen receptor, Wilms' tumor 1, and wild-type p53, leading to the diagnosis of MLA. Subsequently, debulking surgery was performed, and no macroscopic residual tumors were identified. The pathological diagnosis was right tubal carcinoma, mesonephric adenocarcinoma (International Federation of Gynecology and Obstetrics stage IIIC), and pT3cNXM0. Adjuvant chemotherapy was administered postoperatively; however, recurrence was noted, and the patient died 1 year and 6 months after the initial treatment.

Conclusion: MLA is a very rare disease with poor prognosis. Further studies are necessary to identify effective treatment options.

Background: Pleuroparenchymal fibroelastosis (PPFE) is a rare form of interstitial lung disease affecting the upper lobes. Its atypical radiological appearance frequently mimics lung malignancy, complicating early diagnosis. This case highlighted the importance of histopathological confirmation to differentiate PPFE from malignant lesions.

Case summary: A 62-year-old male with a significant smoking history presented with progressive dyspnea and a chronic nonproductive cough. High-resolution computed tomography revealed a localized fibrotic lesion in the left upper lobe with apical pleural thickening and subpleural consolidation. 18F-fluorodeoxyglucose positron emission tomography/computed tomography revealed moderate hypermetabolism (maximum standardized uptake value of 3.2), potentially indicating malignancy. Pulmonary function testing was deferred due to concurrent pneumothorax. The patient underwent video-assisted thoracoscopic surgery with segmental lung resection and talc pleurodesis. Histopathology confirmed dense fibroelastosis with abundant elastin deposition, minimal inflammation, and no evidence of malignancy. Differential diagnoses, including apical cap, chronic hypersensitivity pneumonitis, granulomatous infections, and asbestos-related disease were systematically excluded. Therefore, he was diagnosed with PPFE. Antifibrotic therapy with nintedanib was initiated postoperatively. At the 26-month follow-up, imaging and pulmonary function testing demonstrated stable disease with no recurrence of pneumothorax or functional decline.

Conclusion: Histopathology is essential for distinguishing PPFE from malignancy. Early diagnosis allows individualized therapy to slow progression.

Head and neck cutaneous squamous cell carcinoma (HNCSCC) remains underexplored compared to oropharyngeal squamous cell carcinoma, particularly in relation to human papillomavirus (HPV) and molecular markers such as p16 and p53. While p16 is a well-established surrogate for HPV in oropharyngeal cancer, our review highlights its unreliable role in HNCSCC, where positivity is instead associated with recurrence and metastasis. Similarly, p53 illustrates a dual role - wild-type as a genomic safeguard, mutated as an oncogenic driver - complicating prognostication. Methodological considerations, including the limitations of immunohistochemistry for HPV detection, underscore the need for multi-method and molecular validation in future studies. Ultraviolet radiation is posited as a key modifier of p16 function, decoupling expression from tumor suppression. To contextualize these findings, we draw parallels to glioblastoma (GBM), where subclonal evolution, p53 dysfunction, and intratumoral heterogeneity drive relapse despite aggressive multimodal therapies. GBM exemplifies how bulk-level biomarker generalizations often obscure dynamic cellular ecosystems, reinforcing the necessity of single-cell and spatial approaches. Multi-omics integration - encompassing genome, transcriptome, proteome, and tumor microenvironment mapping - coupled with single-cell RNA sequencing and spatial transcriptomics, offers a path forward for resolving subclonal dynamics in both HNCSCC and GBM. These technologies provide the resolution needed to track tumor-immune-stromal co-evolution, identify therapy-resistant clones, and anticipate recurrence. We argue for a N-of-1, patient- and cell-centric paradigm that reframes biomarkers not as static surrogates but as dynamic readouts of cancer evolution across time and tissue contexts. Conceptually, we propose kinetic and microenvironmental frameworks (e.g., "load-and-lock" barriers; dormancy and immune-synapse stabilization) as hypothesis-generating avenues to stall clonal handoffs and improve outcome prediction. Together, these perspectives argue for revised biomarker frameworks in HNCSCC and ethically inclusive, mechanism-anchored studies that bridge discovery with individualized care. By bridging insights from HNCSCC with the lessons of GBM, this review underscores the need for ethically inclusive, mechanistically informed frameworks that integrate subclonal evolution, biomarker re-interpretation, and precision-personalized hybrid models. Such an approach will be essential for advancing from one-size-fits-all strategies to individualized lifetime cancer care.

Optic neuritis (ON) is a focal inflammatory demyelinating disorder of the optic nerve. Although classically regarded as a sentinel event for multiple sclerosis (MS), ON also occurs in antibody-mediated entities such as aquaporin-4-IgG-positive neuromyelitis optica spectrum disorder (AQP4-NMOSD) and myelin-oligodendrocyte-glycoprotein-antibody disease. In all these settings biological sex is a pivotal determinant of susceptibility, clinical expression, treatment response and long-term outcome. Data synthesized from an extensive literature analysis utilizing PubMed, Scopus, and Web of Science in this review shows that women experience ON far more frequently - with female-to-male ratios ranging from 3:1 in MS to almost 9:1 in AQP4-NMOSD - yet men, when affected, tend to accumulate irreversible neuro-axonal loss more rapidly. Sex-specific patterns arise at every biological stratum: X-linked gene dosage, epigenetic regulation, hormonal cycles from puberty through menopause, metabolic co-modifiers such as obesity and vitamin-D status, and psychosocial forces that influence healthcare utilization. By weaving these elements into an expanded narrative, the present review provides a detailed resource for clinicians and investigators aiming at gender-tailored management of ON.

Background: Pediatric complicated community-acquired pneumonia (CCAP) is on the rise. The three subtypes include para-pneumonic effusion (PPE), necrotizing pneumonia (NP), and empyema.

Aim: To study different sub-types of pediatric CCAP, and compare their etiology, clinical profile, and outcome in the post-pneumococcal vaccination era.

Methods: This prospective observational study was conducted over a 2-year period. All details (demographics, clinical, management, and outcomes) were recorded. Continuous data were presented either as mean and SD, or as median and inter-quartile range. Categorical data were presented as frequencies and percentages (%). Data were analyzed by using the IBM SPSS Statistics for Windows, version 21 (IBM Corp., Armonk, NY, United States).

Results: Of the 80 cases included (71% aged 4-8 years), the distribution was as follows: PPE (42%), empyema (39%), and NP (19%). Bacterial etiology was identified in 28% (empyema 63%, P = 0.012). Staphylococcus aureus (45%) was most common followed by Escherichia coli (E. coli) (22.7%), and Streptococcus pneumoniae (13.6%). Patients with empyema, compared to PPE and NP, were less likely to receive prior antibiotics (32% vs 56% and 58%, respectively, P = 0.03). Duration (days, mean ± SD) of hospitalization was longer in children with NP compared to empyema and PPE (17.7 ± 9.8, 16.1 ± 7.5, and 13.6 ± 4.2, respectively). All children recovered with the medical management except 2 children requiring decortication.

Conclusion: Staphylococcus aureus and E. coli are the most common bacterial etiology in the post-pneumococcal vaccination era. Empyema might be related to a delay in antibiotics administration. NP is the most severe pediatric CCAP with prolonged hospitalization.

Background: Although obesity is a well-established contributor to surgical risks, evidence regarding the specific outcomes of laparoscopic cholecystectomy (LC) in obese patients remains scarce.

Aim: To assess clinicopathologic differences and 1-year outcomes following elective LC in patients with obesity and gallstone disease.

Methods: This retrospective study analyzed data from 65 patients who underwent elective LC for gallstone disease between January 2020 and May 2022, with outcomes assessed at the 1-year follow-up. Patients were categorized as obese (body mass index ≥ 25 kg/m²) or non-obese (body mass index < 25 kg/m²), and comparisons were made across preoperative laboratory values, intraoperative parameters, and patient-reported outcomes.

Results: The obese group had significantly higher American Society of Anesthesiologists scores, higher glycated hemoglobin levels, and lower vitamin D levels than the non-obese group. Elevated triglycerides were more frequent in the obese group, whereas higher high-density lipoprotein levels were more common in the non-obese group. Intraoperative and postoperative outcomes did not differ between the groups. At the 1-year follow-up, 24.6% of patients reported post-cholecystectomy symptoms, with no group differences.

Conclusion: Obese patients had higher American Society of Anesthesiologists scores, lower vitamin D, and elevated triglycerides preoperatively, but these differences did not significantly affect intraoperative findings or 1-year postoperative outcomes compared to non-obese patients.