Medicine最新文献

{"title":"Effect of radiation timing on the capsular contracture of implant-based breast reconstruction: A retrospective cohort study.","authors":"Yoshiko Iwahira, Gojiro Nakagami, Kojiro Morita, Hiromi Sanada","doi":"10.1097/MD.0000000000041438","DOIUrl":"10.1097/MD.0000000000041438","url":null,"abstract":"<p><p>Breast reconstruction using tissue expanders and silicone implants has become increasingly popular in Japan since health insurance began covering the procedure in 2013. Radiotherapy after mastectomy is recommended for certain patients and has been identified as a major risk factor for capsular contractures. However, the effect of radiation therapy timing on the development of capsular contracture has not yet been thoroughly studied. This study aimed to evaluate the effects of radiation therapy timing on the development of capsular contractures in patients who underwent implant-based breast reconstruction performed by a single expert plastic surgeon. This retrospective cohort study included 341 patients undergoing implant-based breast reconstruction and irradiation between April 2003 and March 2019. Patients were categorized based on radiation and operation types. Variables included postirradiation skin condition, implant mobility, and expander placement position. The outcome measure was the development of capsular contracture, assessed using the Baker Classification. Of 340 patients, 43 developed severe capsular contracture (Baker classification Grade III) within 2 years (cumulative incidence, 12.6 %). No significant relationship was found between the radiation or operation type and capsular contracture. Instead, postirradiation skin redness, implant mobility, skin pinchability after 1 year, and expander positioning were found to be significant factors affecting capsular contracture development. The timing of radiation therapy was not a determinant of capsular contracture development. Factors such as postirradiation skin inflammation, implant mobility, ability to pinch the skin, and expander position play pivotal roles in determining capsular contracture development.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"104 6","pages":"e41438"},"PeriodicalIF":1.3,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11813055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of psychotherapy for Hwa-Byung: A systematic review of interventional studies.","authors":"Chan-Young Kwon, Boram Lee","doi":"10.1097/MD.0000000000041315","DOIUrl":"10.1097/MD.0000000000041315","url":null,"abstract":"<p><strong>Background: </strong>This systematic review aimed to review and synthesize the effects of different psychotherapies on Hwa-Byung (HB), a Korean culture-bound syndrome.</p><p><strong>Methods: </strong>Ten electronic databases were comprehensively searched for interventional studies on psychotherapy, including language-based communication, for patients with HB, published until July 2023. The Cochrane risk-of-bias assessment tool and risk-of-bias in non-randomized studies of interventions were used to assess the methodological quality of the included studies.</p><p><strong>Results: </strong>Nine studies including 7 controlled clinical trials were included. Interventions encompassed 6 types: acceptance and commitment therapy, Adlerian counseling, integrated counseling, emotional freedom technique, art therapy, and psychotherapeutic programs for HB treatment. Except for the 2 types of counseling, all interventions were implemented in a group format, with total sessions ranging from 4 to 15 (average 8.11). Most interventions significantly improved HB symptoms compared to the waitlist or before-and-after comparisons. In the before-after comparison, the most frequently reported outcome of effectiveness was the HB Scale total score (100%, 6/6), followed by state anger (50%, 3/6), and state anxiety (50%, 2/4). For other outcomes, statistically significant positive results were reported in less than half of the cases, or there were only a small number of reported cases.</p><p><strong>Conclusions: </strong>To our knowledge, this systematic review comprehensively investigated the effectiveness of psychotherapy for HB and found evidence for some psychotherapies not previously presented in the clinical practice guidelines for HB. However, methodological limitations, including the lack of an appropriate control group, make it difficult to obtain high-quality evidence on psychotherapy for HB.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"104 6","pages":"e41315"},"PeriodicalIF":1.3,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11813000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing the workload of medical diagnosis through artificial intelligence: A narrative review.","authors":"Jinseo Jeong, Sohyun Kim, Lian Pan, Daye Hwang, Dongseop Kim, Jeongwon Choi, Yeongkyo Kwon, Pyeongro Yi, Jisoo Jeong, Seok-Ju Yoo","doi":"10.1097/MD.0000000000041470","DOIUrl":"10.1097/MD.0000000000041470","url":null,"abstract":"<p><p>Artificial intelligence (AI) has revolutionized medical diagnostics by enhancing efficiency, improving accuracy, and reducing variability. By alleviating the workload of medical staff, AI addresses challenges such as increasing diagnostic demands, workforce shortages, and reliance on subjective interpretation. This review examines the role of AI in reducing diagnostic workload and enhancing efficiency across medical fields from January 2019 to February 2024, identifying limitations and areas for improvement. A comprehensive PubMed search using the keywords \"artificial intelligence\" or \"AI,\" \"efficiency\" or \"workload,\" and \"patient\" or \"clinical\" identified 2587 articles, of which 51 were reviewed. These studies analyzed the impact of AI on radiology, pathology, and other specialties, focusing on efficiency, accuracy, and workload reduction. The final 51 articles were categorized into 4 groups based on diagnostic efficiency, where category A included studies with supporting material provided, category B consisted of those with reduced data volume, category C focused on independent AI diagnosis, and category D included studies that reported data reduction without changes in diagnostic time. In radiology and pathology, which require skilled techniques and large-scale data processing, AI improved accuracy and reduced diagnostic time by approximately 90% or more. Radiology, in particular, showed a high proportion of category C studies, as digitized data and standardized protocols facilitated independent AI diagnoses. AI has significant potential to optimize workload management, improve diagnostic efficiency, and enhance accuracy. However, challenges remain in standardizing applications and addressing ethical concerns. Integrating AI into healthcare workforce planning is essential for fostering collaboration between technology and clinicians, ultimately improving patient care.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"104 6","pages":"e41470"},"PeriodicalIF":1.3,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11813001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Construction and validation of a prediction nomogram model for acute gastrointestinal failure in patients with severe traumatic brain injury.","authors":"Yadi Mao, Fei Li, Lidi Shen, Chunmin Huang","doi":"10.1097/MD.0000000000041423","DOIUrl":"10.1097/MD.0000000000041423","url":null,"abstract":"<p><p>This study aims to establish and validate the prediction model of acute gastrointestinal failure (AGF) in patients with severe traumatic brain injury. A total of 665 inpatients from Shaoxing People's Hospital from January 2018 to January 2024 were admitted and randomly divided into training group (466 cases) and validation group (199 cases). Data were collected by general situation questionnaire and AGF assessment tool. According to the results of multivariate logistic regression analysis, the prediction nomogram model was established with R software. Bootstrap method was used for internal verification of the model, and verification group was used for external verification. The area under receiver operating characteristic (ROC) curve, Hosmer-Lemeshow test and calibration curves were used to evaluate the differentiation and calibration degree of the model. Multivariate Logistic regression analysis showed that pulmonary infection, hypoxemia, glasgow coma scale (GCS) score ≤ 8 on admission, hyponatremia and metabolic acidosis were independent risk factors for AGF in patients with severe traumatic brain injury (P < .05). On this basis, a new prediction model was constructed, as follows: logit P = -4.998 + 0.858 × pulmonary infection + 0.923 × hypoxemia + 1.488 × GCS score ≤ 8 + 1.274 × hyponatremia + 1.020 × metabolic acidosis. The area under ROC of the new model was 0.787 (95% CI: 0.831-0.909), and the cutoff point was 0.4589. The sensitivity and specificity of the model were 69.74% and 76.15%, respectively. Hosmer-Lemeshow goodness of fit test showed that the prediction model had a good fitting effect (χ2 = 4.828, P = .681). External verification showed that the Hosmer-Lemeshow goodness of fit test showed that the prediction model had a good fitting effect (χ2 = 12.712, P = .122). Calibration curves showed the nomogram established fits well with the real data. The prediction model constructed in this study has good differentiation and calibration degree, which can intuitively and easily select high-risk patients, and provide reference for early screening and gastrointestinal nursing intervention.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"104 6","pages":"e41423"},"PeriodicalIF":1.3,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11812995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sintilimab-induced photodistributed bullous pemphigoid: A case report.","authors":"Wenjuan Cui, Su Wang, Junzhu Xu, Xiaowei Shen, Murong Hu","doi":"10.1097/MD.0000000000041448","DOIUrl":"10.1097/MD.0000000000041448","url":null,"abstract":"<p><strong>Rationale: </strong>Immune-checkpoint inhibitors have emerged as a frontline treatment for a growing list of malignancies. Immunotherapy-induced bullous pemphigoid (BP) is a rare dermatological immune-related adverse event of immune-checkpoint inhibitor therapy immune-checkpoint inhibitor therapy. We report a case of immunotherapy-associated BP, with lesions presenting in a photodistribution. This case report aims to emphasize the early recognition of rare clinical manifestations induced by immunotherapy to improve patient prognosis.</p><p><strong>Patient concerns: </strong>The patient was a 77-year-old man with a history of right upper lung squamous cell carcinoma on sintilimab (anti-programmed cell death protein-1 [PD-1]) for over a year. After 12 months of initiation of PD-1 inhibitors, nonspecific cutaneous eruption appeared on his head, face, and extremities, mostly pruritic eczematous dermatitis with papules and plaques. The time to development of bullae after medication initiation was 16 months.</p><p><strong>Diagnoses: </strong>Sintilimab-induced BP.</p><p><strong>Intervention: </strong>Oral prednisone was gradually tapered to discontinuation following intravenous methylprednisolone; the skin lesions have basically recovered.</p><p><strong>Outcomes: </strong>Follow-up for 19 months showed no recurrence of the skin lesions.</p><p><strong>Lessons: </strong>This case report emphasizes that the clinical manifestations of BP induced by PD-1/programmed death ligand-1 inhibitors can be diverse. Dermatologists need to increase their awareness of BP caused by PD-1/programmed death ligand-1 inhibitors.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"104 6","pages":"e41448"},"PeriodicalIF":1.3,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11812991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Study on PD-1 inhibitor combined with recombinant human endostatin and chemotherapy followed by IMRT in the treatment of advanced NSCLC.","authors":"FaQiang Ma, ZhengJun Qi, GuangHui Liao, LiLi Zhao, XiaLu Su, ChangFen Dong, FangYang Lu, Yi Sun","doi":"10.1097/MD.0000000000041306","DOIUrl":"10.1097/MD.0000000000041306","url":null,"abstract":"<p><p>Although chemotherapy, targeted therapy, and antiangiogenic drugs have become the cornerstones of treatment for advanced non-small-cell carcinoma (NSCLC) in clinical practice, the emergence of immune checkpoint inhibitors (such as PD-1 inhibitors) in recent years has also provided new options for the treatment of NSCLC. To explore whether PD-1 inhibitors combined with recombinant human endostatin and chemotherapy followed by IMRT have a certain curative effect in the treatment of advanced NSCLC. We retrospectively analyzed 47 patients with stage IIIB, IIIC, and IV NSCLC admitted to our hospital from August 2022 to June 2023. According to the treatment method, the patients were divided into an observation group (24 cases) and a control group (23 cases). The control group only received recombinant human endostatin 105 g and chemotherapy followed by IMRT; the observation group received domestic PD-1 inhibitors, 200 mg, and chemotherapy followed by IMRT on the basis of the treatment plan of the control group. After treatment, the objective response rate (ORR), disease control rate, overall survival, progression-free survival (PFS), duration of response, and incidence of adverse reactions were compared. After treatment, the ORR and disease control rate of the observation group were higher than those of the control group; compared with the control group, the PFS, overall survival, and duration of response period of the observation group were longer (P < .05); the incidence of adverse reactions in the observation group was significantly lower than that in the control group (P < .05). After chemotherapy, the CD3+ and CD4+ index of the observation group was significantly increased, the CD3+ CD8+ was slightly lower than that of the control group, without statistical significance, and the ratio of CD4/CD8 was higher than that of the control group, and the interleukin-2 index was significantly better than that of the routine group, P < .05. PD-1 inhibitor combined with recombinant human endostatin and chemotherapy followed by IMRT in the treatment of advanced NSCLC can significantly improve the ORR and prolong the PFS of patients, and the adverse reactions are controllable. The results of our study may provide help for the treatment strategies of patients with refractory advanced NSCLC, and are worthy of promotion and use.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"104 6","pages":"e41306"},"PeriodicalIF":1.3,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11812992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lung-protective ventilation strategy to improve oxygenation function and respiratory mechanics in patients undergoing robotic bariatric surgery: A randomized double-blind trial (CONSORT).","authors":"Zichen Song, Lin Sun, Peng Chen, Yonghao Yu","doi":"10.1097/MD.0000000000041433","DOIUrl":"10.1097/MD.0000000000041433","url":null,"abstract":"<p><strong>Background: </strong>The respiratory effects of lung-protective ventilation strategy (LPVS) on patients undergoing robotic abdominal surgery are still controversial, and prospective studies are needed to validate the lung-protective effects of LPVS, especially in robotic bariatric surgery.</p><p><strong>Methods: </strong>Forty-two patients undergoing robotic bariatric surgery were included in this study, of whom 20 received an LPVS and 22 received a standard ventilation strategy. Parameters were recorded at 5 intraoperative time points to assess respiratory mechanics, hemodynamics, and oxygenation. The incidence of intraoperative ventilation complications and postoperative pulmonary complications. Statistical analyses were performed using repeated measures analysis of variance and chi-square tests.</p><p><strong>Results: </strong>First, we demonstrated that the LPVS using a small tidal volume, positive end-expiratory pressure ventilation, and low inspired oxygen concentration could reduce peak and plateau airway pressures in patients undergoing robotic bariatric surgery (P < .05). Second, patients' oxygenation index (P < .01) and partial pressure of oxygen (P < .05) increased considerably after lung-protective ventilation treatment, suggesting that this strategy facilitates oxygenation function in patients. Finally, we found that high inhaled oxygen concentration was an independent risk factor for postoperative pulmonary complications in robotic bariatric surgery patients (P < .05).</p><p><strong>Conclusions: </strong>This study confirms that LPVS can improve oxygenation function and respiratory mechanics in patients undergoing robotic bariatric surgery, which is of clinical significance.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"104 6","pages":"e41433"},"PeriodicalIF":1.3,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11813022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical analysis of 101 cases of infectious endophthalmitis.","authors":"Shanshan Li, Xianfeng Song, Xu Wang, Xing Du, Zhen Yang, Yuan Tao","doi":"10.1097/MD.0000000000040048","DOIUrl":"10.1097/MD.0000000000040048","url":null,"abstract":"<p><p>This study aimed to analyze the pathogenesis, clinical features, and treatment of infectious endophthalmitis and provide reference data for its prevention and treatment. The study retrospectively analyzed 101 cases of infectious endophthalmitis patients who received treatment at the Second People's Hospital of Jinan from January 2020 to December 2022, including pathogenic factors, microbiology, treatment, and prognosis of the patients. We found that traumatic endophthalmitis accounted for 48.51% of all cases, with iron foreign bodies being the leading cause of injury, while postoperative endophthalmitis after intraocular surgery accounted for 32.67% of all cases, with cataract surgery being the leading cause. The improvement in posttreatment visual acuity varied significantly among different causes of pathogenesis, with intraocular surgery showing the most improvement. In particular, postcataract surgery endophthalmitis showed better improvement than noncataract surgery-related endophthalmitis. Staphylococcus epidermidis was the main pathogenic bacteria causing infectious endophthalmitis, followed by fungi. Vitrectomy and intravitreal injection were the main treatment methods, with pars plana vitrectomy (PPV) + intravitreal injection (IVT) having a longer treatment time than PPV, IVT, or other approaches. In conclusion, this study provided important reference data for the prevention and treatment of infectious endophthalmitis. Traumatic and postoperative endophthalmitis were the most common causes, with iron foreign bodies and cataract surgery being the main contributors, respectively. The improvement in posttreatment visual acuity varied significantly among different causes of pathogenesis, with postcataract surgery endophthalmitis showing better improvement. Staphylococcus epidermidis was the main pathogenic bacteria causing infectious endophthalmitis, and vitrectomy and intravitreal injection were the main treatment methods.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"104 6","pages":"e40048"},"PeriodicalIF":1.3,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11812999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative radiotherapy for stage pIIIA-N2 non-small cell lung cancer patients undergoing sublobar resection: A retrospective cohort study.","authors":"Shou-Feng Wang, Xin-Bin Pan, Wei Huang, Yin-Nong Zhao","doi":"10.1097/MD.0000000000041462","DOIUrl":"10.1097/MD.0000000000041462","url":null,"abstract":"<p><p>This study assesses the effect of postoperative radiotherapy on survival outcomes in patients diagnosed with stage pIIIA-N2 non-small cell lung cancer (NSCLC) after sublobar resection. Data of patients with stage pIIIA-N2 NSCLC who underwent sublobar resection were extracted from the Surveillance, Epidemiology, and End Results database spanning from 2000 to 2020. Patients were divided into 2 groups: postoperative radiotherapy and observation. Cancer-specific survival (CSS) and overall survival (OS) were analyzed and compared between the 2 groups. A total of 444 patients were included in the study, with 210 (47.3%) receiving postoperative radiotherapy and 234 (52.7%) with observation. The CSS (hazard ratio [HR] = 0.99, 95% confidence interval [CI]: 0.78-1.26; P = .926) and OS (HR = 0.93, 95% CI: 0.75-1.15; P = .512) did not show significant differences between the postoperative radiotherapy and observation groups. Subgroup analysis of patients receiving postoperative chemotherapy revealed comparable CSS (HR = 1.24, 95% CI: 0.89-1.71; P = .203) and OS (HR = 1.12, 95% CI: 0.85-1.49; P = .425) between the 2 groups. Similarly, for patients without postoperative chemotherapy, CSS (HR = 1.11, 95% CI: 0.66-1.84; P = .699) and OS (HR = 1.08, 95% CI: 0.68-1.71; P = .740) were not significantly different between the 2 groups. Postoperative radiotherapy does not improve survival in patients with stage pIIIA-N2 NSCLC following sublobar resection.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"104 6","pages":"e41462"},"PeriodicalIF":1.3,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11813015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Salivary duct carcinoma presenting with unilateral multiple cranial nerve lesions and concurrent intracranial metastasis: A case report.","authors":"Bo Zhu, Qing-Zi Zhang, Kun Guo, Nai-Bing Gu, Zheng-Li Di, Zhi-Qin Liu, Xiang-Chun Yang, Li-Li Chai, Yan-Ping Yang, Xiao-Tao Jia","doi":"10.1097/MD.0000000000041293","DOIUrl":"10.1097/MD.0000000000041293","url":null,"abstract":"<p><strong>Rationale: </strong>Salivary gland ductal carcinoma (SDC) is a rare malignant tumor of the head and neck, accounting for 1% to 3% of salivary gland malignancy. SDC usually occurs in parotid gland, has a high malignancy degree, poor prognosis, and is prone to distant metastasis. In particular, intracranial metastasis accompanied by multiple cranial nerve lesions is very rare, and early diagnosis is difficult, which easily leads to missed diagnosis and misdiagnosis. Therefore, the diagnosis and treatment of SDC face major challenges. We report a unique case of SDC, which initially presented with progressive facial paralysis followed by progressive intracranial metastases and multiple cranial nerve lesions. After surgery and pathological examination, SDC was finally diagnosed.</p><p><strong>Patient concerns: </strong>A previously healthy 53-year-old male with persistent facial paralysis gradually developed symptoms of ipsilateral multiple cranial nerve lesions, and was hospitalized 8 months after onset.</p><p><strong>Diagnoses: </strong>Brain magnetic resonance imaging enhancement showed multiple irregular intracranial T1 and T2 with uneven signal intensity. Brain computed tomography showed intracranial space-occupying lesions, the largest of which was about 55 × 42 × 38 mm, with extensive bone destruction. Pathological findings showed malignant cell mass in the left temporal lobe tumor. Immunohistochemical: (++), CK7(+++), AR(++), Brg-1(+), Her-2(2+), Ki67(+, approximately 80%), consistent with high-grade ductal carcinoma, considering salivary gland origin. The final diagnosis was SDC.</p><p><strong>Interventions: </strong>The space-occupying lesions in the left cavernous sinus region and temporal lobe were partially resected. Local radiotherapy was recommended, but the patient refused.</p><p><strong>Outcomes: </strong>Postoperative symptoms did not improve significantly. Follow-up after 4 months showed no improvement in the extensive cranial nerve lesions on the left side.</p><p><strong>Lessons: </strong>In clinical practice, in the face of persistent facial palsy symptoms that gradually spread to other cranial nerves, the possibility of secondary facial nerve injury and malignant salivary gland tumors, especially SDC, cannot be easily ruled out even if imaging studies do not reveal any space-occupying intracranial lesions. Through the comprehensive use of imaging, pathology and immunohistochemistry and other diagnostic methods, the early detection and accurate diagnosis of SDC can be achieved, so as to provide the best treatment strategy for patients and improve the prognosis.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"104 6","pages":"e41293"},"PeriodicalIF":1.3,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11813024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}