We describe our challenge in diagnosing an unusual and rapidly progressing case of pulmonary pleomorphic carcinoma (PPC)—a rare, poorly differentiated, or undifferentiated non-small-cell carcinoma that can metastasize locally or distantly and has a poor prognosis. Our patient was an elderly man with a one-month history of abdominal pain, anorexia, and weight loss, diagnosed with atrophic gastritis via endoscopy, and treated medically without improvement. A week later, this patient developed pain in the head, neck, and shoulder area, and further examination revealed a thickening of his left neck and shoulder, with no palpable lymph nodes. Computed tomography (CT) of the neck, chest, and abdomen led us to believe that we might be dealing with primary sarcoma of the neck since no lung mass was evident. Further investigation could not be performed because the patient’s status deteriorated rapidly. An autopsy revealed that soft tissue in the left neck and the mesentery was invaded by poorly differentiated polymorphic malignant cells, which were also seen in the lung lesion. Immunohistochemically, these malignant cells were all positive for AE1/AE3, CAM5.2, TTF-1, Napsin-A, and Vimentin. The cells were also positive for programmed death-ligand 1 staining with a low level of tumor proportion score (over 1%). The final diagnosis was PPC with metastases to soft tissues in the left neck and the mesentery. A review of previous case reports of PPC revealed that soft tissue is an uncommon site for metastasis, and that our CT findings were rather unusual. We hereby present our case and review of published case reports, with the hope that an awareness of the heterogeneous features of PPC could prompt timely biopsy and histological diagnosis.

IntroductionGeneral internists in Japanese hospitals sometimes consult on adolescents. Our university hospital encounters more adolescents with mental health complaints than other city hospitals. Consequently, based on our experience, we hypothesized that psychiatric disorders are significantly more common among teenagers who visit general internists. Therefore, we retrospectively analyzed the clinical profiles of teenage outpatients who visited general internists at three hospitals to test this hypothesis. MethodsThis study included 342 patients aged 13-19 years who visited the Departments of General Internal Medicine

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Background Although the number of teenage outpatients is not very high, it is sometimes difficult to manage them. To clarify the factors contributing to this difficulty, we retrospectively analyzed the clinical characteristics of the patients using medical records from three hospitals. Methods The study included 342 patients aged 13–19 years who visited the Department of General Internal Medicine at Toyama University Hospital, N Municipal Hospital, and K General Hospital between January 2019 and December 2021. Data on age, sex, referral status, chief complaint, period from onset to visit, and final diagnosis were collected from the medical records of each hospital. We used the Multiple comparison analysis by the Tukey honestly significant difference method, chi-square test, and residual analysis for statistical analyses of our data. Results Most cases from the two city hospitals visited within one month from the onset and were treated as mild cases of acute upper respiratory infections, gastroenteritis, and traumatic injury. However, 56% of the patients visited the university hospital more than one month after the onset of illness. In addition, half of the patients were diagnosed with stress-related mental diseases, such as adjustment and eating disorders. The teenage patient group at the university hospital also had significantly higher rates of psychiatric diseases than the other age groups. Furthermore, most psychiatric patients complain of various somatic symptoms, such as somatic diseases. This situation may contribute to the difficulty in dealing with teenage outpatients. Conclusion Our data suggest that some teenagers complaining of somatic symptoms have stress-related mental illness, especially in university hospitals. These patients require not only physical management, but also environmental and emotional support. Therefore, the psychosomatic approach is essential for general practitioners, particularly for those who often encounter teenage patients.

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