Bhavini Singh

Pulmonary pleomorphic carcinoma (PC) is a rare and aggressive subtype of sarcomatoid carcinoma. It is characterized by poorly differentiated cells with both epithelial and mesenchymal features and often presents as a peripheral lung mass. Metastasis to the gastrointestinal tract is exceedingly rare. We report the unusual case of an 87-year-old man with a prior history of lung adenocarcinoma who presented with abdominal pain secondary to a small bowel obstruction. Imaging revealed a right lower quadrant mass, and surgical exploration uncovered an undifferentiated malignant tumor involving the small bowel mesentery. Histopathological analysis demonstrated spindle cells, giant cells, and rhabdoid features with positive immunostaining for thyroid transcription factor-1 (TTF-1), Napsin A, and CK7, consistent with metastatic PC. Additional imaging revealed widespread disease including masses in the gastrohepatic region, adrenal gland, and sacrum. This case highlights a rare manifestation of pulmonary PC with metastasis to the small bowel causing obstruction, an uncommon but important differential diagnosis in lung cancer patients presenting with abdominal symptoms. Early recognition is critical, as atypical metastatic patterns may delay diagnosis and impact clinical management.

The ketogenic diet (KD) is a critical, evidence-based intervention within medical nutrition therapy for managing neurological disorders. In this article, we reviewed the published research on the efficacy of the ketogenic diet and its variations in treating epilepsy, particularly for patients unresponsive to anti-epileptic drugs. The literature review was performed on PubMed between 2022 and 2025. The review of clinical studies across various age groups reveals that, while the KD is effective for both focal and generalized seizures, infants often achieve higher rates of seizure freedom compared to adults, potentially due to better dietary compliance. Despite its success, the restrictive nature of the diet presents significant challenges for individuals suffering from epilepsy. The key challenges that reduce compliance over time include side effects, such as gastrointestinal issues, potential for malnutrition, and a high risk of micronutrient deficiencies. The role of the registered dietitian is paramount in this interdisciplinary approach, ensuring personalized education by monitoring growth and adjusting nutritional plans to optimize health outcomes for children unresponsive to anti-epileptic drugs. Ultimately, integrating MNT with traditional pharmacological or surgical treatments offers the most promising path for significant seizure reduction and improved quality of life for epileptic patients.