A Case of a Large and Rare Incidental Pleural Tumor in an Elderly Female.

Solitary fibrous tumors are very rare in the pleura, and they are generally found incidentally. Even though they can potentially become malignant and metastasize, they have minimal clinical symptoms and can still be benign. Due to the low incidence of these tumors, there is no standard of therapy beyond surgical resection. We present an asymptomatic case of a large, rapidly expanding solitary fibrous tumor of the pleura in an elderly female.

Gastrointestinal Stromal Tumor Presenting as Food Impaction and Pseudo-Achalasia.

Gastrointestinal stromal tumors (GISTs) are one of the most common mesenchymal tumors of the gastrointestinal tract. Studies report the incidence of GIST to be 14.5 per million, with 18% being diagnosed incidentally. The most common location is the stomach while the esophagus is the rarest, representing only 0.7% of cases. The clinical manifestations of GISTs vary. Most patients present with bleeding and gastric discomfort. Some may present with life-threatening hematemesis or melena. We present a unique case of a GIST presenting as pseudo-achalasia and food impaction.

Disparities in Referrals to End-of-Life Care in Eligible Hepatocellular Carcinoma Patients.

BACKGROUND: Hepatocellular Carcinoma (HCC) is a malignancy with increasing incidence and morbidity. For patients with a poor prognosis, engagement with advanced care planning and end-of life (EOL) services (I.e., palliative care, hospice) can address physical, financial, and social complications of a terminal diagnosis. Minimal data exist on the demographics of the patients being referred to and enrolling in EOL services for HCC. AIMS: We aim to report the relationship between demographics and EOL service referral. METHODS: Retrospective review of a prospectively maintained high-volume liver center registry of patients diagnosed with HCC from 2004 to 2022. EOL services eligible patients were defined as BCLC stage C or D, evidence of metastases, and/or transplant ineligible. RESULTS: Black patients were more likely to be referred than white patients (OR 1.47 (1.03, 2.11)). Once referred, patients were significantly more likely to be enrolled if they had insurance coverage, though no other factors in models were significant. There were no significant differences in survival among those referred who did or did not enroll, after controlling for other factors. CONCLUSION: Black patients were more likely to be referred compared to white patients and patients who were insured were more likely to be enrolled. Whether this is indicative of black patients being appropriately referred at a higher rate, being offered EOL care instead of aggressive treatment, or other unknown factors warrants further study.

False Reassurance From a Stool Test: A Delayed Cancer Diagnosis.

Colorectal cancer (CRC) is an increasingly prevalent condition in the United States and the world. Numerous screening tools have been created to help prevent and identify early cases of CRC, which have led to better outcomes for patients. These screening tools range from stool tests to more invasive procedures like a colonoscopy. With this array of screening options, patients are often presented with a bevy of choices in their primary care clinic and may have difficulty understanding the difference between screening and treatment. Popular culture has also influenced these decisions as both traditional media and social media have weighed in on the experience with these screening tools. We present a unique case where our patient tested negative on a stool screening exam and proceeded to be diagnosed with CRC within the negative screening period. The case was complicated by the patient's reluctance to undergo a colonoscopy and a unique combination of symptoms that led to a difficult diagnosis.

Malignant Cardiac Tamponade: A Complication of Untreated Breast Cancer.

Carcinomatous pericarditis is a rare complication of locally aggressive breast cancer in which malignant cells directly extend into the pericardium causing inflammation and creating a pericardial effusion. A 40-year-old woman with untreated metastatic breast cancer presented to an outpatient clinic in significant distress with symptoms of progressive shortness of breath and bilateral leg swelling. An urgent echocardiogram demonstrated a large pericardial effusion with echocardiographic evidence of cardiac tamponade. She underwent emergent pericardiocentesis of the effusion that was deemed to be malignant after cytologic evaluation. Subsequently, she opted for palliative treatment involving the surgical creation of a right pericardial window and placement of an indwelling pleural catheter. Internists should maintain a high index of suspicion for malignant cardiac tamponade in at-risk patients, especially those with locally aggressive and advanced malignancies.

Nonuremic Calciphylaxis Precipitated by COVID-19 Infection.

Calciphylaxis is a rare dermatologic condition that is primarily associated with end-stage renal disease (ESRD). Nonuremic calciphylaxis has been reported in patients with autoimmune disorders such as systemic lupus erythematosus and other hypercoagulable states such as anti-phospholipid syndrome. New research throughout the COVID-19 pandemic has shown an increased inflammatory and coagulopathic complication of COVID-19. We present a case of a patient with nonuremic calciphylaxis following treatment for severe COVID-19 and no known cause of hypercoagulability. A 40-year-old Caucasian female with a history of recent COVID-19 infection requiring hospitalization, hypertension, alcohol abuse, anxiety, and one prior spontaneous miscarriage presented to the hospital with bilateral lower extremity wounds. The wounds were seen to have necrosis and eschar formation, as well as blackened mottled skin, and were extremely painful to the patient. The initial lesions were on the anterior thighs bilaterally and spread laterally and to the lower back. Initial autoimmune workup was non-specific, and biopsy confirmed calciphylaxis. Calciphylaxis is a known dermatologic disease that has high mortality and morbidity, but it is usually associated with ESRD. Some cases have been reported for autoimmune or hypercoagulable states. The disease presents with non-healing, painful skin ulcers that are at a high risk of infection and have poor healing. The case presented shows biopsy-confirmed calciphylaxis in the absence of known etiologies, and we hypothesize that it is due to COVID-19 or COVID-19 aggravating an underlying but unidentified hypercoagulable condition.