Hard Palate Perforation in an Elderly Man With Dementia.

A 74-year-old male with a history of mild cognitive impairment presented to the emergency department with failure to thrive and generalized weakness. He was having difficulty swallowing leading to 30 pounds of unintentional weight loss in the last three months. His social history was significant for 12.5 pack-year smoking and drinking (two to three glasses of wine/day). The oral cavity examination revealed a large (3 × 2 cm2) defect with the erythematous border that encompassed the mid-palatal structures and emanated from the hard palate into his nasal cavity. Auto-immune work-up was negative. Palatal biopsy showed squamous cell carcinoma (SCC; well-differentiated). A diagnosis of locally advanced (stage IVa) oral cavity squamous cell carcinoma (OSCC) was made based on PET scan findings. A palatal obturator (prosthesis) was placed to improve his eating, prevent regurgitation. The patient opted for palliative care and did not want to pursue further treatment. He was discharged home with a regular follow-up visit.

Plasmablastic Lymphoma Found on Autopsy in a Post-Transplant Patient.

Plasmablastic lymphoma (PBL) is an aggressive lymphoma often seen in immunodeficient patients. It can be a diagnostic challenge given its high-grade appearance and lack of staining for traditional B-cell markers. We present an interesting case of a 65-year-old African-American female who presented to the emergency department (ED) with complaints of progressively worsening weakness, fatigue, and dizziness for one month, and dark-colored urine for three days. The patient's medical history was remarkable for a renal and pancreatic transplant in 2008.

Fatty Infiltration of Mitral Valve: A Rare Case Report and Review of Literature.

Adipose tissue is a normal anatomical finding in the heart but fat infiltration in cardiac valves is extremely rare with very few cases reported in the literature. We report a case of fatty infiltration in a mitral valve replaced for mitral valve prolapse causing severe mitral regurgitation in a 65-year-old male who presented with shortness of breath and upper respiratory tract infection. The histopathological examination of the mitral valve revealed sheets of mature adipocytes in the spongiosa layer leading to replacement of collagen and elastic fibers. The presence of adipocytes in the prolapsed valve could be considered to arise from the proliferation of pluripotent valvular interstitial cells. Herein, we have reviewed the previously reported cases of fatty infiltration in the mitral valve and discussed the pathogenesis and effect on valvular function.

An Incidental Finding of Extra-adrenal Myelolipoma in the Upper Abdominal Cavity Attached to Mesentery: A Rare Case.

Myelolipoma are tumors of adrenal glands typically found in the adrenal gland, and are comprised of marrow elements and fat. We report a case of an extra adrenal myelolipoma in a 91-year-old patient, who presented to the emergency department with complaints of abdominal pain and shortness of breath. A CT scan of the abdomen and pelvis revealed a mixed attenuation soft tissue mass with admixed fat located within the mesentery inferior to the body of the stomach. A fine needle aspirate of the mass demonstrated a cellular aspirate with maturing trilineage hematopoiesis and mature adipocytes. This case is being presented due to the rarity of extra adrenal myelolipomas.

Malignant Melanoma Metastasizes to Colonic Polyp.

Malignant tumors metastasizing to the colon has been observed rarely. Gastrointestinal metastasis can present as benign, unpigmented polyps endoscopically. Most patients do not display any symptoms, and if symptomatic, they usually present with gastrointestinal bleeding. For patients with the history of melanoma, histopathology of polyp can change or alter the course of management. This is a case of a 74-year-old male diagnosed with recurrent melanoma of left ear. Colon cancer screening found blood in his stool. Colonoscopy displayed to have three polyps, one polyp was found to be malignant melanoma. The patient was started on Pembrolizumab, and was tolerating immunotherapy well with no new complaints three months later.

Acalculous Cholecystitis: Is an Elective Interval Cholecystectomy Necessary.

BACKGROUND: Acute acalculous cholecystitis (AAC) accounts for 5-10% of cases of acute cholecystitis. The advantage of interval cholecystectomy for patients with AAC is unclear. Therefore, a retrospective analysis of patients diagnosed with AAC at our institution was performed over a 5-year period. METHODS: Patients were identified via hospital coding using the keywords "acalculous cholecystitis, cholecystostomy and gall bladder perforation." Follow-up data was obtained by performing a retrospective review of the patients' hospital records. RESULTS: A total of 33 patients with AAC were identified and followed for a median period of 18 months. The median age at presentation was 70 (10-96) and American Society of Anesthesiologists (ASA) grade was 3 (1-5). Twenty-three patients (70%) were treated with antibiotics alone, 7 patients (21%) with percutaneous cholecystostomy and 3 patients (9%) with laparoscopic cholecystectomy. The 90-day mortality rate was 30% with significant correlation to comorbid status, as all deaths occurred in ASA grade 3-5 individuals (p = 0.020). Two patients (6%) developed recurrent AAC and were managed non-operatively. CONCLUSION: Antibiotics and cholecystostomy were the mainstay of AAC management, and comorbid status influenced related mortality. Our results suggest that it appears safe to avoid interval cholecystectomy in patients who recover from AAC, as they are typically high-risk surgical candidates.