An unusual location of solitary fibrous tumor in heart-A case report and review of literature.

BACKGROUND: Solitary fibrous tumor (SFT) are rare spindle cell tumors originating from the mesenchymal cells mostly from the visceral pleura. SFT was first described as a distinct entity in 1931 by Klemperer et al. Until now, we have limited data regarding the manifestation and behavior of extra pleural forms such as cardiac SFT. Here we present a case of SFT involving the pericardium where the diagnosis was made by imaging followed by biopsy findings. We also review the literature of SFT involving the heart and the management approaches. CASE PRESENTATION: An 81-year-old male presented with progressive dyspnea. Computed tomography (CT) of the chest showed a 6.2 × 5.3 cm soft tissue mass in the anterior mediastinum. Further imaging with CT angiogram showed a stalk-like connection to the pericardium. A biopsy of the mass showed spindle cells positive for BCL-2, CD34, and STAT 6, indicative of a solitary fibrous tumor. A surveillance approach was adopted for the patient. CONCLUSION: Primary pericardial tumors are exceedingly rare, with a prevalence rate of 0.001%-0.007%. Diagnosing a SFT requires a positive CD34 and BCL-2 marker. The current recommendation is resection of localized disease which has been documented to be curative in cases of benign disease however our patient was put on surveillance.

Systemic argyria with severe anemia (hemoglobin 2.4 g/L).

Argyria is a rare disease in which chronic usage of products with a high silver content leads to deposition of silver granules in organs such as the skin, resulting in a permanent blue-gray discoloration. We present a 68-year-old woman with a 10-year history of chronic anemia of unknown etiology who was admitted for progressive generalized weakness, dyspnea, and a widespread slate-gray tint to her skin. She had previously consumed 1 tablespoon per day of colloidal silver orally for 7 years. Hematologic workup on admission showed the hemoglobin to be 2.4 g/dL with low ferritin and normal copper, zinc, and ceruloplasmin, indicating an iron-deficiency anemia. Differentiating the correct etiology of her anemia and skin discoloration was crucial since argyria can cause pseudocyanosis and microcytic anemia secondary to silver-induced copper deficiency. This case highlights the importance of asking and counseling patients about their nonprescription supplements.

Hypothyroidism following gastric sleeve surgery resolved by ingesting crushed thyroxine tablets.

Bariatric procedures for weight loss have increased in the past few decades. Levothyroxine malabsorption has been reported following gastric bypass; however, few studies have addressed this issue after gastric sleeve procedures. Levothyroxine dosing is usually weight based and administered at approximately 1.6 µg/kg body weight. Absorption occurs mainly in the jejunum and upper ileum, which can be altered by gastric pH, other drugs, food, and other factors. We present a 35-year-old woman with longstanding iatrogenic hypothyroidism treated with thyroxine, whose thyroid-stimulating hormone level rose following a gastric sleeve procedure despite taking levothyroxine daily.

Resolution of hypercalcemia in primary hyperparathyroidism with vitamin D replacement.

Vitamin D deficiency is common in patients with primary hyperparathyroidism. We present a case of primary hyperparathyroidism with a positive parathyroid scan and history of nephrolithiasis. The patient had normal albumin and renal function but was vitamin D deficient. After treatment with vitamin D for 13 months, her parathyroid hormone values declined in parallel with the elevation in vitamin D. Although her total calcium normalized, her ionized calcium remained elevated throughout treatment. We believe vitamin D deficiency should be carefully monitored in primary hyperparathyroidism.