ABSTRACT
Rosai-Dorfman disease (RDD) is a rare medical condition with bilateral painless lymphadenopathy. We present the case of a young man diagnosed with a very unique presentation of Rosai-Dorfman disease. A 40-year-old African-American man presented with a firm, non-tender, progressive chest and neck mass appeared three months ago. Imaging of the neck demonstrated an 8.6-cm anterior neck subcutaneous soft tissue mass extending into the anterior mediastinum through the sternum with erosive changes in the sternum and the lesion is abutting the right common carotid artery and innominate vein and surrounds the medial aspect of the clavicles bilaterally. Ultrasound (US)-guided biopsy showed marked polytypic-appearing plasma cell proliferation associated with relatively prominent histiocytes with hemophagocytosis/emperipolesis and focal neutrophils. There were S100+ histiocytes; however, findings were not typical for RDD. As that biopsy was not diagnostic, incisional biopsy with adequate sampling was performed. Surgical pathology demonstrated a very abnormal infiltrate with prominent histiocytes including areas with the features of extranodal RDD. BRAF V600E immunohistochemistry (IHC) was negative. Modified radical neck dissection, proximal sternal resection and superior mediastinal nodal dissection surgery was recommended. However, the patient refused the procedure. Typical manifestations are lymphadenopathy with fever that our patient did not experience. Bone involvement happens in 5-10% of cases. There is not enough data about blood vessel invasion which make our case unique. Treatment plan is still controversial. Clinical monitoring is recommended if the symptoms are tolerable as regression has been reported in many cases (20-50%). Surgery is reserved for patients with vital organ involvement or extra-nodal disease.
ABSTRACT
OBJECTIVES: Frailty is a prevalent clinical syndrome associated with a high risk of adverse health outcomes, including disability, morbidity, and mortality, that has become a major challenge for the healthcare system. The aim of this prospective study was to determine the level of healthcare utilization in prefrail and frail community-dwelling older military veterans. METHODS: We studied a cohort of community-dwelling older veterans aged 65 years and older 1 year at the Miami Veterans Affairs Medical Center to determine their levels of healthcare utilization. We administered the 5-item FRAIL (Fatigue, Resistance, Ambulation, Illnesses, & Loss of Weight) scale, from which patients were categorized into three groups: robust, prefrail, and frail. Chart reviews were conducted to confirm weight loss and number of illnesses. One year later, information regarding hospital admissions, emergency department (ED) visits, and primary care visits was obtained. RESULTS: We evaluated 291 participants, mean age 74 ± 8 years, 112 (38.5%) of whom were African American, 179 (61.5%) were white, and 40 (13.7%) were Hispanic. Overall, 49 (16.8%) participants were frail, and 161 (55.4%) prefrail. After adjusting for age and Charlson Comorbidity Index, frail status was associated with ED admission (odds ratio [OR] 2.7, 95% confidence interval [CI] 1.2-6.1) and primary care visits (OR 3.4, 95% CI 1.5-7.3); however, it was not significantly associated with hospital admission (OR 2.2, 95% CI 0.9-5.2). CONCLUSIONS: In a sample of community-dwelling older veterans, frailty was found to be significantly associated with an increased frequency of ED visits and primary care visits, but not with hospital admissions. Identifying patients with frailty may allow for targeted interventions that improve healthcare outcomes and may reduce healthcare utilization.
