Internal Carotid Artery Aneurysm Mimicking a Pituitary Adenoma: A Case Report and Review of the Literature.

Background/Objective: A thrombosed internal carotid artery (ICA) aneurysm mimicking a pituitary adenoma can be catastrophic if unrecognized. We report a unique case of the rare presentation of ICA aneurysms masquerading as pituitary adenomas, which can preserve pituitary function when treated early. Case Report: A 54-year-old man with type 2 diabetes, aortic valve replacement, and stroke presented with sudden onset severe headache and left eye pain. Left third nerve palsy was noted. Laboratory studies showed low thyroid-stimulating hormone, follicle-stimulating hormone, luteinizing hormone, testosterone, and insulin-like growth factor 1 levels and baseline, post-30-minute, and post-60-minute cortisol levels of 16, 17, and 14 µg/dL, respectively, after adrenocorticotropic hormone stimulation. Magnetic resonance imaging of the pituitary revealed a heterogeneously enhancing 2.0 × 2.1 × 2.1-cm sellar/suprasellar mass with peripheral enhancement abutting the left cavernous sinus. Given the acute third nerve palsy without visual defects and magnetic resonance imaging findings, other sources of sellar occupying etiology were suspected. Therefore, carotid cerebral angiography was performed and revealed a mostly thrombosed left ICA aneurysm projected into the sellar/suprasellar region. The patient underwent successful endovascular treatment with a resolution of the cranial nerve palsy and hormonal abnormalities at 3-month follow-up. Discussion: Our case demonstrates the importance of swift recognition of ICA aneurysms masquerading as pituitary adenomas. Early recognition and treatment may lead to the complete resolution of presenting symptoms and hormonal deficiencies. Conclusion: Clinicians should have a high index of suspicion for ICA aneurysm in the differential diagnosis for a sellar mass. Careful evaluation is essential because misdiagnosis may lead to catastrophic consequences.

The Perspective of a Breast Cancer Patient: A Survey Study Assessing Needs and Expectations.

Background Patient satisfaction is one of the key indicators of health care quality. We aim to identify patient's needs and expectations in a breast cancer clinic to provide patient-centered care and better overall satisfaction.  Methods A 17-item survey was administered to 110 patients at a breast cancer clinic. The survey was designed after a thorough literature review and approved by an oncologist and a palliative care physician.  Results Self-reported knowledge about the disease was reported adequate by 90.9% of our patients yet only 55.45% of our patients could identify the stage of their cancer. More education was desired by 32.7% of patients including various treatment options (29%), common complications (24.5%), prognosis (26.3%) and risk factors (11.8%). The majority of our patients were having some form of cancer-related emotional stress and physical symptoms. The majority of our patients (57.27%) wanted their oncologist to address social/emotional issues and 25.45% felt the need for more focus on physical symptoms in their subsequent visits. End-of-life (EoL) care discussions were considered an integral component of overall care by 29% of our patients. Components of EoL care discussions that patients stated they could benefit from included prognosis (27.27%), life expectancy (29%), the treatment effect on the quality of life (22.7%), palliative care (9%), hospice (10.9%), advance directives (11.8%), and family involvement in medical decision-making (13.6%). There was a difference noted regarding their EoL care discussion based on the stage of cancer. Patients with early-stage disease wanted their oncologists to decide on the frequency of this discussion (72.7%). Patients with advanced disease wanted EoL care discussion to be done more frequently as initiated by them or their oncologist or if there's a change in the treatment plan.  Conclusions A discrepancy between self-reported and actual knowledge in breast cancer patients emphasizes the need for patient education. Most patients rely on their oncologists for their diagnosis-related emotional and social issues. Surprisingly, more than a quarter of our patients consider EoL care discussions important even though the majority of our patients were healthy and having stage I and II disease.

Multiple Myeloma Relapse as Intracranial Plasmacytoma: A Rare Presentation.

Multiple myeloma (MM) infrequently involves the central nervous system (CNS). The usual sites of involvement are skull and meninges; however, intracranial tumors are exceedingly rare. We report the case of a 60-year-old female who presented to our center for the complaint of recurrent syncope. The patient was diagnosed with MM approximately one and a half years ago and had received chemotherapy followed by an allogeneic bone marrow transplant and was in remission afterward. We initiated workup for syncope and a brain MRI revealed an intracranial mass. Histopathological studies of the intracranial mass confirm the diagnosis of plasmacytoma and further testing shows relapse of MM. This is a unique case of MM relapse with isolated intracranial plasmacytoma. It usually carries a poor prognosis. Early diagnosis and management are imperative to improve survival.

Pantoea agglomerans Bacteremia: Is It Dangerous?

Introduction. Pantoea agglomerans, an anaerobic Gram-negative bacillus, is a rare cause of opportunistic infections affecting premature infants to seniors. We present a 34-year-old man who was presented for the management of diabetic ketoacidosis and developed Pantoea agglomerans bacteremia after one week of hospitalization. Case Presentation. A 34-year-old African-American male with uncontrolled diabetes mellitus type I and recurrent skin infections was admitted with diabetic ketoacidosis. He had left upper extremity abscess, preliminary wound cultures were positive for Gram-positive cocci, and an initial set of blood cultures were negative. He was started empirically on vancomycin. One week after admission, he started having chills followed by a recurrent increase in body temperature to 102 degrees Fahrenheit. The wound was healing, without active infection. Chest X-ray and CT scan of abdomen and pelvis to rule out infection were negative. Repeat blood cultures showed P. agglomerans in both the tubes. The patient was successfully treated with intravenous ceftriaxone, and he recovered fully without any complication. Discussion. Pantoea agglomerans is a bacteria associated with plants; however, it can infect humans and vertebrate animals. The outcome seems favourable with the institution of appropriate antibiotics even in immunocompromised patients.