Rare Acute Presentation of a Low-Grade Thymic Neuroendocrine Tumor.

Primary neuroendocrine tumor (NET) of the thymus is very rare. Here we report an unusual presentation of grade-I typical thymic NET in a 63-year-old female who presented with signs and symptoms of congestive heart failure (CHF) due to the mass effect from the huge tumor. A computed tomography (CT) scan of the chest revealed a mediastinal mass measuring 16.4 x 12 x 15.3 cm displacing most of the left lung parenchyma, with mass effect on the heart, and encasing the ascending aorta and main pulmonary trunk. Pathology report from the thymic mass biopsy showed tumor cells strongly expressing synaptophysin, chromogranin A, and cluster of differentiation (CD)56 markers. The diagnosis was consistent with grade-I typical thymic NET based on low Ki-67 and morphology. The patient was not in agreement for acute surgery or oncological treatment options. Thus, the plan was made to embolize the arteries from the right coronary artery that were feeding the mass in an effort to shrink the size with goals of future surgical resection. However, given the advanced stage of the diagnosis with mass effect on the heart and the patient's reluctance to consider the main definitive treatment options, the prognosis was extremely poor and the patient eventually passed away.

Hypercoagulable workup in a community hospital setting: to test or not to test; that is the question.

Background: Thrombophilia tests are often ordered unnecessarily and/or inappropriately, with significant impact on healthcare costs, hospital resources, time, and potential harm to the patient. Objective: To identify the incidence of unnecessary and inappropriate thrombophilia testing in a community hospital setting. Methods: We retrospectively reviewed electronic medical records for patients who underwent inpatient thrombophilia testing at The Brooklyn Hospital Center from 1/1/2018 to 12/31/2018. The indications, and details of the tests, and associated costs were recorded. Results: A total of 62 patients were included (mean age 45.8, 67.7% female). In 57/62 (91.9%) patients, tests were ordered in the acute phase of thrombosis. At the time the tests were ordered, 29/62 (46.8%) patients were on anticoagulation. Positive results were found in 21/62 (53.2%) patients, but was repeated in only 1/21 (4.7%) patient. Results for 51/62 (82%) patients were obtained after discharge. The hematology-oncology service was consulted in 5/62 (8.1%) cases and recommended testing in only 1 (1.6%) patient. Only 1 (1.6%) patient had both an appropriate indication and appropriate testing. Costs for the 273 total tests were $26,400. Conclusion: Thrombophilia tests were often ordered inappropriately and unnecessarily. We recommend testing only for patients with inpatient status under recommendation from the hematology-oncology service.

Splenic infarction in babesiosis: A rare presentation.

Babesiosis is a protozoan parasitic infection transmitted by the Ixodes tick. Splenic infarction is a rare, but potentially life-threatening complication of babesiosis; it is therefore vital that this complication is recognized.

Myelophthisic Anemia in a Patient with Lobular Breast Carcinoma Metastasized to the Bone Marrow.

Breast tumors have a predilection for metastasizing to the bone leading to cells being displaced by the cancer cells subsequently producing immature leukocytes and erythrocytes in the peripheral blood. We present a case of a 57-year-old female who was found to have myelophthisic anemia secondary to stage four lobular breast carcinoma metastasized to the bone marrow after being misdiagnosed as having thrombotic thrombocytopenia purpura. Diagnosis of myelophthisic anemia requires a thorough workup and treatment is based upon secondary management of the malignancy.

An Extremely Rare Case of Advanced Metastatic Small Cell Neuroendocrine Carcinoma of Sinonasal Tract.

Small cell neuroendocrine carcinoma (SNEC) is a rare form of malignancy. It mainly presents as bronchogenic neoplasm, and the extrapulmonary form accounts for only 0.1% to 0.4% of all cancers. These extrapulmonary tumors have been described most frequently in the urinary bladder, prostate, esophagus, stomach, colon and rectum, gall bladder, head and neck, cervix, and skin. Primary SNEC of the sinonasal tract is extremely rare with only less than 100 cases reported in the literature. Because of extreme rarity and aggressiveness of the tumor, the management for this entity varies considerably mandating multimodality approach. In this paper, we report a patient presented with left-sided facial swelling, and the histopathologic examination confirmed primary SNEC of left sinonasal tract. The tumor involved multiple paranasal sinuses with invasion into the left orbit and left infratemporal fossa and metastasized to cervical lymph nodes and bone. The patient encountered devastating outcome in spite of optimal medical management and treatment with palliative chemotherapy highlighting the necessity for further research of primary SNEC of head and neck.