Mesenteric Solitary Fibrous Tumor with High Risk for Aggressive Behavior: A Case Report.

A 64-year-old female presented to the emergency department (ED) with complaints of two days of intermittent fever and chills, progressively worsening back pain, and hematochezia. Initial evaluation and computer tomography (CT) imaging work up revealed a hypervascular and necrotic appearing pelvic mass, measuring 11.7 x 7.8 x 9.7 cm, closely associated with the inferior mesenteric vein (IMV) in conjunction with portal venous gas. Flexible sigmoidoscopy with biopsy was performed to identify the etiology of the lesion and revealed an ulcerated non-obstructing mass in the recto-sigmoid colon measuring 3 cm in length and involving 1/3 of lumen circumference with oozing present. Interventional radiology (IR) embolization of the feeding vessels was done pre-operatively due to high vascularity of the mass. Pathology of the mass was consistent with a malignant solitary fibrous tumor.

Incidental Pancreatic Solid Pseudopapillary Tumor Masked by Hemorrhagic Trauma.

An 18-year-old female presented to a tertiary care center after sustaining blunt abdominal trauma. Work up, including computer tomography (CT) revealed a hypo-attenuated collection in the pancreatic body with concern for ductal injury on magnetic resonance cholangiopancreatography (MRCP). These findings were consistent with posttraumatic intrapancreatic hematoma. An exploratory laparotomy with distal pancreatectomy and splenectomy were performed with concern for a grade 3 pancreatic injury. Pathology of the excised pancreas showed presence of a solid pseudopapillary tumor in the body of the pancreas which had been obscured by the hematoma on imaging.

Ascending Colon Schwannoma an Unusual Cause of Acute Lower Gastrointestinal Bleeding.

This is a case report of a 61-year-old female who presented with acute lower gastrointestinal bleeding resulting from a schwannoma involving the ascending colon. The patient was successfully treated with laparoscopic hemicolectomy. Schwannoma involving the large bowel is a rare entity; only around 90 cases of colonic schwannomas are reported in world literature. Although the vast majority of these tumors demonstrate a slow growing and benign profile, recurrence and malignant transformation can occur. Given the exceptional rarity of this pathological process, much of what is currently understood about this disease comes from case studies. Continued reporting of this pathology will be essential for further development and understanding its clinical and pathologic presentation.

Severe rash associated with dexmedetomidine use during mechanical ventilation.

Dexmedetomidine, a sedative administered by continuous infusion, is used to facilitate mechanical ventilation through alpha(2)-receptor activation. The drug's most common adverse reactions include hypotension, hypertension, nausea, bradycardia, and dry mouth. However, to our knowledge, no reports of dermatologic allergic reactions from dexmedetomidine use have been published. We describe a 22-year-old man who was intubated after being injured in a motor vehicle collision. He had been receiving propofol and fentanyl infusions for sedation during mechanical ventilation and was transitioning to dexmedetomidine. Within 4 hours of receiving dexmedetomidine 0.2 microg/kg/hour, the patient developed a wheal-and-flare rash encompassing 60% of his body surface area. The infusion was immediately discontinued; over the next 24 hours most of the rash receded, and within 48 hours of drug discontinuation the rash had completely resolved. According to the Naranjo adverse drug reaction probability scale, the likelihood that this rash was induced by dexmedetomidine was probable. Clinicians should be aware of this potential dermatologic adverse effect from dexmedetomidine, and patients receiving the drug should be closely monitored.