Histiocytic sarcoma is a rare malignancy with only 10 reports confirmed primarily involving the CNS. The diagnosis is dependent on the finding of malignant cells with histiocytic morphology and immunophenotype. The authors report a case of pathologically proven HS of the CNS. A 16-year-old boy presented with headaches, emesis, and altered sensorium. Noncontrast head CT scanning demonstrated a left parietal mass consistent with a tumor. Surgery was undertaken. Intraoperative findings revealed green-yellow exudates consistent with an abscess. Cultures were obtained and broad-spectrum antibiotics were started. The patient subsequently underwent multiple surgical procedures, including drainage and debulking of abscesses and hemicraniectomy. Two months after initial presentation, the patient's diagnosis of histiocytic sarcoma was confirmed. Pathological examination demonstrated necrotizing inflammation with preponderant neutrophil infiltration, variably atypical mononuclear and multinucleate histiocytes, and numerous mitoses. Additional immunohistochemistry studies confirmed immunoreactivity for CD68, CD45, CD45RO, and CD15 and were negative for CD3, CD20, melanoma cocktail, CD30, CD1a, CD34, HMB-45, and melan-A. Once the diagnosis of histiocytic sarcoma was confirmed, antibiotics were stopped and radiation therapy was undertaken. Despite treatment, the patient's neurological status continued to decline and the patient died 126 days after initial presentation. This case represents a rare confirmed example of CNS histiocytic sarcoma. A profound inflammatory infiltrate seen on pathology and green exudates seen intraoperatively make the condition difficult to distinguish from an abscess. Immunohistochemistry showing a histiocytic origin and negative for myeloid, dendritic, or other lymphoid markers is essential for the diagnosis. Further research is needed to establish consensus on treatment.

As NPs continue to provide care in a variety of settings, including emergency departments and urgent care areas, they must be familiar with the progression of symptoms that might indicate SIH and be prepared to make appropriate referrals to prevent iatrogenic morbidity.

As nurse practitioners become more vital to primary care, they are also more apt to play a role in end-of-life care. In order to be proficient providers, NPs must familiarize themselves with issues surrounding EOL care.

Individuals have rights not only to health care but also to a safe environment including clean water sources and ambient air. These rights should be protected regardless of demographic variables. Unfortunately, there are injustices that infringe upon these human rights including the hydraulic fracturing of shale rock or "fracking."Fracking is a technique that is used to release trapped oil and gas from shale to be used as an energy source. Fracking has been shown to contaminate surrounding air and water sources. Fracking wells are disproportionately located in areas of poverty and minority. While areas of fracking can temporarily boost the local economy, there are risks to the environment and the community. Systems need to be in place to protect the affected communities. The vulnerable and poor populations need to be protected and should have input into the location of these fracking wells. In addition, nurses need to be knowledgeable of this type of environmental injustice, be active politically, and advocate for the rights of the affected populations. Nurses have a responsibility to educate ourselves, stay abreast of current affairs and policies regarding fracking, and educate patients on the health risks of fracking so that we as a group and our patients can advocate for environment justice for vulnerable populations.

No abstract