Internal Medicine Commons^™

Characteristics Of Breast Cancer In Carriers Of Pathogenic Variant In Atm In A Large Academic Health Center, Ujjwal Karki, Tara Rangarajan, Dana Zakalik

Conference Presentation Abstracts

Background: Pathogenic variants (PVs) in ATM are associated with an increased risk of breast, pancreas, and other cancers. The clinical and pathological characteristics of ATM-associated breast cancers have not been well defined. Methods: Patients who underwent multigene panel testing between December 2012 and May 2023 and were identified to harbor ATM PVs were included in the study. We analyzed demographics, germline findings, histopathology, genomic recurrence score, and management of ATM PV carriers with breast cancer. Results: A total of 222 individuals were identified to have PVs in ATM, of whom 184 (83%) were female. The majority were Caucasian (n = …

Breast Cancer In Pms2 Related Lynch Syndrome: Evidence Of A Possible Association?, Ujjwal Karki, Tara Rangarajan, Dana Zakalik

Conference Presentation Abstracts

Background: Lynch syndrome (LS) is a hereditary cancer predisposition syndrome caused by pathogenic variants (PVs) in mismatch repair genes, MLH1, MSH2, MSH6, and PMS2. LS is associated with increased risk of colorectal, and endometrial cancers but breast cancer risk is uncertain, with some studies suggesting MSH6 and PMS2 PVs may have a higher risk for breast cancer. Our study outlines the incidence and clinical characteristics of breast cancer in PMS2-related LS identified at a large academic center. Methods: Patients with PMS2 PVs identified between July 2009 and May 2023 were selected from a database at the Nancy and James Grosfeld …

Assessment Of Portal System Hemodynamics For The Prediction Of Portal-Vein Thrombosis In Cirrhosis - A Systematic Review And Meta-Analysis, Marko Kozyk, Suprabhat Giri, Ankita Singh, Kailash Kolhe, Akash Roy, Kateryna Strubchevska

Conference Presentation Abstracts

Background: The pathogenesis of portal vein thrombosis (PVT) in cirrhosis is multifactorial, with altered hemodynamics being proposed as a possible contributor. The present systematic review was conducted to study the role of assessment of portal hemodynamics for the prediction of PVT in patients with cirrhosis. Methods: Three databases (Medline, Embase, and Scopus) were searched from inception to February 2023 for studies comparing portal venous system parameters in patients with cirrhosis developing PVT with those not. Results were presented as mean difference (MD) or odds ratio (OR) with their 95% confidence intervals (CI). Results: A total of 31 studies (patients with …

Efficacy And Safety Of Transjugular Intrahepatic Portosystemic Shunt In Patients With Hepatocelluar Carcinoma - A Systematic Review And Meta-Analysis, Marko Kozyk, Suprabhat Giri, Ankit Singh, Akash Roy, Kateryna Strubchevska, Taraprasad Tripathi, Ranjan Kumar Patel

Conference Presentation Abstracts

Background: Patients with hepatocellular carcinoma (HCC) and cirrhosis can present with features of severe portal hypertension, which can be worsened further with associated portal vein tumoral thrombosis (PVTT). Due to the technical difficulties and short survival of these patients, HCC was traditionally considered a relative contraindication for transjugular intrahepatic portosystemic shunt (TIPS). However, there is an increasing body of evidence supporting the use of TIPS in HCC. The present study aimed to analyze the efficacy and safety of TIPS in patients with HCC. Methods: A literature search of MEDLINE, Embase, and Scopus was conducted from 2000 to October 2022 for …

A Single Center Analysis Of Patients Undergoing Liver Resection For Intrahepatic Cholangiocarcinoma, Nazli Begum Ozturk, Laith H. Jamil

Conference Presentation Abstracts

Background: Intrahepatic cholangiocarcinoma (iCCA) is the second most common primary liver cancer with increasing rates of incidence and mortality. Surgical resection with negative margins and regional lymphadenectomy is the mainstay of the treatment for patients with resectable-iCCA. Because of its rarity and low resectability rate of iCCA, prognostic markers and outcomes of patients who undergo liver resection are not well defined. We aimed to evaluate the characteristics of patients undergoing liver resection for iCCA at our institution over ten years. Methods: All patients with iCCA who had liver resection between 3/2013-3/2023 at our institution were included in the study. An …

Deletion Of Interleukin-17a Augments Portal Fibrosis In A Mouse Model Of Cholestatic Liver Injury, Takashi Kitagataya, Kirsta Olson, Michelle Baez-Faria, Nazli Begum Ozturk, Kaiyel Cutshaw, Anuradha Krshnan, Maria Eugenia Guicciardi, Kevin D. Pavelko, Gregory J. Gores

Conference Presentation Abstracts

Background: The underlying mechanism contributing to cholestatic liver injury remains unclear. The proinflammatory cytokine interleukin-17A (IL-17A) has been implicated in human cholestatic liver injury. However, mechanistic insights on how IL-17A modulates cholestatic liver injury are lacking and require further exploration in preclinical models. Herein, we examined the effects of IL-17A genetic deletion in a mouse model of cholestasis. Methods: Ageand gender-matched littermate WT and Il-17a-/- were fed intermittently on 0.1% 3,5-diethoxycarbonyl-1,4-dihydrocollidine (DDC) diet or control diet (n=10, each) and standard diet for 21 days to induce cholestatic liver injury. We assessed liver inflammation, ductular reaction, and fibrosis using complementary approaches. …

Urinary Cytokines As Potential Biomarkers Of Mild Cognitive Impairment And Alzheimer’S Disease: A Pilot Study, Nazia Saiyed, Ali Yilmaz, Sangeetha Vishweswaraiah, Abhishek Maiti, Ilyas Ustun, Sarah Bartolone, Travonia Brown-Hughes, Roland Thorpe Jr, Tammy Osentoski, Stacey Ruff, Amita Pai, Michael E. Maddens, Khaled Imam, Stewart Graham

Conference Presentation Abstracts

No abstract provided.

Rare Autoimmune Disease Caused By Not-So Rare Virus, Tiffany Marchewka, Acho Bernard, Molly Kempa, Kathryn Heal, Joseph M. Fullmer

Conference Presentation Abstracts

No abstract provided.

Detection Of Progression Or Regression Of Breast Cancer By Circulating Tumor Dna (Ctdna), Ujjwal Karki, Bipin Ghimire, Emma Herrman, Siddhartha Yadav, Mohammad Muhsin Chisti

Conference Presentation Abstracts

Circulating tumor DNA (ctDNA) are short DNA sequences shed by tumor cells into the systemic circulation. Studies have shown potential utility of the test to predict relapse or recurrence following treatment in solid tumors, but sensitivity and specificity have varied widely, ranging from 19-100% and 80-100% respectively, in breast cancer specifically. Moreover, literature describing the utility of monitoring dynamic changes in ctDNA trends is limited. We aim to evaluate the correlation between ctDNA test, both single test as well as dynamic trends in value over time, with imaging findings.

Sars-Cov-2 Immunization/Therapeutics, Matthew Sims

Conference Presentation Abstracts

No abstract provided.

Residency Program Directors Meeting, Sandor Shoichet

Conference Presentation Abstracts

No abstract provided.

The Diagnostic Role Of Cytokeratin 8/18 Immunohistochemical Marker For Lean Non-Alcoholic Fatty Liver Disease, P Telli, M Buyuk, Nazli Begum Ozturk, Z Istemihan, K Nuriyev, A Atasoy, B Cavus, A Cifcibasi Ormeci, U Akyuz, K Demir

Conference Presentation Abstracts

Introduction

Non-alcoholic fatty liver disease (NAFLD) is one of the leading causes of chronic liver diseases. NAFLD spectrum begins from simple steatosis to non-alcoholic steatohepatitis (NASH), progressive fibrosis, cirrhosis, and even hepatocellular carcinoma. Although most NAFLD patients are overweight and obese, 30% are lean. We analyzed lean and non-lean NAFLD patients’ liver biopsies for cytokeratin 8/18 immunohistochemical staining differences.

Aims & Methods

Thirty biopsy-proven NAFLD patients (15 patients with BMI ≤ 25 kg/m2, 15 patients with BMI > 25 kg/m2) were included in the study. Demographic, biochemical, and histologic features of the patients were recorded. Biopsy specimens from our archive were …

Bet Protein Complexes With Ets1 And Mediates The Senescence-Associated Secretory And Apoptotic Resistant Phenotypes Of Senescent Cholangiocytes, Jeong-Han Kang, Patrick Splinter, Christy Trussoni, Nicholas E. Pirius, Maria Eugenia Guicciardi, Anuradha Krishnan, Nazli Begum Ozturk, Gregory J. Gores, Nicholas F. Larusso, Steven P. O'Hara

Conference Presentation Abstracts

Background: We reported that cholangiocyte senescence is a pathogenic feature of Primary Sclerosing Cholangitis (PSC) and is regulated by the transcription factor, ETS1. We also showed that Histone 3 Lysine 27 is acetylated at senescence-associated loci. The bromodomain and extra-terminal domain (BET) proteins are epigenetic readers that bind acetylated histones, recruit transcription factors, and drive gene expression. Thus, we tested the hypothesis that BET proteins interact with ETS1 to drive gene expression and promote cholangiocyte senescence. Methods: We performed immunofluorescence to assess cholangiocyte expression of two BET proteins, BRD2 and BRD4, in tissue from PSC patients and PSC mouse models …

Deletion Of Chemokine Receptor 6 Augments Ductular Reaction And Fibrosis In A Mouse Model Of Cholestatic Liver Injury, Nazli Begum Ozturk, Kaiyel Cutshaw, Anuradha Krishnan, Gregory J. Gores

Conference Presentation Abstracts

Background: The chemokine CCL20 is expressed by activated cholangiocytes implicating its’ receptor, CC-chemokine receptor 6 (CCR6) in immune cell trafficking to the liver during cholestatic liver injury. In particular, the innate immune cells macrophages and neutrophils have been identified in cholestatic liver injury. Therefore, our aim was to investigate the effect of CCR6 deletion on a mouse model of 3,5-diethoxycarbonyl-1,4-dihydrocollidine (DDC) diet-induced cholestatic liver injury. Methods: Age and gender matched WT and Ccr6-/- mice were placed on an DDC or a control diet for 21 days. Serum biochemistry, liver injury and the ductular reaction (DR) were examined by standard …

Impact Of Serum Igg Levels Against Sars-Cov-2 On Clinical Outcomes For Hopitalized Covid Patient, Bipin Ghimire, Bijaya Thapa, Nishant Aggarwal, Luai Madanat, Melinda Sager, Daniel O'Connor, Alexandra Halalau

Conference Presentation Abstracts

BACKGROUND: The SAR-CoV-2 pandemic continues to negatively impact the healthcare system globally with over 800,000 deaths in the United States and millions more worldwide. The cases are rising despite availability of vaccines. For most immunocompetent patients these vaccines will generate a humoral response and also a memory T-cell response. Few if any studies have reported data that measure anti-spike IgG titers and also correlate those titers with clinical outcomes in the instance of breakthrough infection.

METHODS: We conducted a pilot prospective observational clinical study enrolling 30 immunocompetent patients who were admitted with a positive SARS-CoV-2 PCR. Leftover blood from admission …

A Systematic Review And Meta-Analysis Of Diagnostic Accuracy Of Whole-Body 18f-Fdg Pet And 18f-Fdg Pet/Ct In Detecting Occult Malignancy In Patients With Idiopathic Inflammatory Myopathy, A Ali, R Alkilany, J Asif, B Basida, Z Al-Sagri, N Mahabadi, H Sarakbi

Conference Presentation Abstracts

Background Idiopathic inflammatory myopathies (IIMs) are chronic, systemic autoimmune diseases that can cause muscle inflammation, weakness, and skin manifestations. Several studies have confirmed the association between IIMs and malignancy in adult population with varied frequency (4-42%), highest in patients with dermatomyositis. Detecting occult malignancy is a diagnostic challenge involving cost- and time-consuming methods. The (18)F] fluorodeoxyglucose positron emission tomography ([(18)F] FDG-PET) role in this context has been studied in multiple studies.

Objectives The purpose of this study is to assess the diagnostic performance of whole-body 18F-FDG PET or 18F-FDG PET/CT for detection of occult malignancy in patients with IIMs.

Methods …

Recurrent Myopericarditis Following Mrna-1273 Sars-Cov-2 Vaccination In A Patient With Previous Sars-Cov-2 Myopericarditis, Lauren Reinhold, Simon R. Dixon, Carl B. Lauter

Conference Presentation Abstracts

Introduction: Coronavirus disease (COVID-19) caused by SARS-CoV-2 infection has been associated with myocarditis. The novel mRNA vaccines, BNT162b2 and mRNA-1273, that encode the SARS-CoV-2 spike glycoprotein have shown to be a safe combatant to the pandemic. Myocarditis has become a rare, newly recognized complication of the SARS-CoV-2 mRNA vaccinations. The mechanism remains unknown, but multiple have been proposed. Case description: A 24-year-old healthy Caucasian female presented to the hospital with acute chest pain. The patient received her first dose of mRNA-1273 SARS-CoV-2 vaccine two days prior to onset of symptoms. She reported sharp mid-sternal chest pain worse with inspiration and …

Merkle Cell Carcinoma While On Rituximab - Is It A Coincidence?, Bana Antonios, Emma Herrman, Mohammad Muhsin Chisti

Conference Presentation Abstracts

A 79-year old woman with history of relapsed Stage II, grade III follicular lymphoma was treated with four cycles of rituximab and bendamustine with an excellent response. She was subsequently placed on maintenance rituximab infusions every eight weeks. Six months later, she presented to the dermatology clinic with a newly raised erythematous papule on her left cheek. Excisional biopsy confirmed a diagnosis of Merkel cell carcinoma which was resected with wide margins. Merkel cell carcinoma (MCC) is a rare aggressive skin malignancy, with a dramatic increase in incidence in the past few decades. It grows and metastasizes rapidly and diagnosis …

Small Cell Carcinoma Of The Anal Canal: A Rare Entity, Shailesh Niroula, Ujjwal Jung Karki, Bipin Ghimire, Shrinjaya Thapa

Conference Presentation Abstracts

Neoplasm of anal canal are <5% of the malignancy of gastrointestinal tract. Majority of the cancers are squamous cell and adenocarcinoma. Primary small cell carcinoma of the anal canal is a very rare diagnosis with only handful of cases reported in literature. 66-year-old female with multiple co-morbidities presented with rectal pain. She had initially noticed hemorrhoids six months prior to presentation. CT abdomen and pelvis showed bilateral inguinal lymphadenopathy and diverticulosis. Patient then had colonoscopy which showed mass in the anal canal, initial biopsy showed squamous cell carcinoma with basaloid features. Lymph node biopsy was also positive for metastatic cancer likely anal in origin. PET scan showed metastatic lesion in the lumbar vertebra. Review of slides was done before starting chemotherapy as component of small cell carcinoma was also seen. Due to diagnostic dilemma, patient was initially started on Carboplatin and Paclitaxel first cycle as it is effective against both squamous and small cell carcinoma. Repeat evaluation of the slides confirmed small cell cancer as the diagnosis and chemotherapy was changed to carboplatin and etoposide. Patient received 3 cycles of the carboplatin and etoposide after which atezolizumab was added. She received total of 6 cycles of the chemotherapy. Repeat PET scan showed partial favorable response. Due to rarity of the disease, there was significant delay in diagnosis of the cancer. Diagnosis of small cell carcinoma in the anal canal relies on neuroendocrine differentiation. There is no formal evidence-based recommendation regarding treatment. They are considered equivalent to pulmonary small cell carcinoma and treated in similar manner.

Evaluating Emotional Distress Among Michigan Food Insecure Communities During The Covid-19 Pandemic, Abiba Salahou, Deidre Hurse, Angela Gill, James F. Grogan

Conference Presentation Abstracts

No abstract provided.

9-Month Course Of Refractory Anti-Nmda Receptor Encephalitis With Initial Negative Markers: Diagnostic And Therapeutic Challenges, Camilla Cascardo, Alexander Ismail, Francisco Davila, Nicole Marijanovich

Conference Presentation Abstracts

Anti-NMDA receptor encephalitis is a progressively debilitating, clinically heterogeneous, frequently fatal disease caused by autoantibodies directed against the N-methyl-D-aspartate receptor that affects 1 in 1.5 million people each year. Risk of misdiagnosis or delayed treatment is high due to variable presentations and potential false negative results.

Aml: A Real Pain In The Sacrum, Markie Zimmer, Hazem Alakhras, Daniel Misra, Sara Aguinaga

Conference Presentation Abstracts

A 60 year old previously healthy female presented for evaluation of a painful sacral decubitus ulcer. In the initial workup, CBC showed leukocytosis of 51 with a monocytic differentiation and 55% blasts, macrocytic anemia of 4.6 Hgb, and thrombocytopenia of 32. She denied any classic B-type symptoms, but did have four days of fatigue and chronic night sweats, previously attributed to menopause. She had no evidence of bleeding, and was transfused appropriately, but had ongoing severe thrombocytopenia. Oncology was consulted and bone marrow biopsy confirmed the diagnosis of acute myeloid leukemia with monocytic differentiation. After initiation of antibiotic therapy for …

Hepatoid Adenocarcinoma Of Lung: A Rare And Challenging Tumor, Bipin Ghimire, Ashbina Pokharel, Samiksha Pandey, Ujjwal Jung Karki, Can Wang, Michael Stender

Conference Presentation Abstracts

Hepatoid adenocarcinoma (HAC) is an extremely rare extra-hepatic malignant tumor having hepatic features on pathology. Stomach is the most common site, and hepatoid adenocarcinoma of lung (HAL) accounts for 2.3 – 5% of all HACs. Less than 100 cases of HAL have been reported worldwide since its concept was put forward in 1990. A 63-year-old female presented to the ED with back pain. Initial evaluation revealed anemia (hemoglobin 6.7), hypercalcemia (12.1 mg/dl), GFR 54 mL/min. X-ray thoracic spine and chest showed two vertebral compression deformities and lytic lesions on multiple ribs. Initially, multiple myeloma was considered likely but further evaluation …

A Rare Case Of Segmental Arterial Mediolysis, Ashbina Pokharel, Lauren Reinhold, Ashbita Pokharel, Judith Bateman

Conference Presentation Abstracts

Segmental arterial mediolysis (SAM) is a rare vasculopathy of unknown etiology characterized by disruption of the arterial layer, which can result in vessel dissection, hemorrhage and ischemia. Literature review has demonstrated a varied presentation ranging from benign abdominal pain to life threatening hemorrhage. We report a case of 58 year old female with past medical history of deep vein thrombosis/pulmonary embolism secondary to Protein C and S deficiency on Coumadin who presented with right flank pain for 3 days. Complete blood count and complete metabolic panel were within normal limits. CT scan of abdomen and MRI showed ischemia of segment …

Pituitary Metastasis Of Non-Small Cell Lung Cancer, Faris Alkhouri, Joseph Salib, Jack Artinian

Conference Presentation Abstracts

Lung cancer is the most commonly diagnosed cancer worldwide. Metastasis to other organs is also common. Of these, approximately 25% involve metastasis to the brain. In the brain, however, it is known that only 1% of brain metastasis involve the pituitary gland. In this report, we present a 70-year-old woman that was diagnosed with Non-Small Cell Lung Cancer (NSCLC) a year ago presenting with metastasis to the pituitary. A 70-year-old woman with past medical history of longstanding tobacco abuse, COPD, hypertension, and lung cancer (NSCLC stage IB in the upper right lobe diagnosed 1 year ago) presented to the emergency …

A Case Of Acute Unilateral Adrenal Hemorrhage Associated With Metastatic Lung Adenocarcinoma, Batoul Nasser, Ramona Berghea

Conference Presentation Abstracts

The most common cancer that metastasizes to the adrenal glands is lung cancer. Adrenal hemorrhage due to metastasis of lung cancer is extremely rare and associated with unilateral adrenal hemorrhage, while bilateral adrenal hemorrhages are typically associated with cardiovascular diseases and systemic anticoagulant therapy. Our 55-year-old male with a past medical history significant for metastatic lung adenocarcinoma and coronary artery disease (CAD) presented with acute right upper quadrant abdominal and flank pain. On presentation, patient was in distress, with fatigue, weakness, pain with deep inspiration, nausea, and vomiting. Patient also had anemia (hemoglobin 11.2). A CTA of the abdomen and …

Cannabis And Acute Coronary Syndrome: A Case Report Exploring Potential Links, Fawaz Habba

Conference Presentation Abstracts

No abstract provided.

From Head To Hilum: Angiosarcoma With Pulmonary Metastasis, Tanaz Salimnia, Lauren A. Abplanalp, Raashi Chawla, K Hughes, R Ghandchi, Matthew Weatherhead, Sanjay Dogra

Conference Presentation Abstracts

With an estimated five-year survival of less than 40 percent, angiosarcomas are rare and often misdiagnosed fataltumors originating from blood or lymphatic vessels with a predilection for the head and neck. They account for 1percent of all soft tissue sarcomas and are often mistaken for benign mimickers leading to the late-stage diagnosiswhen the body is already riddled with metastatic disease with the lung being the most common site of metastases.This case illustrates the myriad of pulmonary complications associated with this uncommon but fatal vasoformativemalignancy. The patient is a 73-year-old male diagnosed with angiosarcoma of the right scalp status post excision,reconstruction, …

Clinical Pathways Leading To Antibiotic Initiation In Patients With Suspected Infection And Their Association With Delays And Mortality, X Han, C Lopez-Espina, P A. Verhoef, A Spicer, A Bhargava, L Schmalz, Matthew Sims, Alexandra Halalau, Nicholas Maddens, Aimee Espinosa

Conference Presentation Abstracts

Rationale: Delayed antibiotic therapy is associated with increased mortality in patients hospitalized with infection. The decision toinitiate therapy in patients with suspected infection is influenced by a variety of information, such as vital signs, and laboratoryresults. Identifying different patterns of events that lead to initiation is necessary to discover factors that could serve as targets forinterventions to expedite this process. We aimed to identify the most common sequences of events that precede antibioticordering and to quantify the time intervals between each event that contribute to antibiotic delays. Methods: This was aretrospective study of adult patients hospitalized at 4 community hospitals …

Hiv-Associated Nephropathy Presenting As The First Manifestation Of Hiv-2 Infection, Kamil Sardarli, Rania Daboul, Sumesh Khanal, Sami Zarouk

Conference Presentation Abstracts

HIV-2 is distinguished from HIV-1 with low virulence, longer asymptomatic period, slower decline in CD4 count, low viral load, and low mortality from AIDS. While the kidney pathology associated with HIV-1 is well established, due to its low prevalence, kidney pathology in HIV-2 is not well documented. We report a case of HIV associated nephropathy (HIVAN) as the first presentation in a patient with HIV-2. A 65 year old man from Ghana presented within a few days of arrival to the United States with nausea, loss of appetite, shortness of breath, and bilateral lower extremity edema. He has a past …