Digital Commons Network^™

When Metabolism Meets Mind: The Diagnostic Challenges Behind Late-Onset Otc Deficiency, Rebecca Hoshaw Do, Lauren Amendola Do, Faap, Catherine Raquel Bs, Mallory Logsdon Do, Faap

Scientific Day

Introduction/Background:

Ornithine transcarbamylase deficiency (OTCD) is the most prevalent urea cycle disorder (UCD), affecting ~1 in 60,000 people. As an X-linked condition, it was historically associated with severe neonatal disease in males. However, newer data shows females often present postnatally with highly variable symptoms and age of onset, frequently causing mis- or delayed diagnosis.

Description:

We report a case of a 10-year-old female with cyclic vomiting syndrome, attention deficit/hyperactivity disorder, and recent orthopedic surgery who presented with acute onset altered mental status, lethargy, and visual hallucinations without focal neurologic deficits on exam. Initial labs were notable for normal glucose and …

Event Recap Flyer And Award Winners, Advocate Health - Midwest

Scientific Day

Recap flyer from the 52nd Annual Scientific Day, including list of award recipients.

From Bronchioles To Blasts: A Diagnostic Turn In A High-Risk Infant, Danielle Dejournett Md, Marie-Ellen T. Sarvida Md, Travis J. Matics Do

Scientific Day

Background/Significance:

Acute respiratory distress in infancy is commonly attributed to viral bronchiolitis; however, children with trisomy 21 represent a high-risk population in whom alternative diagnoses must be considered. In these patients, respiratory symptoms may reflect congenital heart disease, pulmonary hypertension, airway anomalies, reactive airway disease, and many more pathologies. In the setting of subtle bleeding manifestations, it is important to include hematologic and oncologic diseases in the initial diagnostic approach.

Description:

An 11-month-old male with trisomy 21, bicuspid aortic valve with aortic root dilation, laryngomalacia, and dysphagia presented to the emergency department for three days of congestion, increased work of …

Improving The No-Show Rate At The Sinai Family Care Center, Kylie Mcallister Do, Nica Lim Md, Kymarie Kuster-Kosmoski Md, Keyonna Taylor-Coleman Md, Lisa Sullivan Vedder Md

Scientific Day

Background/Significance:

Patient no-show (NS) rates in residency-based primary care clinics are a common problem. Adverse effects include disruption in continuity of care, inefficiency, reduced productivity, delayed care, increased ED visits, and negative impact on resident learning. Studies examining approaches to reducing NS rates in the primary care setting have been conducted, but the best approach remains unclear and is likely highly dependent on unique clinic characteristics. At the Aurora Sinai Family Care Center (FCC) clinic, the overall NS rate was 27% in 2024. Currently, all FCC patients receive automated call reminders two days before a scheduled appointment. This project implemented …

Assessing The Learning Curve For A Novel Approach To Esophagectomy Within A Large Community Health System, Ruby Armstrong Bs, Isaac Kriley Md, Kristen Kolberg Md, Sarah Riutta Phd, Geoffrey Bellini Md, Wesley Papenfuss Md

Scientific Day

Background/Significance:

Transhiatal Endoscopic with Transcervical Endoscopic Esophageal Mobilization (THE TEEM) esophagectomy is a minimally invasive novel approach to treating esophageal cancers and is a technically demanding operation requiring multiple surgical specialties. This study aims to identify the learning curve for this novel approach.

Purpose:

To evaluate the learning curve for a novel approach to esophagectomy.

Methods:

A retrospective review of 154 consecutive patients who underwent THE TEEM between 2/2015 and 12/2021 was conducted. Patients were divided into chronologic quartiles by surgery date (Q1-Q4). Demographics and perioperative outcomes were compared, including length of stay (LOS), intensive care unit (ICU) disposition, ICU …

Procedure Metrics And 30-Day Clinical Outcomes Of Two Pulsed Field Ablation Platforms For Atrial Fibrillation: A Comparative Study, Kareem Malas Md, Lynn Erickson Ms, Pmp, David Boulware Ms, Kevin Sattler Phd, Austin Deets Md, Hinduja Nallamala Do, Rebecca Riley Do, Abhishek Gowda Do, Mph, Milica Starcevic Bs, Mahmoud Ali Md

Scientific Day

Background/Significance:

Pulsed field ablation (PFA) for the management of atrial fibrillation is efficacious and safe. As adoption rapidly grows, there is interest in understanding how commercially available PFA platforms differ in operational characteristics and short-term clinical outcomes.

Purpose:

We compared procedural metrics and 30-day clinical outcomes between the first-time use of the Boston Scientific FARAPULSE pentaspline and Medtronic Affera Sphere-9 PFA systems.

Methods:

We analyzed the first cases who underwent PFA with no prior ablation using the pentaspline (n=35, 55.6%) or the Sphere-9 catheter (n=28, 44.4%) at our center. Continuous variables are presented as median (Q1, Q3) and categorical variables …

Preoperative Self-Assessment Of Cognition In Older Patients Undergoing Elective Orthopedic Surgery, Kymarie Kuster-Kosmoski Md, Sarah Riutta Phd, Brandon Bukovitz Md, Ariba Khan Md, Mph

Scientific Day

Background/Significance:

Postoperative delirium is a significant problem in older adults undergoing surgery. The risk varies widely by surgery type; for elective orthopedic procedures delirium may occur in >40% of older adults. Many factors influence the risk of delirium; evidence indicates age and pre-existing cognitive impairment are the strongest predictors of postop delirium. Our institution does not have a robust preop screen for cognitive impairment and postop delirium risk in older adults undergoing elective orthopedic procedures.

Purpose:

To preoperatively administer a brief cognitive screening tool, the AD8, to older adults undergoing elective joint replacement surgery to (1) assess feasibility of administering …

A Unique Complication Of Roux-En-Y Gastric Bypass: Relapse Of Atypical Anorexia Leading To Persistent Hypoglycemia In A Transgender Patient, Syed Basit Haider Md, Sameen Hassan Md

Scientific Day

Introduction/Background:

Post-bariatric hypoglycemia is a known complication of Roux-en-Y gastric bypass (RYGB), often due to dumping syndrome or, rarely, noninsulinoma pancreatogenous hypoglycemia syndrome (NIPHS), characterized by hyperinsulinemic postprandial hypoglycemia from pancreatic β-cell hyperplasia. Eating disorders, including anorexia, are prevalent in bariatric candidates (up to 17-19% with binge eating or depression per meta-analyses). Though anorexia nervosa relapse, post-surgery is uncommon and underreported. Current guidelines (AACE/TOS/ASMBS 2020) recommend preoperative mental health evaluation but do not view eating disorders as absolute contraindications unless active and untreated.

Description:

A 37-year-old transgender woman (MtF) with prior type 2 diabetes and morbid obesity (>270 lbs) …

The Impact Of Microvascular Fluorescence Angiography (Mfa) On Healing And Outcomes Of Hyperbaric Oxygen Therapy Patients Following Lower Extremity Amputations Complicated By Flap Ischemia, Gaurav Narula Md, Benjamin Banks Md, Prashan Gunasekara Md, Dawn Wankowski Ms, David Boulware Ms, Sarah Riutta Phd, Laurie Gesell Md, Facep, Fuhm

Scientific Day

Background/Significance:

Microvascular Fluorescence angiography (MFA) evaluates focal tissue perfusion and facilitates determination of ongoing or resolving ischemia. Our department utilizes MFA to validate or revise treatment plans for compromised surgical flaps in patients receiving hyperbaric oxygen therapy (HBOT). This study assessed whether the use of MFA impacted outcomes of patients with toe amputation compromised flaps who underwent HBOT guided by MFA compared to those who did not receive MFA.

Purpose:

To assess healing outcomes of MFA guided HBOT of compromised flaps of toe amputations.

Methods:

In this retrospective chart review study from 1/1/16 to 3/31/25, outcomes of healing, time to …

Comparison Of Patient Treatment Compliance And Adherence In Monoplace Versus Multiplace Hyperbaric Oxygen Therapy Chambers, Prashan Gunasekera Md, Gaurav Narula Md, Ritika Saxena Mph, Dawn Wankowski Ms, Sarah Riutta Phd, Laurie Gesell Md, Facep, Fuhm

Scientific Day

Background/Significance:

Hyperbaric oxygen therapy (HBOT) requires substantial patient commitment, often 20–40+ outpatient sessions, and premature discontinuation along with missed treatments are associated with poorer wound healing and limb salvage outcomes. Psychological and social determinants of health (SDOH) including anxiety, claustrophobia, and social connectedness, may influence adherence. Multiplace chambers allow peer interaction and continuous staff support that may mitigate anxiety, whereas monoplace chambers may increase perceived isolation. Limited data exists comparing treatment completion between chamber types.

Purpose:

To compare treatment compliance between monoplace and multiplace HBOT chambers and explore associations between adherence metrics in an outpatient hyperbaric program.

Methods:

A retrospective …

Myxedema Coma In The Setting Of A Normal Tsh, Piotr Halon Do, Rebecca Krasny Md, Noor Alkhawam Md

Scientific Day

Background/Significance:

Myxedema coma (MC) is an endocrine emergency precipitated by physiological stress and characterized by hypothermia, bradycardia, hypoglycemia, and altered mental status. Diagnosis is primarily clinical but is typically associated with low Free T4/T3 and elevated TSH, although cases with normal or minimally abnormal thyroid tests have been reported. There is a paucity of literature on the benefit of thyroid hormone replacement therapies and steroids in critically ill patients with features of MC with nondiagnostic labs.

Description:

An 81-year-old female with a history type two diabetes and chronic kidney disease presented with altered mental status and weakness. She was bradycardic …

Exercise Induced Raynaud's Phenomena In A Pediatric Patient, Clifford Klimas Do, Paula Gamero Kubota Md

Scientific Day

Introduction/Background:

Although rare, cardiac myxomas can present with devastating symptoms including Raynaud's phenomena, stroke or even sudden death. It is important to rule out cardiac myxomas when evaluating a pediatric patient with vasooclusive symptoms. This case illustrates an example of a pediatric patient presenting with exercise induced Raynaud’s phenomena that was found to be due to a cardiac myxoma.

Description:

A 12-year-old female with a PMH of superficial angiomyxoma and subglottic infantile hemangioma presented to the ER for acutely worsening bilateral lower extremity pain in the setting of physical activity. She also endorsed episodic bilateral lower extremity pallor, paresthesia, and …

Successful Cryoablation Of An Occult Sacral Phosphaturic Mesenchymal Tumor After Delayed Localization: A Case Of Tumor-Induced Osteomalacia, Hannah Larry Do, Andrew Cecil Do, Anil Chandel Md

Scientific Day

Introduction/Background:

Tumor-induced osteomalacia (TIO) is a rare paraneoplastic disorder caused by fibroblast growth factor 23 (FGF23)–secreting phosphaturic mesenchymal tumors, leading to renal phosphate wasting, hypophosphatemia, and impaired bone mineralization. Patients commonly present with bone pain, weakness, and fractures, and diagnosis is frequently delayed due to nonspecific symptoms and difficulty localizing small tumors. 68Ga-DOTATATE PET/CT has the highest sensitivity for tumor detection; however, repeat imaging is often required. While complete surgical excision is curative in most cases, tumors in anatomically complex locations such as the sacrum may not be amenable to surgery. Image-guided ablation has emerged as a therapeutic alternative.

Description: …

Safely Placing Mesh In Multi-Recurrent Right Inguinal Hernia Repair With Appendectomy, Nicole Hadjiloucas Md, Nicholas Armstrong Md

Scientific Day

Introduction/Background:

Patient is a 54-year-old male with a history of 5 prior inguinal hernia repairs with multiple layers of mesh who presented to our office with discomfort in his right groin, seeking elective repair. During our procedure multiple meshes were encountered, including a portion of Marlex mesh encompassing the appendix. A decision was made at the time to perform an appendectomy. Our case reviews the decision to place mesh for hernia repair, after performing appendectomy, and measures taken to limit infection. We have shown in this case that it is safe to place mesh even if the bowel is transected. …

From Dyspnea To Recovery: Multidisciplinary Management Of Hormonal Contraceptive-Associated Pe In An Adolescent, Christopher Bentsen Md, Viktoriya Bikeyeva Md, Giovanni Paolella Md, Suhaib M. Hyder Md, Kelsey Danley Md, Neal Sawlani Md, Ibrahim Shaik Md

Scientific Day

Introduction/Background:

The incidence of pulmonary embolism (PE) in hospitalized children is rare, with only 56 per 100,000 patients affected, predominantly females. Although rare, the use of hormonal contraceptives (HC) in adolescent females is linked to 79% of all venous thromboembolism (VTE) and PE cases. This risk is further doubled when using transdermal HC compared to oral. This case highlights the importance of recognizing the life-threatening hypercoagulable side effects of HC in adolescent women, particularly when symptoms may mistakenly be attributed to benign causes.

Description:

A 17-year-old female with no medical history presented with a two-week history of pleuritic chest pain …

Yentl Syndrome Refuted: Cholesterol Management From A Multicenter Healthcare System, Anya Lei Koza Do, Venkateswara Gogineni Phd, Tanvir Bajwa Md, Suhail Allaqaband Md, David Boulware Ms, M Fuad Jan Md

Scientific Day

Background/Significance:

According to the GOULD registry, the median low-density lipoprotein (LDL) after coronary revascularization is 99mg/dL. Similarly, a large-scale New York City health system cohort (2018-2023) reports 52% of those who underwent revascularization had a median follow-up LDL<70 mg>/dL.

Purpose:

Our retrospective study assesses the current practices of cholesterol-lowering therapy and secondary risk reduction strategies for patients who have undergone percutaneous intervention or coronary artery bypass grafting from September 2011 to September 2023 across all 25 Advocate Aurora Health medical centers in Wisconsin and Illinois.

Methods:

Among the 42,561 identified patients, 20,501 were excluded because of incomplete data. The primary …

Combination Therapy Versus Monotherapy And The Risk Of Diabetic Ketoacidosis Among Patients On Sglt2 Inhibitors And Glp-1 Receptor Agonists, Chimezirim Ezeano Md, Mph, Ekow Essien Md, Rodolfo Alpizar-Rivas Md, Fccp

Scientific Day

Background/Significance:

Sodium-glucose co-transporter-2 inhibitors (SGLT2i) reduce cardiovascular and renal events but carry a recognized risk of diabetic ketoacidosis (DKA), including euglycemic presentations. Whether combining SGLT2i with glucagon-like peptide-1 receptor agonists (GLP-1RA) modifies DKA risk compared with monotherapy remains unclear. We evaluated 1-year DKA risk among adults with type 2 diabetes treated with combination therapy versus either agent alone.

Purpose:

To compare the 1-year incidence and hazard of DKA across three treatment strategies: (1) SGLT2i + GLP-1RA vs GLP-1RA alone; (2) SGLT2i + GLP-1RA vs SGLT2i alone; and (3) SGLT2i alone vs GLP- 1RA alone.

Methods:

We conducted a retrospective multicenter …

Predischarge Ct Does Not Impact Detection Rate Of Postoperative Pancreatic Fistula After Distal Pancreatectomy: A Community Quaternary Experience, Ruby Armstrong Bs, Areej Sami Md, Manuel Lamptey Ms, Kristen Kolberg Md, Mary Brandt Md, Sarah Riutta Phd, Geoffrey Bellini Md, Wesley Papenfuss Md

Scientific Day

Background/Significance:

Post-operative pancreatic fistula (POPF) remains a challenging complication after distal pancreatectomy (DP). CT scan is commonly used to evaluate postop fluid collections/ POPF. We sought to identify predictive factors of POPF in our post-operative cohort with focus on patients who underwent post-operative CT due to suspicion for fistula at our institution.

Purpose:

The primary objective of this study was to evaluate the rate of POPF in all DP patients, and POPF in DP patients with negative post-operative CT (NegCT). We hypothesized that BMI (>30) would increase risk of NegCT in setting of POPF. The secondary objective of this …

The Creation And Assessment Of A Novel Faculty Development Program: Scholarship And Collaboration For Hospitalist Learners In Research (Scholar), Melanie Marsh Md, Ryan Wolf Md, Elizabeth Halvorson Md, Ms, Sheena Mckenzie Md, Mba, Faap

Scientific Day

Background/Significance:

With the rapid growth of Pediatric Hospital Medicine (PHM) and the growing number of PHM fellows requiring scholarship oversight, there is a critical need for PHM faculty who can supervise fellows in the execution of scholarly requirements. However, variation exists in faculty skill sets and available training for PHM fellows.

Purpose:

We developed and implemented a 1-year research program for fellows and junior faculty grounded in the four pillars of Boyer’s Model of Scholarship. Scholarly productivity and self-reflective, behavior-based assessments were evaluated before and after the program.

Methods:

A needs assessment of PHM faculty at four children’s hospitals within …

Latency After Preterm Pre-Labor Rupture Of Membranes (Pprom) And Outcomes At A Single Community Hospital, Ciera Danen Md, James O. Adefisoye Phd, Jessica Jf Kram Mph, Marie Forgie Do

Scientific Day

Background/Significance:

Preterm pre-labor rupture of membranes (PPROM, membrane rupture <37 weeks>gestation) is associated with increased morbidity/mortality. Guidelines recommend inpatient management until the risks of pregnancy outweigh the risks of neonatal prematurity under 34 weeks’ gestation. Latency, time from PPROM to delivery, varies from days to weeks secondary to potential maternal/fetal complications. ACOG cites that most people deliver within 7.0 days with latency inversely correlating with gestational age at the time of PPROM. However, this is based on an older study out of Israel that may not be generalizable in the US. Updated studies can improve counseling for estimated gestational age at …

Characteristics Associated With Tub Entry And Delivery In Water: A Secondary Analysis Of Waterbirth Intervention Participants, Emily Malloy Phd, Cnm, Facnm, Amanda Luff Phd, Jessica Jf Kram Mph, James O. Adefisoye Phd, Valerie Oliver Cnm, Cara Wolf Dnp, Cnm, Marie Forgie Do, Maryanne Scherer Cnm, Lisa Hanson Phd, Cnm, Facnm

Scientific Day

Background/Significance:

Waterbirth is a pain management option that promotes physiological birth with limited availability in US hospitals. We conducted the first US-based randomized controlled trial (RCT) of hospital waterbirth, finding it was a viable option for low-risk individuals and reduced use of intravenous narcotics and epidural analgesia while increasing satisfaction. To further support person-centered care, it is important to understand which individuals who planned waterbirth ultimately gave birth in water and how preferences and medical needs shifted during labor.

Purpose:

To identify factors linked to waterbirth tub use during labor and successful delivery in water among those planning a waterbirth. …

Impact Of A Machine Learning-Based Clinical Decision Support Tool On Antibiotic Prescribing For Suspected Urinary Tract Infection In The Emergency Department, Chloe Williams Md, Alex Biskis Ms, Ravi Chacko Md, Phd, Ryan Mckillip Md

Scientific Day

Background/Significance:

Unnecessary antibiotic prescribing for suspected urinary tract infections (UTIs) remains common in emergency departments (EDs). Machine learning (ML)–based clinical decision support tools have been proposed as a strategy to improve antibiotic stewardship, but their influence on prescribing behavior and clinician confidence remains unclear.

Purpose:

To determine the impact of an ML–based clinical decision support tool on antibiotic prescribing and clinician confidence for suspected UTI among ED providers.

Methods:

We conducted a randomized controlled, scenario-based survey with a crossover design to evaluate the impact of an ML-driven UTI decision support tool on antibiotic prescribing decisions among providers practicing at Advocate …

Pfas Exposure And Gastrointestinal Cancer: A Population-Based Exploratory Study, Ashley Robinson Do, Eli D. Ehrenpreis Md, Agaf, Facg, Ethan Anderson Do

Scientific Day

Background/ Significance:

Per- and polyfluoroalkyl substances (PFAS) are persistent environmental pollutants known as “forever chemicals.” PFAS accumulate in human tissue and have potential for carcinogenesis. Prior studies have examined the effects of environmental exposure to PFAS on human disease and suggest a link between PFAS exposure and breast and thyroid cancer, but associations with gastrointestinal (GI) malignancies have not been assessed.

Purpose:

We conducted a geographic ecological analysis to examine correlations between PFAS concentrations and the incidence of GI and other cancers across the United States.

Methods:

County-level cancer incidence rates for multiple cancers were merged with maximum PFAS drinking …

When Lightning Strikes Twice - A Rare Case Of Siblings With Autoimmune Encephalitis, Crystal Banh Bs, Peter Awad Bs, Travis J. Matics Do, Usha Appalaneni Md, Sheena Mckenzie Md, Mba, Faap

Scientific Day

Introduction/Background:

Pediatric autoimmune encephalitis is a rare condition with high morbidity. Diagnosis requires a high index of suspicion. Earlier initiation of treatment, particularly in refractory cases, improves long-term outcomes. We describe a case of anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis in a child whose diagnosis and treatment were hastened due to a history of the same in her sibling, a previously described but rare occurrence.

Description:

A 4-year-old female presented with acute onset of fever, truncal ataxia, and altered speech. Her parents noted that their older daughter had similar symptoms two years ago and was diagnosed with autoimmune encephalitis. In our patient, …

Recognizing Synchronous Primary Lung Cancer, Noah Gordon Do, Danielle Gratza Do, Wissam Raad Md, Abdul Hamid Alraiyes Md

Scientific Day

Introduction/Background:

Lung cancer remains the leading cause of cancer death worldwide. Therefore, management decisions that follow nodule identification represent a crucial moment in patient care. Synchronous multiple primary lung cancer (SMPLC) refers to the simultaneous diagnosis of two or more distinct cancerous lesions rather than metastasis from a single primary site. This phenomenon is estimated to occur in approximately 2% of patients diagnosed with lung cancer. Although the underlying pathogenesis is incompletely understood, carcinogen exposure is able to create a large area of genetic alteration increasing the risk of dysplasia - a concept known as field cancerization.

Description:

A 71-year-old …

Inadvertent Removal Of Infected Hepatic Artery Stent Graft Causing Recurrent Cholangitis During Percutaneous Transhepatic Cholangiography With Internal–External Biliary Drain Placement, James Costin Md, Ross Whitlock Md, Laurence Donahue Md, Elliot Berger Do, Praveen Sankrithi Do

Scientific Day

Introduction/Background:

Endovascular stent-grafts are established treatments for hepatic artery stenosis and pseudoaneurysm. In rare cases there have been reports of migration/erosion, infection, and possibly serve as a persistent nidus for bacteremia. There have been reported cases of infected hepatic arterial stents and coils spontaneously excreted into the bowel and others requiring surgical intervention for removal including liver transplant. We report the first case in which percutaneous biliary access and internal– external drain placement coincided with endovascular stent migration with ultimate nonoperative removal/excretion of an infected proper hepatic artery stent-graft and resolution of recurrent cholangitis.

Description:

A patient with complex prior …

Complete Radiographic Response Of Disseminated Post-Kidney Transplant Kaposi Sarcoma After Conversion From Tacrolimus To Sirolimus, Ravjot Kaur Virdi Do, Mph, Jon M. Richards Md, Eli D. Ehrenpreis Md, Agaf, Facg

Scientific Day

Introduction/Background:

Iatrogenic Kaposi Sarcoma (KS) is a human herpesvirus-8 (HHV-8)-driven angioproliferative neoplasm that can occur after solid-organ transplantation. Post-transplant KS often involves lymph nodes and viscera and is managed primarily by reducing or modifying immunosuppression. Conversion from calcineurin inhibitors (CNI) to mechanistic target of rapamycin (mTOR) inhibitors is frequently employed given potential antitumor and antiangiogenic effects. This report details a unique case of disseminated, predominantly extracutaneous KS, initially concerning for post-transplant lymphoproliferative disorder (PTLD), which achieved complete radiographic response after CNI-tosirolimus conversion alone.

Description:

A woman with end-stage renal disease from congenital renal hypoplasia underwent deceased-donor kidney transplant at age …

Multimodality Imaging In Msh6-Associated Lynch Syndrome: Radiologic Contributions To Early Detection And Management Of Recurrent Gi Malignancy, Tecora Turner Md, Tisileli Tuifua Md, William Macdonald Md

Scientific Day

Background/Significance:

Lynch syndrome, caused by pathogenic variants in DNA mismatch repair (MMR) genes, increases risk for colorectal, small-bowel, and periampullary cancers. In MSH6-associated disease, tumors may appear proficient on immunohistochemistry (pMMR) despite underlying germline dysfunction, complicating surveillance. Because lesions often arise beyond routine endoscopic reach, cross-sectional imaging plays a critical role in early detection and treatment planning.

Description:

Patient with Lynch syndrome (germline MSH6 c.3694del3, likely pathogenic, and an additional MSH6 p.S998F variant of uncertain significance in trans) developed invasive colon adenocarcinoma at age 38 with pMMR by immunohistochemistry. Years later, endoscopy suggested a duodenal lesion with high-grade dysplasia; contrast-enhanced …

A Rare Case Of Primary Breast Merkel Cell Carcinoma In A Male Gendered Patient, Sydney A. Pekarek Do, Archana Chandrashekar Do, M Bassel Attasi Md, Emily E. Klosterman Do, Joslyn Albright Md

Scientific Day

Introduction/Background:

Merkel cell carcinoma (MCC) is an aggressive, rare neuroendocrine tumor, typically arising in the skin. However, there are few documented cases of neuroendocrine tumors of breast parenchyma with Merkel cell differentiation. This accounts for less than 0.1% of all breast cancers with almost all cases being described in females.

Description:

We present here a 62-year-old, immunocompetent, Hispanic male with a palpable and painful right sided breast mass, present for three to four months. On the exam, a four-centimeter mass was palpated in the 9 o’clock region of the right breast without associated skin nodularity or dermal attachment. Diagnostic mammography …

Staging Laparoscopy For Pancreatic Ductal Adenocarcinoma: Experience From A Large Quaternary Care System, Mary Brandt Md, Astrid Levesque Bs, Rebecca Kirschner Md, Geoffrey Bellini Md, Wesley Papenfuss Md, Dawn Wankowski Ms

Scientific Day

Background/Significance:

Detection of radiographically occult metastatic disease (ROMD) in pancreatic ductal adenocarcinoma (PDAC) remains vital for staging. There is no standardized approach, but borderline resectable or locally advanced disease, CA 19-9 > 394, location in the pancreatic body or tail, and no neoadjuvant therapy are predictive of ROMD and often used to select patients for staging laparoscopy. Peritoneal washings have been used at the time of laparoscopy to further detect occult disease, with positive cytology considered by NCCN guidelines to be metastatic (M1) disease.

Purpose:

We sought to study characteristics of patients undergoing laparoscopy with or without washings to inform a …