Medical Specialties Commons^™

Granular Cell Tumor Of The Breast: A Breast Malignancy Mimicker, Emma Herrmann, Markie Zimmer, Bana Antonios, Bipin Ghimire, Mohammad Muhsin Chisti

Conference Presentation Abstracts

Granular cell tumors are soft tissue neoplasms that can arise from virtually any body site. They are thought to arise from Schwann cells of the peripheral nervous system. The overwhelming majority are benign, with only 1-2% of cases being malignant. Granular cell tumors of the breast can often mimic breast malignancy. A 62-year-old female with past medical history of hypertension and prior tobacco use had abnormal screening mammography. Family history was positive for breast malignancy in 2 sisters and a maternal first cousin. Prior mammography was unremarkable, aside from one year prior which revealed a concerning 6 mm nodule in …

Refractory Non-Tumor Lambert Eaton Syndrome Treated With Rituximab, Bipin Ghimire, Samiksha Pandey, Ashbina Pokharel, Emma Herrmann, Mohammad Muhsin Chisti

Conference Presentation Abstracts

With a worldwide prevalence of 3-4 per million, Lambert-Eaton syndrome is a rare entity. It often occurs as a paraneoplastic syndrome, most commonly associated with small cell lung cancer. Less frequently, it occurs as an autoimmune disease in the absence of cancer. Both entities demonstrate circulating immunoglobulins against presynaptic voltage-gated calcium channels and Electromyogram (EMG) with an increase in compound muscle action potential on repetitive stimulation. A 35-year-old female with past medical history of hypothyroidism presented with bilateral lower extremity weakness, generalized fatigue, blurry vision, and slurred speech in 2010. Upon further workup, Lambert-Eaton syndrome was diagnosed after she tested …

Metronidazole Neurotoxicity--Not Your Usual Suspect, Markie Zimmer, Bana Antonios, Emma Herrmann, Ramona Berghea

Conference Presentation Abstracts

An 85-year-old female with past medical history notable for chronic lymphocytic leukemia and Stage III Merckel cell carcinoma presented to our hospital for evaluation of generalized weakness of a few weeks duration. Notably, she had a recent hospital admission for E. coli bacteremia in the setting of hepatic abscesses that underwent ultrasound guided drainage. She was discharged to inpatient rehabilitation, and ultimately home, with a planned six-week course of ceftriaxone and metronidazole, in addition to oral vancomycin for C. difficile infection. Upon readmission, she was fatigued and had progressive lower extremity weakness. She denied any bowel or bladder incontinence or …

Utilization Of 2d Barcode Technology To Create Surgical Pathology Reports, Zhenhong Qu, Elaine Qu, James Huang, Mark A. Micale, E Li

Conference Presentation Abstracts

Introduction/Objective: After professional transcription service is eliminated, pathologists inevitably undertake the task of diagnostic data entry into pathology repot by adapting a variety of methods such as speech recognition, manual typing, and pre-texted command. Errors and inefficiency in reporting remain common problems, especially for information with unusual syntax such as genotype or nucleotide sequences. To overcome these shortcomings, we introduce here a novel application of a well-established technology as a complementary method, namely 2- dimensional (2D) barcode symbology. Methods/Case Report: Commonly used diagnostic wordings of pathology reports including specimen type, surgical procedure, diagnosis, and test results are collated and organized …

Cost-Effectiveness Analysis Of Recombinant Zoster Vaccine For The Prevention Of Herpes Zoster In Immunocompromised Adults Diagnosed With Select Cancers In The United States, Desmond Curran, Brandon Patterson, Justin Carrico, Ahmed Salem, Elizabeth La, Stephane Lorenc, Katherine Hicks, Sara Poston, Christopher Carpenter

Conference Presentation Abstracts

Introduction / Background / Significance: Immunocompromised (IC) populations diagnosed with cancer are at increased risk for herpes zoster (HZ) due to their underlying disease and/or therapy. This risk is highest among individuals receiving hematopoietic stem cell transplant (HSCT) to treat multiple myeloma, lymphomas, or other diseases. HZ is characterized by a painful vesicular rash. IC populations with HZ are also at increased risk of developing HZ-related complications such as postherpetic neuralgia, a persistent pain that can last for months or years. This study evaluates the cost-effectiveness of recombinant zoster vaccine (RZV) versus no vaccine for the prevention of HZ in …

A Unique Case Of Renal Pelvic Urothelial Carcinoma With Extensive Small Round Cell Sarcoma Differentiation Showing Swsr1 Gene Rearrangement, Zubin Shetty, Mitual Amin, Savitha Balaraman, Sugandh Shetty

Conference Presentation Abstracts

Introduction: Ewings-like sarcoma is a rare subgroup of small round cell sarcoma with immunohistochemistry and morphological similarities to Ewing Sarcoma. We report a rare case of renal pelvis invasive urothelial carcinoma with small round cell sarcoma differentiation showing EWSR1 gene rearrangement. Case: An 84-year-old male presented with 6 months of intermittent painless gross hematuria. Workup revealed a 5.4cm left renal pelvicalyceal mass suspicious for transitional cell carcinoma and a 2.5cm enhancing left renal cortical lesion. The patient underwent an uncomplicated robotic left nephroureterectomy. Pathology revealed small round cell sarcoma composing greater than 80% of the renal pelvis tumor with the …

Late Onset Burkitt Post Transplant Lymphoproliferative Disorder (Ptld) Following Solid Organ Transplant, Melinda Sager, Devika Aggarwal

Conference Presentation Abstracts

Post Transplant Lymphoproliferative Disorder (PTLD) is an uncommon complication after solid organ transplant, with several different monomorphic subtypes; Burkitt Lymphoma PTLD (B-PTLD) is particularly rare and aggressive.

A 30 year old female with a history of IgA nephropathy and two renal transplants presented to the emergency room with nausea, vomiting, and diffuse abdominal distention and pain that started one week prior to presentation. CT imaging showed significant mesenteric and pelvic lymphadenopathy with moderate ascites, paracentesis was performed. Her immunosuppressive therapy was adjusted: azathioprine was held, tacrolimus was decreased for lower target level, and steroid was continued. A lymph node biopsy …

Interobserver Variability In Differentiated Vulvar Intraepithelial Neoplasia Between Surgical Pathology Subspecialties, Grace Y. Wang

Conference Presentation Abstracts

Abstract:Background: Differentiated vulvar intraepithelial neoplasia (dVIN) is a human papillomavirus-independent lesion with potential for rapid progression to invasive squamous cell carcinoma (SCC). The histologic features of dVIN are diverse and have overlapping characteristics with lichen sclerosus (LS) and lichen simplex chronicus (LSC); and may be diagnosed by dermatopathologists or gynecologic pathologists. The goal of our study is to examine interobserver variability in the diagnosis of dVIN between pathologists with different subspecialty expertise. Design: Biopsies diagnosed as dVIN, LS and LSC from 2011-2018 were retrieved from the pathology database at a large academic institution. Using Fleiss kappa statistic, histologic features and …

Posterior And Middle Facets Of The Subtalar Joint: The Retrospective Search For An Early Sign Of Peritalar Subluxation And Progressive Flatfoot Deformity, Elijah C. Auch, Nacime Mansur, Shuyuan Li, Kevin Dibbern, John Femino, Daniel Baumfeld, Cesar De Cesar Netto, Thiago Alexandre Alves

Conference Presentation Abstracts

INTRODUCTION | Adult acquired flatfoot deformity (AAFD) is a complex three-dimensional (3D) pathology characterized by peritalar subluxation (PTS) of the hindfoot. The objective of this study was to compare the amount of subluxation between the middle and posterior facets in patients with AAFD. METHODS | In this IRB-approved retrospective comparative study, seventy-six AAFD patients (87 feet) who underwent weightbearing CT (WBCT) were included. Two blinded Fellowship-Trained Orthopedic Foot and Ankle Surgeons with >10 years of experience measured subtalar joint subluxation at the posterior and middle facets as well as the Foot and Ankle Offset (FAO). Intra- and interobserver agreement was …

Percutaneous Distal Metatarsal Mini-Invasive Osteotomy: Comparison Between Standard Vs. Modified Intraosseous Approach - A Cadaveric Study, Elijah C. Auch, Fernando S. Martins, Victoria Vivtcharenko, Eli Schmidt, Shuyuan Li, Alexandre L. Godoy-Santos, John Femino, Cesar De Cesar Netto

Conference Presentation Abstracts

BACKGROUND | The objective of this cadaveric study was to identify and compare the structures at risk of damage in standard versus modified intraosseous distal mini-invasive metatarsal osteotomy (DMMO). Our hypothesis was that the modified DMMO technique may be a safer, less complex procedure that could decrease the risk of iatrogenic injuries. METHODS | 11 thawed fresh-frozen under the knee cadaveric specimens underwent DMMO of the forefoot. The modified technique proposed by this study enters the dorsal cortex (at 45 degrees) straight through to the plantar cortex followed by cutting the lateral cortices (panels D, E, F). The standard technique …

A New Pediatric Monteggia Fracture Type 4 Variant, Ehab S. Saleh

Articles

Introduction: Monteggia fracture-dislocations are rare and complex injuries that usually involve a fracture of the proximal ulna associated with a proximal radioulnar and radiocapitellar joint dislocations. These injuries comprise

Pulmonary Artery Sling-An Extremely Rare Etiology Of Dysphagia, Khola Qamar, Abhinav Tiwari

Conference Presentation Abstracts

No abstract provided.

Hereditary Hemochromatosis As An Independent Risk Factor For Liver Cancer: A Matched Case-Control Study Of The National Inpatient Sample Database, Maryam Haider, Ali F. Alsbihi, Zaid Imam, Adnan Malik, Sana Iqbal, Mahum Nadeem, Ahmed J. Chaudhary

Conference Presentation Abstracts

No abstract provided.

Social Determinants Of Health Correlating With Mechanical Ventilation Of Covid-19 Patients; A Multi-Center Observational Study, Alexa Giovanatti, Heba Elassar, Patrick Karabon, Tracy Wunderlich-Barillas, Alexandra Halalau

Conference Presentation Abstracts

Importance: Several studies have relayed the disproportionate impact of COVID-19 on marginalized communities, however few have specifically examined the association between social determinants of health and mechanical ventilation (MV). Objective: To determine which demographics impact MV rates among COVID-19 patients. Design: This observational study included COVID-19 patient data from eight hospitals’ EMR between February 25, 2020 to December 31, 2020. Associations between demographic data and MV rates were evaluated using uni- and multivariate analyses. Setting: Multicenter (8 hospitals), largest health system in Southeast Michigan Participants: Inpatients with a positive RT-PCR for SARS-CoV-2 on nasopharyngeal swab. Exclusion criteria were missing demographic …

Intracardiac Leiomyomatosis Presenting As Syncope, Ujjwal Karki, Bijaya Thapa, Shailesh Niroula, Bipin Ghimire, Tucker Billups, Shrinjaya Thapa

Conference Presentation Abstracts

Primary cardiac tumors are rare, with incidence less than 0.1 percent. Secondary tumors are 20 times more common. Tumor thrombus extending to the right heart is commonly seen with renal cell carcinoma. Less common etiologies include intravenous leiomyoma, gynecological malignancies, Wilms tumor, hepatoma, and adrenocortical carcinoma. 46-year-old female with history of uterine fibroid presented with two episodes of syncope, lasting 30 seconds each. Echocardiogram revealed a mobile echogenic mass in right atrium extending from the inferior vena cava (IVC) and moving across the tricuspid valve, causing dynamic obstruction. Cardiac MRI showed the mass originated from the renal vein with similar …

Gallstone Ileus Complicating Rectal Cancer: A Red Herring Cause Of Abdominal Pain, Nicholas Lazar, Ovidiu Niculescu, Carol Lima, Neiberg Lima

Conference Presentation Abstracts

A 68-year-old male with a history of alcohol abuse presented with a one-week history of fatigue and weakness, and a one-year history of fecal incontinence. On admission, vital signs were stable. Physical exam revealed cachexia, skin pallor, and mild abdominal distention. Fecal occult blood testing was positive. Laboratory analysis was significant for hemoglobin of 6.8g/dL. Of note, computed tomography (CT) scans of his chest, abdomen, and pelvis done months prior for evaluation of anemia and incontinence had shown rectal wall thickening, lung nodules concerning for metastasis, and gallstones. He declined further diagnostic evaluation and was lost to follow up. During …

Synergistic Bleomycin Toxicity And Evali: A Lethal Combination, Daniel O'Connor, Nader Mina, Hira Iftikhar

Conference Presentation Abstracts

Introduction: Both vaping and bleomycin-based chemotherapy regimens are known risk factors for acute lung injury. Few, if any, cases are documented in the literature of these insults co-occurring. Case description: A 20-year-old male was diagnosed with Stage III testicular cancer in Autumn of 2020. He began BEP (bleomycin-etoposide-platinum), of which he completed three cycles before developing pulmonary sequelae. Social history was notable for marijuana use and vaping, including during his active chemotherapy, to help with cancer-related nausea, anxiety, and anorexia. Winter 2021, he visited the ED for dizziness, fatigue, and diarrhea, felt to be consistent with chemotherapy side effects, but …

Pediatric Obesity: A Survey Study Of Patients And Caregivers’ Concern And Interest In Specialized Programs, Dina Abdo, Ryan Rogers, Susan Edlibi, Aimee M. Pollak, Stacey Shubeck, Charity Owusu-Asare, Reem Wassef, Kerry P. Mychaliska

Conference Presentation Abstracts

Background: Body mass index (BMI) greater than or equal to the 85th percentile for age and sex is considered overweight in the pediatric population. Pediatric obesity is defined as a BMI at or above the 95th percentile. According to the Centers for Disease Control (CDC), obesity prevalence has tripled over the past fifty years; one in five school-aged children has a diagnosis of obesity. The purpose of this study is to survey caregivers’ perceptions and concerns about their child’s weight, as well as assess patient and caregiver interest in a comprehensive healthy lifestyle program.

Methods: This IRB approved study conducted …

Stability Of The Sacral Table Angle In Pediatric Patients With Spinal Pathology, David G. Wallington, Patrick D. Albright, Alexandria I. Chrumka, Rebecca D. Funk, Dale E. Rowe, Joseph K. Weistroffer, Karen M. Bovid

Conference Presentation Abstracts

INTRODUCTION | Pelvic incidence, lumbar lordosis, and pelvisacral angle are common radiographic measures used to evaluate sagittal alignment of the spine and pelvis to assist in clinical decision making. However, the natural history of the sacral table angle (STA) is not well characterized, and there remains uncertainty regarding STA progression over time. Previous studies have established that the STA is stable over time in adult patients, however this question has not been answered for younger patients who have not reached skeletal maturity. In this study, we aim to determine sacral table angle stability over time in a younger patient population. …

Anti-Nmda-Receptor Encephalitis In A Patient With Ovarian Teratoma, Harboring Brain Histology Of Varying Developmental Stages And Regions With Chronic Inflammation, S Fatemi, E Qu, J Fullmer

Conference Presentation Abstracts

Introduction/Objective Anti-NMDA-receptor encephalitis is a subacute, autoimmune disorder thought to be caused by autoantibodies directed against the N-methyl-D-aspartate (NMDA) receptor. Clinical symptoms of anti-NMDAR encephalitis may mimic schizophrenia and psychotic spectrum disorders or substance-induced psychosis. Although initially described in association with ovarian teratomas in women, anti-NMDAR encephalitis has been reported in individuals without paraneoplastic association, as well as in males. Herein, we report a case of a 29-year-old woman with suicidal ideation and other neuropsychiatric manifestations who was found to have a right ovarian cystic mass by imaging study. Microscopically, the resected ovarian mass is composed of mature skin, fat, …

Crossfire: Controversies In Urology Debate: Prophylactic Suburethral Sling At Time Of Prolapse Sling In Era Of Mesh Controversy, Eric Scott Rovner, Alexander Gomelsky, Ariana L. Smith, Leslie Minor Rickey, Jason P. Gilleran

Conference Presentation Abstracts

No abstract provided.

Allogenic Fibular Bone Graft Reconstruction With Complete Regeneration Of The Lateral Malleolus After En Bloc Resection Of A Distal Fibular Aneurysmal Bone Cyst: A Case Report, Kalli E. Mortenson, Lawrence M. Fallat

Articles

Aneurysmal bone cysts are expansile lytic lesions that most commonly affect the metaphysis of long tubular bones. These lesions are locally aggressive and predominately occur within the first two decades of life. Currently the most widely used surgical treatment involves intralesional curettage of the affected bone. However, there have been several reports of high recurrence rates with this technique. We present a case of a 12 year old female who presented with an aneurysmal bone cyst of the lateral malleolus of the right ankle. The patient underwent multiple surgeries and ultimately had complete surgical resection of the cystic lesion and …

Going Off The Deep End - The Life And Controversies Of Henry Heimlich, Md, Bradford L. Walters, Matthew Drogowski

Articles

No abstract provided.

How Much Time Do General Surgical Pathologists Spend On Diagnostic Data Entry?, Zhenhong Qu, Lanjin Zhang, Xianzhong Ding, Kausar Jabbar

Conference Presentation Abstracts

Context: As many pathology institutions have eliminated transcription service by office assistants, pathologists assume the task of diagnostic data entry (DDE) into pathology reports in the laboratory information system. This is not a trivial undertaking, yet tangible data are lacking on how much DDE adds to the workload of pathologists. Without such data, it is very difficult to assess the financial benefit of such a task shift and establish benchmarks. Design: Four practicing pathologists covering a general surgical pathology service in 3 institutions with different laboratory information systems were selected for their dominant DDE method (speech recognition, pre-text, or manual …

The Surgical Treatment Of Cervical Myelopathy In Patients Who Ambulate Independently, Ambulate With Assistive Devices, Or Are Wheelchair Bound: A Michigan Spine Surgery Improvement Collaborative Study, Rafid Kasir, Lonni Schultz, Richard W. Easton, Victor Chang, Jad Khalil

Conference Presentation Abstracts

We examine whether wheelchair bound patients undergoing cervical spine surgery for cervical myelopathy have improvement in patient-reported outcome measures.

Indications For A "Surgery First" Approach For The Treatment Of Lower Extremity Arterial Disease, Mohineesh Kumar, Steven D. Rimar, Graham W. Long, Diane M. Studzinski, O W. Brown

Conference Presentation Abstracts

No abstract provided.

Use Of Immunohistochemistry To Determine Expression Of Rab5 Subfamily Of Gtpases In Mature And Developmental Brains, Kwok Ling Kam, Paige Parrack, Marcellus Banworth, Sheeja Aravindan, Guangpu Li, Kar Ming Fung

Books and Book Chapters

Rab GTPases are essentially molecular switches. They serve as master regulators in intracellular membrane trafficking from the formation and transport of vesicles at the originating organelle to its fusion to the membrane at the target organelle. Their functions are diversified and each has their specific subcellular location. Their expression may vary significantly in the same cell when the level of protein production is significantly different in different physiologic status. One of the best examples is the transition from fetal to mature status of cells. Expression and localization of Rab GTPases in mature and developing brains have not been well studied. …

Musculoskeletal Injuries And Conditions In The Orthopaedic Surgeon: A Survey, Katherine Swank, Jamie Furness, Erin A. Baker, Corinn Gehrke, Rachel S. Rohde

Conference Presentation Abstracts

Musculoskeletal conditions are common in orthopaedic surgeons and may lead to morbidity and missed work.

The Routine Use And Cost Analysis Of Acid-Fast Bacilli And Fungal Cultures In Foot And Ankle Surgery: A Retrospective Study, Zein S. El-Zein, Scott Diamond, Margaret C. Bohr, Erin A. Baker, Mackenzie M. Fleischer, Corinn Gehrke, Paul T. Fortin, Zachary Vaupel

Conference Presentation Abstracts

This study highlighted low rates of positive AFB/fungal cultures in our foot and ankle surgery department and demonstrated that routine use of such cultures poses substantial costs to the hospital.

Modulation Of The Acute Post-Anterior Cruciate Ligament Rupture Intra-Articular Environment Via Recruitment Of Marrow-Derived Stem Cells To Promote Bone Tunnel Healing In Acl Reconstruction, Kevin C. Baker, Samantha Hartner, Mackenzie M. Fleischer, Michael D. Newton, William B. Acker, Perry Altman, Christopher Bush, Tristan Maerz, Asheesh Bedi

Conference Presentation Abstracts

Acute, post-injury peripheral blood mobilization therapy with a CXCR4 antagonist improved bone tunnel healing and graft integration following ACL reconstruction surgery in a rat model.