Amador, Catalina

Gonzalez-Castellon, Marco

Greiner, Timothy

Hariharan, Praveen

Krishnan, Mridula

English

University of Nebraska Medical Center Research: DigitalCommons@UNMC

Graduate Medical Education Research Journal Graduate Medical Education Research Journal Volume 3 Issue 1 Article 23 Intravascular B-Cell Lymphoma Presenting as Cortical Venous Thrombosis Praveen Hariharan University of Nebraska Medical Center Mridula Krishnan University of Nebraska Medical Center Timothy Greiner University of Nebraska Medical Center Catalina Amador University of Nebraska Medical Center Marco Gonzalez-Castellon University of Nebraska Medical Center Follow this and additional works at: https://digitalcommons.unmc.edu/gmerj Digital Commons Network Logo  Part of the Higher Education Commons, and the Medicine and Health Sciences Commons Recommended Citation Hariharan, P., Krishnan, M., Greiner, T., Amador, C., , Gonzalez-Castellon, M. Intravascular B-Cell Lymphoma Presenting as Cortical Venous Thrombosis. Graduate Medical Education Research Journal. 2021 Oct 04; 3(1). https://digitalcommons.unmc.edu/gmerj/vol3/iss1/23 This Conference Proceeding is brought to you for free and open access by DigitalCommons@UNMC. It has been accepted for inclusion in Graduate Medical Education Research Journal by an authorized editor of DigitalCommons@UNMC. For more information, please contact digitalcommons@unmc.edu. Intravascular B-Cell Lymphoma Presenting as Cortical Venous Thrombosis Creative Commons License This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License. This conference proceeding is available in Graduate Medical Education Research Journal: https://digitalcommons.unmc.edu/gmerj/vol3/iss1/23 Sept. 2021  |  Vol. 3  |  Issue 1 Oral Presentations 37*Names in bold type indicate presenting author.Methods:fractures were prospectively enrolled between 2018 and 2020. Patients with MCS <4mm on standard NWB ankle radiographs with stress views obtained in the emergency department. Patients were placed in a walking boot and instructed to weight-bear as tolerated (WBAT). WB radiographs were obtained one up WB radiographs, surgical intervention management continued with WBAT in a walking boot. AOFAS scores were obtained at three months and six months for all patients. Results: 44 patients met inclusion criteria for analysis, 22 patients had a MCS >4mm on initial gravity stress views. All 22 of those patients, as well as the remaining 22 patients, continued to show MCS <4mm on all follow-up weight-bearing radiographs up to six-month follow-up while using our novel WBAT protocol. The average AOFAS scores were comparable for both groups. Conclusion:in a walking boot is a viable method to fractures. Given that all patients at subsequent follow-up had a MCS <4mm, including those who widened on initial stress radiographs, an immediate WB protocol may offer an improved indication of ankle stability when compared to the current gold standard stress radiographs. Finally, we saw excellent patient-reported outcomes utilizing our immediate weight-bearing protocol. Proceedings of the 3rd Annual Graduate Medical Education Research Symposium | Oral Presentations — ReviewsMohammad Aladawi1 1, Baha Abu-Esheh2, Deaa Abu Jazar3, Ahmad Armouti4, Ahmed Bayoumi5, Ezequiel Piccione11University of Nebraska Medical Center, College of Medicine, Department of Neurological Sciences 2Mercy Hospital, Department of Neurology 3University of Texas Medical Branch – Galveston, Department of Neurology 4University of South Florida Morsani College of Medicine, Department of Neurology 5Yale University, Department of NeurologyMentor: Ezequiel PiccioneProgram: NeurologyType: Review/Meta-analysisBackground: of Guillain Barre Syndrome (GBS) due to known to be postinfectious following several types of infections. Although causality can only be proven through large epidemiological studies, we intended to study this association by a thorough review of the literature.Methods: We searched PubMed, EMBASE and Google scholar, and included all papers with English or Spanish full text and original data of patients with GBS and recent demographics, diagnostic investigations and the latency between arboviral and neurological symptoms. Further variables were pooled to identify GBS clinical and electrophysiological variants, used treatments and outcome. Certainty of GBS diagnosis was Results: GBS cases. Nighty nine cases had a average age of 56.07 years. The average latency period between the arboviral symptoms and neurologic manifestations days. The predominant GBS clinical and electromyography variants were the classical sensorimotor GBS and acute demyelinating polyneuropathy respectively. Forty cases required intensive care, 33 cases required mechanical ventilation, and 6 cases were complicated by death.Conclusion: GBS commonly reported sensorimotor demyelinating GBS with frequent facial palsy. The time between the onset of infectious and neurological symptoms suggests a post-infectious mechanism. Early diagnosis as it might be associated with a severe disease course requiring intensive care and mechanical ventilation. 1, Erica B. Lee1, Adam V. Sutton1 1University of Nebraska Medical Center, College of Medicine, Department of DermatologyMentor: Program: DermatologyType: Review/Meta-analysisBackground: common, benign, skin lesion that accounts for approximately 3% of all skin specimens reviewed by dermatopathologists. A cellular variant that accounts for 5% of all cutaneous established guidelines for CDF treatment, this review was aimed to review current treatment patterns in comparison to how we treat these lesions at our institution. Methods: A PubMed literature search was performed using keyword ‘cellular Results:treatments of CDF’s. Clinically, it is similar to DF, but in many cases measures greater than 2 cm (DF is typically < 1 cm). Though CDF’s have traditionally been thought to be of low malignant potential, cases of distant metastasis have been reported in the literature. There is a wide range of local recurrence rates after initial excision from 10%-50%. neoplasm with intermediate malignant distinction. The spindle cells of CDF stain the surrounding stroma and few cells around Graduate Medical Education Research Journal38 Oral Presentations*Names in bold type indicate presenting author.DFSP stains diffusely positive for CD34 and stains diffusely positive in CDF and negative in DFSP (Table 1). Conclusion: Given the wide range of local recurrence (10% to 50%), invasive behavior of the tumor, and potential of distant metastasis, comprehensive margin assessment (via Mohs Micrographic Surgery) represents an important treatment modality for select head and neck and neoplasms that have had previous wide local excision with positive margins are of particular concern. At our institution, we remove select CDF using comprehensive margin assessment, utilizing Hematoxylin & Eosin staining along with Toluidine Blue staining. This technique  allows for higher cure rates and tissue conservation. Proceedings of the 3rd Annual Graduate Medical Education Research Symposium | Oral Presentations — Case ReportsIntravascular B-Cell Lymphoma Presenting as Cortical Venous ThrombosisPraveen Hariharan1, Mridula Krishnan2, Timothy Greiner3, Catalina Amador3, Marco Gonzalez-Castellon11University of Nebraska Medical Center, College of Medicine, Department of Neurological Sciences  2University of Nebraska Medical Center, College of Medicine, Department of Internal Medicine, Division of Oncology and Hematology  3University of Nebraska Medical Center, College of Medicine, Department of Pathology and MicrobiologyMentor: Marco Gonzalez-Castellon, MDProgram: NeurologyType: Case ReportBackground:presenting with diverse neurological symptoms including ischemic infarcts, hemorrhage and peripheral nervous system presenting as multifocal cortical venous thrombosis. Case: A 59-year-old right-handed Guatemalan immigrant female presented with subacute onset of altered mental status, lethargy, dysarthria, transient left face and arm numbness, unintentional weight loss and poor appetite. Physical exam was remarkable for disorientation to time and place and absence of any focal neurological A CT scan of the brain revealed two areas of hemorrhages. Magnetic resonance (MR) imaging of the brain showed edema obtained that revealed multifocal cortical vein thrombosis. Blackblood MR Angiogram showed vessel wall enhancement involving peripheral arteries and veins. Cerebrospinal and normal cell count. The malignancy screen was negative. Extensive infectious and She developed bilateral lower extremity weakness with upgoing toes after 10 days of admission. MR Thoracic spine revealed T2 hyperintensities at the level of T10. A bone marrow biopsy revealed large, atypical B-cells in the lumina of sinusoids and skin biopsy demonstrated evidence of intravascular diffuse large B-cell lymphoma although peripheral smear was negative. Conclusion:diffuse large B-cell lymphoma subtype characterized by selective growth of B-cells within lumina of small vessels due to lack of CD29 that is critical for extravasation of lymphocytes. Neurological presentations are diverse and diagnosis could be delayed given a normal peripheral smear. One needs to maintain a high index of suspicion presenting with B-symptoms and ischemic or hemorrhagic strokes. Table 1.Clinical Firm, skin colored to hyperpigmented, papule, plaque or nodule. Dimpling with lateral pressure. Commonly < 1 cm in size.Firm, skin colored to hyperpigmented, papule, plaque or nodule. Frequently, > 2 cm in diameter.Traditionally, a hyperpigmented, slow growing, nodule or plaque with irregular nodularity on the trunk.Dermatopathology Proliferation of spindle cells in storiform pattern extending into the mid to deep dermis. Collagen trapping peripherally.Hypercellular proliferation of spindle cells in fascicular pattern extending into the subcutaneous tissue with smooth, pushing, border.Proliferation of spindle cells in storiform pattern extending into deep subcutaneous tissue with honeycomb pattern, encasing adipocytes.IHC XIIIa (+), CD 34 (-), CD 99 (+)XIIIa (+), CD 34 (+, weakly, of stroma and few cells on periphery only) CD 99 (+)XIIa (-), CD 34 (+, strong, diffuse), CD 99 (-)Recurrence Rate 2% to 3 % 10% to 50 % Up to 60% (varies based on surgical margins and technique used)Treatment: Observation Mohs Surgery Mohs Surgery

Intravascular B-Cell Lymphoma Presenting as Cortical Venous Thrombosis

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Intravascular B-Cell Lymphoma Presenting as Cortical Venous Thrombosis

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