1
|
Haiderbhai S, Heitkamp L, Nickell A, Erie E, Nichols L. A Diagnostic Dilemma and Classification Conundrum: Atypical Histiocytic Neoplasm Presenting as a Calvarial Mass. Cureus 2024; 16:e54828. [PMID: 38529420 PMCID: PMC10963024 DOI: 10.7759/cureus.54828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 03/27/2024] Open
Abstract
Histiocytic disorders are a wide range of disorders arising from abnormal proliferation and infiltration of dendritic cells. The Histiocyte Society has arranged the disorders into five main groups: L, C, M, R, and H. We present a case in which an elderly woman presented with a solitary osseous lesion in her skull in the right anterior calvarium. Biopsy and histological studies were strongly positive for cyclin D1; positive for CD68, S100, and ZBTB46; weakly positive for OCT2; and equivocal for ALK1 and CD163. Genomic studies also identified KRAS and GPS2 mutations. KRAS-positive genomic analysis favors a diagnosis of histiocytoma, while the solitary calvarium and spontaneous resolution with remission favor a diagnosis of Langerhans cell histiocytosis (LHC). Despite the strong clinical evidence favoring LCH, our patient's clinical and histologic features did not fit any of the five histiocytic categories and were classified as an atypical histiocytic disorder.
Collapse
Affiliation(s)
- Shabbir Haiderbhai
- Internal Medicine, Sanford Health, Fargo, USA
- Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Fargo, USA
| | - Leesha Heitkamp
- Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Fargo, USA
| | - Austin Nickell
- Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Fargo, USA
| | - Ellen Erie
- Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Fargo, USA
| | - Laura Nichols
- Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Fargo, USA
- Internal Medicine, Sanford Health, Fargo, USA
| |
Collapse
|
2
|
Corn M, Nickell A, Lessard C, Jackson A. Pituitary apoplexy during pregnancy with transsphenoidal resection and intraoperative fetal monitoring: A case report. Case Rep Womens Health 2023; 39:e00543. [PMID: 37771424 PMCID: PMC10522850 DOI: 10.1016/j.crwh.2023.e00543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 09/30/2023] Open
Abstract
Introduction Prolactinomas resulting in pituitary apoplexy are an uncommon obstetrical complication. The hemorrhage can cause compression and necrosis of the pituitary gland as well as the optic chiasm, necessitating surgical intervention. Case A 35-year-old woman, G0, presented for an infertility consult with a prior diagnosis of polycystic ovarian syndrome. Evaluation for oligomenorrhea found an elevated prolactin level of 69.76 ng/mL, an elevated DHEA-S of 524, and HgbA1c of 5.7%. The patient denied visual or neurological symptoms. Infertility treatment was started, and magnetic resonance imaging (MRI) of the brain was recommended; however, the patient forewent imaging. Within a few months, she was pregnant. At 27 weeks of gestation, the patient developed sudden visual field loss to the right eye and presented to her optometrist. MRI of the pituitary identified a sellar mass with suprasellar extension, consistent with a recently hemorrhaged pituitary macroadenoma or pituitary apoplexy with displacement of the optic chiasm. Due to the risks of permanent optic nerve damage, the patient underwent endoscopic endonasal transsphenoidal hypophysectomy with intraoperative fetal monitoring at 30 weeks 1 day of gestation. At 39 weeks of gestation a cesarean section was performed due to the recent procedure. Her delivery and postpartum period were without complications. Discussion Pituitary apoplexy presenting in pregnancy is a rare and potentially life-threatening disorder due to an acute ischemic infarction or hemorrhage of the pituitary gland. Surgical management of the pituitary gland in pregnancy is rarely recommended, except in cases of severe visual disturbance and uncontrolled Cushing's disease.
Collapse
Affiliation(s)
- Megan Corn
- University of North Dakota School of Medicine and Health Sciences, Department of Obstetrics and Gynecology, Northeast Campus, 1301 N Columbia Rd, Grand Forks, ND 58203, USA
| | - Austin Nickell
- University of North Dakota School of Medicine and Health Sciences, Department of Obstetrics and Gynecology, Southeast Campus, 1301 N Columbia Rd, Grand Forks, ND 58203, USA
| | - Collette Lessard
- Altru Health System, Department of Obstetrics and Gynecology, 1000 S Columbia Rd, Grand Forks, ND 58201, USA
| | - Adam Jackson
- Sanford Health System, Department of Neurosurgery, 2301 25th St S, Fargo, ND 58103, USA
| |
Collapse
|
3
|
Nickell A, Sergev O, Alberto N, Bande D, Guerrero DM. Effectiveness of the vacuum assisted aspiration AngioVac system in the removal of intravascular masses. Catheter Cardiovasc Interv 2023; 101:1161-1165. [PMID: 36924019 DOI: 10.1002/ccd.30634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/16/2023] [Accepted: 03/03/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Invasive procedures used to manage intravascular masses such as vegetation from endocarditis, deep vein thrombosis, and septic emboli are associated with high rates of complications and mortality, especially in patients with several pre-existing comorbidities. A minimally invasive technique that has become more popular in recent years is the AngioVac procedure. This single-centered, retrospective study focuses on patient presenting comorbidities and indications for the procedure as well as postprocedural outcomes. METHODS A total of 33 patients who underwent an AngioVac procedure at Sanford Health between March 2014 and October 2019 was reviewed. Data were collected on pre-existing comorbidities, indication of procedure, length of stay, and postoperative outcomes. RESULTS We evaluated a total of 33 patients who underwent an AngioVac procedure for removal of intravascular mass. The most common indications for the procedure were endocarditis (24/33, 73%); intracardiac mass (5/33, 15%); and deep vein thrombosis or pulmonary embolism (2/33, 6%). Post-procedural blood transfusion was required in nearly half (15/33, 45%). Almost all patients (31/33, 94%) required intraoperative vasopressor use. Nearly all patients (32/33, 97%) were directed to the intensive care unit following the procedure with an average length of stay of 8 days (interquartile range: 3-13). Most common complications seen after the procedure were shock requiring vasopressors, (13/33, 39%), pleural effusion (9/33, 27%), and sepsis (4/33, 12%). Procedural success in this single-centered experience was 85% (28/33), which was defined as size reduction of the initial vegetation by >50% in the absence of severe intraoperative complications and absence of need for further valvular surgical intervention. CONCLUSION For surgically high-risk patients, the AngioVac procedure may offer a less invasive option in the management of right sided endocarditis requiring vegetation debulking, intravascular thrombi or cardiac masses.
Collapse
Affiliation(s)
- Austin Nickell
- University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, USA
| | - Orlin Sergev
- University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, USA
| | - Neville Alberto
- University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, USA.,Sanford Health, North Dakota, USA
| | - Dinesh Bande
- University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, USA.,Sanford Health, North Dakota, USA
| | - Dubert M Guerrero
- University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, USA.,Sanford Health, North Dakota, USA
| |
Collapse
|
4
|
Fisher C, Johnson K, Okerman T, Jurgenson T, Nickell A, Salo E, Moore M, Doucette A, Bjork J, Klein AH. Morphine Efficacy, Tolerance, and Hypersensitivity Are Altered After Modulation of SUR1 Subtype K ATP Channel Activity in Mice. Front Neurosci 2019; 13:1122. [PMID: 31695594 PMCID: PMC6817471 DOI: 10.3389/fnins.2019.01122] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 10/04/2019] [Indexed: 01/26/2023] Open
Abstract
ATP-sensitive potassium (KATP) channels are found in the nervous system and are downstream targets of opioid receptors. KATP channel activity can effect morphine efficacy and may beneficial for relieving chronic pain in the peripheral and central nervous system. Unfortunately, the KATP channels exists as a heterooctomers, and the exact subtypes responsible for the contribution to chronic pain and opioid signaling in either dorsal root ganglia (DRG) or the spinal cord are yet unknown. Chronic opioid exposure (15 mg/kg morphine, s.c., twice daily) over 5 days produces significant downregulation of Kir6.2 and SUR1 in the spinal cord and DRG of mice. In vitro studies also conclude potassium flux after KATP channel agonist stimulation is decreased in neuroblastoma cells treated with morphine for several days. Mice lacking the KATP channel SUR1 subunit have reduced opioid efficacy in mechanical paw withdrawal behavioral responses compared to wild-type and heterozygous littermates (5 and 15 mg/kg, s.c., morphine). Using either short hairpin RNA (shRNA) or SUR1 cre-lox strategies, downregulation of SUR1 subtype KATP channels in the spinal cord and DRG of mice potentiated the development of morphine tolerance and withdrawal. Opioid tolerance was attenuated with intraplantar injection of SUR1 agonists, such as diazoxide and NN-414 (100 μM, 10 μL) compared to vehicle treated animals. These studies are an important first step in determining the role of KATP channel subunits in antinociception, opioid signaling, and the development of opioid tolerance, and shed light on the potential translational ability of KATP channel targeting pharmaceuticals and their possible future clinical utilization. These data suggest that increasing neuronal KATP channel activity in the peripheral nervous system may be a viable option to alleviate opioid tolerance and withdrawal.
Collapse
Affiliation(s)
- Cole Fisher
- Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Duluth, MN, United States
| | - Kayla Johnson
- Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Duluth, MN, United States
| | - Travis Okerman
- Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Duluth, MN, United States
| | - Taylor Jurgenson
- Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Duluth, MN, United States
| | - Austin Nickell
- Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Duluth, MN, United States
| | - Erin Salo
- Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Duluth, MN, United States
| | - Madelyn Moore
- Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Duluth, MN, United States
| | - Alexis Doucette
- Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Duluth, MN, United States
| | - James Bjork
- Department of Biomedical Sciences, Medical School Duluth, Duluth, MN, United States
| | - Amanda H Klein
- Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Duluth, MN, United States
| |
Collapse
|
5
|
Joseph G, Nickell A, Cohen E, Burke NJ, Colen S, Lawlor K, Guerra C, Stewart SL. Abstract P4-10-05: Engaging linguistically and ethnically diverse low income women in health research: A randomized controlled trial. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p4-10-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Underserved breast cancer survivors are typically offered fewer opportunities to participate in cancer research. To address this disparity, a community based navigator program, Shanti's Margot Murphy Breast Cancer Program (Shanti) initiated a collaboration with UCSF researchers and BreastCancerTrials.org (BCT), a nonprofit clinical trials matching service to explore the potential role of a trusted community-based organization as a source of culturally appropriate education and access to clinical trial information. Through formative research, we developed the Health Research Engagement Intervention (HREI), a one-on-one navigator-client education session emphasizing the range of treatment and non-treatment quality-of-life and observational studies, conducted at a time when the participant is not in the initial crisis of diagnosis. The HREI ends by providing participants with an information card listing BCT and other organizations that provide information about health research for breast cancer patients and survivors.
Methods: We tested the HREI in a randomized controlled trial, comparing the HREI to simply providing the information card. Pre and post intervention surveys one month apart measured our primary outcome of health research information-seeking behavior. Secondary outcomes include health research knowledge, attitudes towards research participation, and health empowerment. All Shanti clients who spoke English, Cantonese or Spanish and had “low care navigation needs” (either completed treatment or no longer in the crisis of initial diagnosis and/or burdened by treatment protocols) were eligible.
Results: We recruited 133 Shanti Clients, including 59 who spoke English, 48 Cantonese, and 26 Spanish; 66 were randomized to the intervention arm and 67 to the control arm, and 130 completed both pre- and post-test surveys. Almost one-third of participants in both the intervention and control arms reported having talked to someone about health research or having called a telephone number or visited a website listed on the card (30% vs. 30%, p=0.94); a smaller proportion of participants confirmed that their information-seeking was related to the content of the educational materials (17% vs. 9%, p=0.22). On average the change from pre- to post-test in a 5-item knowledge score, adjusted for pre-test knowledge, was greater in the intervention group than in the control group (p=0.028), but the proportion of participants who were very confident that they could find health research information (had health empowerment) remained essentially unchanged in both study arms (intervention: 20% post vs. 21% pre, p=0.76; control: 25% post vs. 25% pre, p=1.00). Women were more likely to seek information if they had higher pre-test knowledge scores (odds ratio [OR]=3.5 per item, 95% confidence interval [CI] 1.5-8.4) or a greater increase in knowledge from pre- to post-test (OR=2.2 per item, 95% CI 1.1-4.7); there was no association between information-seeking and health empowerment (OR=0.6, 95% CI 0.2-2.5) or study arm (OR=1.6, 95% CI 0.5-4.9).
Conclusion: The HREI had a positive impact on knowledge of health research but did not significantly affect health empowerment or health research information-seeking behavior.
Citation Format: Joseph G, Nickell A, Cohen E, Burke NJ, Colen S, Lawlor K, Guerra C, Stewart SL. Engaging linguistically and ethnically diverse low income women in health research: A randomized controlled trial [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-10-05.
Collapse
Affiliation(s)
- G Joseph
- University of California, San Francisco, San Francisco, CA; The Shanti Project, San Francisco, CA; University of California, Merced, Merced, CA; University of California, Davis, Davis, CA; BreastCancerTrials.org, San Francisco, CA
| | - A Nickell
- University of California, San Francisco, San Francisco, CA; The Shanti Project, San Francisco, CA; University of California, Merced, Merced, CA; University of California, Davis, Davis, CA; BreastCancerTrials.org, San Francisco, CA
| | - E Cohen
- University of California, San Francisco, San Francisco, CA; The Shanti Project, San Francisco, CA; University of California, Merced, Merced, CA; University of California, Davis, Davis, CA; BreastCancerTrials.org, San Francisco, CA
| | - NJ Burke
- University of California, San Francisco, San Francisco, CA; The Shanti Project, San Francisco, CA; University of California, Merced, Merced, CA; University of California, Davis, Davis, CA; BreastCancerTrials.org, San Francisco, CA
| | - S Colen
- University of California, San Francisco, San Francisco, CA; The Shanti Project, San Francisco, CA; University of California, Merced, Merced, CA; University of California, Davis, Davis, CA; BreastCancerTrials.org, San Francisco, CA
| | - K Lawlor
- University of California, San Francisco, San Francisco, CA; The Shanti Project, San Francisco, CA; University of California, Merced, Merced, CA; University of California, Davis, Davis, CA; BreastCancerTrials.org, San Francisco, CA
| | - C Guerra
- University of California, San Francisco, San Francisco, CA; The Shanti Project, San Francisco, CA; University of California, Merced, Merced, CA; University of California, Davis, Davis, CA; BreastCancerTrials.org, San Francisco, CA
| | - SL Stewart
- University of California, San Francisco, San Francisco, CA; The Shanti Project, San Francisco, CA; University of California, Merced, Merced, CA; University of California, Davis, Davis, CA; BreastCancerTrials.org, San Francisco, CA
| |
Collapse
|