Large Primary Neuroendocrine Tumor of the Liver in a 57-year-Old Female Presenting With MSSA Bacteremia

Primary neuroendocrine tumors (NETs) are rare forms of malignancy, representing just .5% of known cancers and having an overall incidence of 0.2/100,000. The most common sites of origin are bronchopulmonary and gastrointestinal, most commonly the appendix, pancreas, and ileum. We report the case of a 57-year-old female who was admitted for refractory MSSA bacteremia and several weeks of abdominal pain. CT imaging done on presentation demonstrated a 12.5 x 19.4 x 17.3 cm heterogeneous right liver mass with associated mass effect. The patient was taken to the operating room and a right hepatectomy and cholecystectomy were performed without complication. Histological examination revealed necrotic tumor in sheets and nests with marked nuclear pleomorphism. Immunohistochemistry demonstrated positive staining for pancytokeratin, synaptophysin, chromogranin, and TTF-1, consistent with undifferentiated NET. While rare, NETs can originate from a variety of organs outside the gastrointestinal and bronchopulmonary tract, including the liver.

Primary pulmonary angiosarcoma

Primary pulmonary angiosarcoma is a rare type of malignant vascular tumour with poor prognosis. Diagnosis is often late due to non-specific symptoms and low clinical suspicion for angiosarcoma. A 72-year-old man presented to hospital with a 6-month history of mild progressive dyspnoea, with associated cough, episodes of presyncope and weight loss. CT pulmonary angiogram (CTPA) was reported as a large saddle pulmonary embolism extending into both the right and left pulmonary arteries. Further Multidisciplinary team meeting (MDM) discussion, and review of CTPA and subsequent investigations revealed a large primary pulmonary artery sarcoma which was later confirmed histology. The patient was referred to the cardiothoracic surgeons and underwent left radical pneumonectomy.

P007 COMPLETE FASCIAL CLOSURE IN LARGE HERNIAS AFTER LIVER TRANSPLANT USING BOTOX

Aim Hernias after liver transplant (HaLT), being transverse, preclude mechanical muscle release for fascial advancement. However, even with large HaLT, complete fascial closure is possible following Botox muscle release. Material and Methods A retrospective review included 31 consecutive large primary HaLT repairs between 2017 and 2021. Patients were immunosuppressed, with BMI=33+/-5. Fascial defects were 13+/-5cm (range 7.5-28cm) transversely and 11+/-3cm (range 5-17cm) vertically. Botox was administered 29+/-3days preoperatively. After extensive myofascial mobilization, mesh was inserted intraperitoneally and covered with omental flap alone or with posterior components, followed by fascial closure, progressive tension sutures and drains. Results Operative time was 235+/-69min (range 111-418min), with no enterotomy or blood transfusion. Complete fascial closure was achieved in all. No mortality or abdominal compartment syndrome occurred. Two patients had long ICU stays (135 and 75days, aspiration and caecal necrosis), but were discharged with intact repairs, off dialysis and sound mentally. Other patients had a postoperative hospital stay of 5.8+/-2.2days (range 3-13days). Mean follow-up was 48+/-28.3 months (range 1-84 months). One patient with a mainly left sided repair developed a hernia on the right, beyond the mesh edge. No other recurrence or mesh infection occurred. One wound required open abscess drainage. Two seromas were aspirated. Conclusions Abdominal wall reconstruction with complete fascial closure is possible following abdominal muscle release with Botox, even in large HaLT. However, these immunosuppressed patients with multiple comorbidities may develop significant medical complications. One recurrence along the mesh edge suggests the need for complete incision mesh coverage, not just hernia coverage.

Identification of prodromal presentations of Parkinson’s disease among primary care outpatients in Germany

Background: This study aimed to identify clinical features that predate the diagnosis of PD in a primary care setting. Methods: This retrospective case-control study was based on data from the Disease Analyzer database (IQVIA) and included 17,702 patients with Parkinson’s disease and 17,702 non-PD controls matched for age, sex, and index year. We analyzed the prevalence of 15 defined diagnoses and symptoms documented within 2 years, ≥2 to <5, and ≥5 to <10 years prior to the index date in patients with and without PD. Logistic regression analyses were conducted to assess the association between PD and the predefined diagnoses. Results: The prevalence of motor, neuropsychiatric and autonomic features was higher in those with a later diagnosis of Parkinson’s disease than controls for all three periods except for rigidity in the ≥2 to <5 and ≥5 to <10-year periods and erectile dysfunction in the most recent period before diagnosis. The clinical presentation recorded in the greatest percentage of patients was depression, followed by dizziness, insomnia, and constipation, but these were also common in the control population. The odds ratios were highest for increase in tremor, followed by balance impairment and memory problems, particularly in the latest period before diagnosis, and by constipation particularly in the earliest period examined. Conclusion: The prodromal features of PD could be identified in this large primary care database in Germany with similar results to those found in previous database studies despite differences in methodologies and systems.

A novel class of small tRNA-like noncoding transcripts arising from the human NEAT1-MALAT1 region critically influences innate immunity and angiogenesis

Background The evolutionary conserved NEAT1-MALAT1 gene cluster encounters high interest in cardiovascular medicine and oncology. The cluster generates large primary transcripts which remain nuclear, whereas novel tRNA-like transcripts (mascRNA, menRNA) enzymatically generated from these precursors translocate to the cytosol. We previously found that NEAT1 and MALAT1 deficient mice display accelerated atherosclerosis and vascular inflammation due to immune dysfunctions. Methods While the previously investigated mice were deficient in the entire NEAT1 or MALAT1 locus, here we aimed to selectively disrupt only tRNA-like transcripts “menRNA” arising from NEAT1, or “mascRNA” arising from MALAT1. To none of these a biological function has been assigned so far. Both lncRNAs give rise to transcripts of vastly different size (NEAT1: 23kb MENb, 3.7kb MENe, 59nt “menRNA”; MALAT1: 8.3 kb primary, 59nt “mascRNA”), and traditional knockout methods are unable to selectively inactivate one of the small transcripts only. Through CRISPR/Cas9 editing we therefore developed human monocyte-macrophage cell lines with short deletions in the respective tRNA-encoding sequences to disrupt normal menRNA or mascRNA formation, respectively. These editing procedures do not affect transcription of the respective lncRNA parent transcripts, and also not disturb regular formation of the triple-helix structures at their 3'-ends which support stabilization of the respective lncRNAs (Fig. 1). Results We found the tRNA-like transcripts menRNA and mascRNA critically influence innate immunity and angiogenesis. In addition to common anomalies resulting from their selective CRISPR-Cas9 mediated deletion (Fig. 1), there are specific disturbances associated with either Δmasc or Δmen cells (Fig. 2). Both ΔmascRNA and ΔmenRNA human monocytes show profoundly altered ribosomal RNA/protein and tRNA-modifying enzyme expression, display anomalous growth/ angiogenetic factor expression, fundamentally change angiogenetic patterns in co-cultures with human endothelial cells, and have gravely disturbed innate immune responses (LPS, DNA and RNA viruses) (Fig. 1). CRISPR-engineered ΔmenRNA cells share remakable similarities with human post-MI PBMCs, suggesting the NEAT1-menRNA system may significantly contribute to post-MI residual inflammatory risk despite optimal standard therapy (Fig. 2). Conclusions Beyond prior work in knockout mice documenting immune function of the NEAT1-MALAT1 cluster, the current study identifies menRNA and mascRNA as important novel components of human innate immunity with relevance for angiogenetic processes. These data provide a second mechanistic link for the apparent relevance of the NEAT1-MALAT1 gene cluster in cardiovascular and malignant diseases. As prototypes of a novel class of small noncoding RNAs (distinct from miRNAs and siRNAs) they may constitute cytosolic therapeutic targets. FUNDunding Acknowledgement Type of funding sources: Other. Main funding source(s): DZHK Shared Expertise Project/B19-006_SE/FKZ 81X2100257/Transcriptome analysis of circulating immune cells to improve the assessment of prognosis and the response to novel anti-inflammatory treatments after myocardial infarction Figure 1. Common anomalies Figure 2. Specific anomalies

Isolated large renal hydatid cyst treated by laparoscopic nephrectomy

Hydatid disease is caused by Echinococcus granulosus, which causes rare isolated presentation in the kidneys, and is estimated to be about 2-4% of all cases. We herein present a case of a 45-year-old symptomatic male patient with a large primary hydatid cyst in the left kidney that was treated successfully by laparoscopic left nephrectomy.

Childhood Obesity Management at the 9-11 Year Well Child Check-An Opportunity for Expert Committee Recommended Comorbidity Screening

Our study assessed how primary care providers in a large outpatient network follow ECR guidelines with regards to laboratory screening for comorbidities of obese patients in the 9 to 11 year age group. This retrospective cohort study included 706 patients seen in an outpatient network with a 10 year well child check from 7/1/17 to 7/1/18 and a BMI greater than or equal to the 95th percentile. Our study found 42% of patients, who met ECR guidelines, had no lipid screening or obesity co-morbidity screening obtained. The most frequently abnormal test was the lipid panel, at 23%, and notably 16 % of Hemoglobin A1C screening resulted pre-diabetic range. Our study serves as an updated review of ECR compliance in a large primary care network and suggests an opportunity to enhance education on screening recommendations.