ORAL PRESENTATIONS – STUDENTS
RARE ADULT GRANULOSA CELL TUMOR (AGCT) PRESENTING WITH SYMPTOMS OF A BENIGN OVARIAN FIBROMA Aniko Nowakowski, M. Patrick Stagg, Mina Khodabandeh; LSUHSC School of Medicine, New Orleans, LA.
Introduction: Adult-type granulosa cell tumors (AGCT) account for 2-5% of all ovarian malignancies. ACGT is usually present with abdominal distention and hyperestrogenism. Most cases are associated with a FOXL2 mutation and increased serum inhibin. AGCT is likely to recur, yet the overall prognosis is favorable. We report a rare case of AGCT presenting with massive ascites and bilateral pleural effusion, features of Meig’s triad. Because of the unusual presentation, the accurate diagnosis of this rare malignancy was delayed. Case: A 55-year-old female with heart failure and hypertension who presented with abdominal distention and shortness of breath on mild exertion. Her symptoms had progressed for 6 months. She reported over 40-lbs. of weight loss, lower extremity edema, and vaginal spotting. Physical examination revealed reduced lung sounds, abdominal fluid and mass, and a bilateral 3+ edema of knees. Imaging confirmed ascites, pleural effusion, and ovarian mass. Low-SAAG ascites and exudative effusion were found. Cytology reported effusions contained atypical cells. Ca-125 was 892. The pleural effusion recurred in 2 weeks. A Pleurx catheter was
placed, and image-guided biopsy of suspicious omental mass revealed Round cell neoplasm.
Because of her severe symptomatology and uncertain diagnosis, an abdominal hysterectomy and bilateral salpingo-oophorectomy with peritoneal staging was performed. Samples obtained from ascitic fluid, retroperitoneal lymph nodes, omentum, appendix, peritoneum, and paracolic spaces were all negative for malignancy. Pathologic evaluation revealed left ovarian mass which was focally positive for AE1/AE3, SMA KIT, and PAX. Negative for CK7, CK 20, S100, CD34, chromogranin, DOG CD3, CD20and BCL1. Pathologic consultation confirmed AGCT diagnosis, stage 1 (pT1, PN0). The patient is in remission, being followed with CT scans and inhibin levels. Discussion: Middle-aged women with AGCT rarely present with abdominal or lower extremity swelling and shortness of breath. They are likely to be initially misdiagnosed if they have comorbidities, such as obesity, COPD, heart failure, cirrhosis, or history of DVT. The prevalence of this clinical scenario in benign ovarian fibroma can also make the diagnosis challenging. AGCT should be considered in the differential when encountering these symptoms.
STROKE AND COVID-19: A REVIEW OF CASE REPORT TRENDS Mahant Malempati, Ifechukwude J. Biose, Timothy E. Gressett, Gregory J. Bix; Tulane University School of Medicine, New Orleans, LA.
Introduction: The mechanisms by which COVID induces stroke are not entirely understood however, one hypothesis is that COVID-19 contributes to this increased incidence because of cytokine storm, thrombosis, platelet activation, extrinsic and intrinsic coagulation pathway activation, endothelialitis, and neutrophil extracellular traps (NETs) Methods/Results: We discuss a series of case reports of patients who had a stroke while hospitalized with COVID. Patients were selected using PubMed and Google Scholar. Inclusion criteria were recent cases (limited to 2019-2022) in English language publications only. Systemic reviews were excluded
from the search. We then performed an analysis on the following variables for all 68 patients: age, Covid Induced Stroke (CIS), Stroke then Covid (STC), Covid and Stroke (CAS), NIHSS score, type of stroke, mortality, functional outcomes, and comorbidities listed. In addition, we compared the distribution of comorbidities, stroke type, sex, and age. We found that most patients admitted to the hospital for COVID-19 subsequently developed a stroke (55/68). Interestingly, among the cases we included in our study, hypertension (36/67) was prevalent in more patients than diabetes mellitus(22/67) compared to other comorbidities. This finding has been corroborated across other 42
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