POSTER PRESENTATIONS – STUDENTS
THE MOLECULAR OLIGOASTROCYTOMA Nathaniel Untch, Darshan Trivedi, MD, PhD, Joseph Keen, DO; University of Queensland - Ochsner Clinical School, New Orleans, LA.
Introduction: Oligoastrocytomas, once a perplexing subgroup of central nervous system (CNS) tumors, have undergone a transformative reevaluation in recent years. First described by Celli et al. in 1994 to describe oligodendroglial tumors where astrocytes formed more than 20% of the tumor, significant diagnostic ambiguity persisted due to difficulty accurately determining tumor composition. Due to progress in molecular diagnostics in 2016, oligoastrocytoma was removed from the WHO brain tumor classification and reclassified as astrocytoma or oligodendroglioma based on characteristic mutations like IDH1 and 1p/19q codeletion, respectively. Our case proposes the obsolescence of oligoastrocytoma, providing molecular evidence that such tumors exist. Case: A 50-year-old female presented with two days of lower extremity weakness, diarrhea, and lethargy. The glascow coma scale was 15, intact sensation, and antigravity strength in all extremities. CT of the brain without contrast revealed a 3.9 x 5.0 cm area of low density in the high left frontal-parietal vertex and 3 mm of midline shift. An MRI of the brain with and without contrast further showed infiltration of the superior frontal and cingulate gyri with small intralesional hemorrhage and minimal perilesional edema, concerning a low-grade glioma. T2 weighted imaging showed a hyperintense, non-contrast
enhancing lesion with a T2/FLAIR mismatch sign with 100% specificity for IDH-mutant, 1p19q non-co deleted astrocytomas. 44 days later, she underwent a maximal safe resection with >80% resection of the mass. Intraoperative specimens returned consistent with a low-grade glioma demonstrating low-grade infiltrative glial neoplasm. Chromosomal microarray analysis performed by Mayo Clinic Laboratories revealed IDH1, TERT promoter, and TP53 mutations and a partial 1p loss with monosomy 19, completing a histologic and molecular analysis containing the features of both oligodendroglioma and astrocytoma. A final diagnosis of Astrocytoma, IDH-mutant CNS WHO Grade 2, noting this tumor possesses the unique characteristics of an emerging dual- genotype IDH-mutant oligoastrocytoma. The patient is currently recovering well and receiving ongoing adjuvant radiation to the T2 FLAIR plus margin. Discussion: Given that this tumor possesses 1p/19q and TERT mutations characteristic of oligodendroglioma and IDH1 mutations characteristic of oligodendroglioma and astrocytoma, we propose reconsidering oligoastrocytoma as a diagnosis since an increasing collection of such tumors will be uncovered as the prevalence of molecular testing continues to grow.
SGLT-2 INHIBITORS: WONDER DRUGS? NOT SO FAST Kristen Williams, Mandie DiMarco, Jack Hebert, William Gibson MD, Domonique Smith MD, Brian Coe MD, Arash Ataei MD, Kyle Hoppens; LSU Health School of Medicine, New Orleans, LA.
Introduction: Sodium-Glucose transport Protein 2 Inhibitors (SGLT2i) were originally introduced to manage type 2 diabetes mellitus (T2DM), but now have indications for chronic heart failure and chronic kidney disease. The most common side effects are directly associated with increased urine glucose including female genital mycotic infections, urinary tract infections, and polyuria. An uncommon but serious adverse event is Fournier’s gangrene. Although rare, the often-devastating effects should be taken into consideration when initiating an SGLT2i in patients with increased risk.
Case: A 75-year-old woman with a history of chronic heart failure, type 2 diabetes, and obesity with recent hospitalizations for syncope with a right atrial thrombus treated with thrombolytics and another hospitalization for heart failure exacerbation where she was discharged with empagliflozin presented for five days of progressive altered mental status where she declined from her baseline function to a nonverbal state with decreased responsiveness. In the ED, she was febrile and hypotensive. She was intubated for airway protection and vasopressors and antibiotics were 51
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