ABSTRACTS FROM THE 2019 ANNUAL LOUISIANA AMERICAN COLLEGE OF PHYSICIANS ASSOCIATES MEETING Each year medical students from the four medical schools and residents from the eight Internal Medicine training programs in Louisiana are invited to submit abstracts for the Annual Louisiana American College of Physicians (ACP) Associates Meeting. The content of these abstracts includes clinical case vignettes or research activities. The abstracts have all identifying features removed (i.e., names, institutional affiliations, etc.) before being sent to physician judges. Each judge scores each abstract independently and then the scores from all judges are averaged and ranked. This year we are excited to be able to publish the 15 most highly ranked abstracts presented at this year’s competition that were selected for oral presentations. An Additional 12 abstracts presented as posters (out of 92 total) were selected by judges for publication. All abstracts (15 oral and 12 poster) were presented at the Associates Meeting held at The Louisiana Cancer Research Center in New Orleans on January 22, 2019. We would like to thank the Journal of the Louisiana State Medical Society and appreciate its efforts to publicize the hard work of these trainees.
Shane Sanne, DO Chair , Louisiana Associates Liaison Committee Lee S. Engel, MD, PhD, FACP Governor , Louisiana Chapter ACP
METASTATIC EMBRYONIC CARCINOMA: AN ATYPICAL TRIGGER FOR ACUTE PANCREATITIS J. Nguyen; C. Jones Department of Internal Medicine Tulane University Health Sciences Center, New Orleans *Presented as a mystery case Introduction: Acute pancreatitis is sudden inflammation of the pancreas that may be mild or life threatening. The usual causes include hypertriglyceridemia, alcohol abuse, and obstructing gallstones or pancreatic mass. Case: A 29 year old man with a past medical history of pancreatitis presented with abdominal pain, which began three days prior to admission. He complained of nausea, vomiting, dark color urine, and epigastric pain. Physical examination demonstrated diffuse abdominal tenderness and palpable right and left
patient included a total of 4 cycles Bleomycin, Etoposide and Cisplatin with follow up CT scans and possible surgical consultation if residual mass is present after chemotherapy. Discussion: In a young, otherwise healthy patient, it is tempting to ascribe pancreatitis to benign, common causes. However, if the history is unrevealing for these underlying causes, a thorough search is necessary. Unanticipated metastatic embryonic carcinoma causing obstructive lymphadenopathy is an extremely rare cause of pancreatitis, but malignancy of all causes deserves to be on the differential diagnosis.
inguinal lymph nodes. An abdominal CT revealed bulky retroperitoneal conglomerate masses and peritoneal lymphadenopathy. Fine needle aspiration and biopsy of the mass revealed reactive lymphadenopathy raising concerns for metastatic carcinoma. Furthermore, labs illustrated elevations in alpha fetoprotein, LDH, and BhCG. MRI/ MRCP then revealed a massive necrotic retroperitoneal mass that was impinging the proximal common bile duct. Gastroenterology was consulted and a biliary stent was placed by ERCP. Although testicular/ scrotal ultrasound revealed no masses, it is being considered as the primary source of the metastatic mass due to additional stain results. Pathology results showed that the mass was SALL4 (positive), and OCT3/4 (focally positive). These results were suggestive of a metastatic carcinoma with embryonic carcinoma and less likely of other extragonadal germ cell tumors. Per recommendations from Hematology/ Oncology, the treatment plane for the
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