Auburn Research Day 2021

Cl i n i ca l Case Repor t | Med i ca l St udent Second Primary Malignancies Following Diagnosis of Small Cell Lung Cancer

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Brynn Hentschel, OMS-II; Caroline Houston, OMS-II; Alexys Ramos, OMS-II; David Stephen, DO Edward Via College of Osteopathic Medicine - Auburn Campus

Background: A patient’s life would forever change following a diagnosis of Small Cell Lung Cancer (SCLC). A second primary malignancy would only compound the severity of a life altering event. With occurrence of lung cancer and subsequent malignancies increasing, it is even more important to evaluate patients with classic symptoms. The rate of occurrence of a second cancer is high, starting at the first year of observed/expected incidence, through 10 years after diagnosis. (highest at first year, and slowly decreasing- ending with a multiplicative factor as high as 4.12) The type of second cancer is dependent on tissue affected, attributed causation, and lifestyle factors. Methods: Thorough review of 22 cases, articles and studies; discussing the treatment of SCLC, metastasis of SCLC to brain, recurrence of SCLC, prevention of second primary malignancy, multiple primary malignancies, general second primary malignancy in tissue and the evolution of SCLC treatment methods. Results: There was a correlation with increased age and stage of cancer resulting in worse outcomes and occurrence of second primary malignancy. The most common second primary malignancy was squamous cell carcinoma, most likely occurring in the

gastrointestinal tract, lung or uterus. Those who had any associated comorbidities saw frequency of cancer in associated areas, head and neck cancers correlated with a smoking history. The organ affected in the primary cancer is more likely to have a second cancer within the same organ or within organ systems. Conclusions: It seems that second primary malignancies are more common than expected when associated with Small Cell Lung Cancer. This is seemingly attributed to long term smoking/cigarette use, as well as following chemotherapy treatments. Comorbidity and lifestyle factors impact survival, recovery and recurrence in an immense way. As medicine continues to evolve there will need to be a further consideration for lifestyle factors and their resultant effect on the occurrence of second primary malignancy and prognosis overall.

Cl i n i ca l Case Repor t | Med i ca l St udent Fatal Coronary Artery Vasculitis with Mixed Features

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GW Birsic MS-1; BE Hentschel OMS-II; Dr. S Fiester; Michael Ward, MD; James Fulcher, MD Department of Pathology, Prisma Health, Greenville, SC

Atherosclerotic cardiovascular disease is often investigated by medical examiners as a cause of “sudden death.” Due to the variation in presentation of ASCVD, the examiner must be cautious when assigning a final diagnosis. The presented case depended on histology to reach a perplexing, final diagnosis that many would have overlooked. Postmortem diagnosis was fatal vasculitis due to presence of stenosis, vasculitis and classic Polyarteritis Nodosa-like changes within the heart. However, the patient lacked a hallmark of PAN: renal involvement. Further contradictory, the vasculitis within the liver showed a highly granulomatous appearance, more consistent with IgG4 disease. In these mixed appearance cases with limited history, exact categorization of the disease may prove difficult to impossible. The right coronary artery could be mistaken for atherosclerotic disease due to the classic yellow plaque with calcified deposits as seen without microscopic

assistance. This leads the examiner to assume an incorrect diagnosis. This case exemplifies the importance of histological examination of stenosing lesions. Under histological examination, the vessel contained a softer, circumferential white plaque that yielded periarteriolar granulomas. For this reason, a diagnosis of atherosclerotic cardiovascular disease was modified, in favor of a coronary vasculitis.

19 2021 Via Research Recognit ion Day