Louisiana Research Day Program Book 2025

Case Studies: Section 1

Case Studies: Section 1

Kyra Salinkas, OMS-II; Sabeen Wazir, OMS-II; Berony Geneste, OMS-II; John Lipka, MD 1 VCOM-Louisiana 93 CHEMO AND SALIVARY SURPRISES: LOW-GRADE MUCOEPIDERMOID CARCINOMA IN A PEDIATRIC HODGKIN’S SURVIVOR

Samantha Valaitis, OMS-III; Savannah Newell, PhD; Clemens Soeller, MD 1 VCOM-Louisiana; 2 Franklin Medical Center RHC, Winnsboro, LA 92 OSTEOPENIA IN A 4-YEAR-OLD MALE: A CASE OF SUSPECTED NUTRITIONAL DEFICIENCY AND BONE DECONDITIONING

Context/Impact: Osteopenia in young chil dren is an often-underdiagnosed condition. This case underscores the importance of considering osteopenia as a potential cause of recurrent fractures in pediatric patients, particularly in the context of nutritional deficits and lack of physi cal activity. The case contributes to the growing body of literature on childhood osteopenia and highlights the potential for bone loss due to disuse and insufficient vitamin D intake in young children. Report of Case: A 4-year-old male was re ferred for evaluation following a left distal radial metaphyseal fracture and complaints of left leg pain with refusal to walk. According to the mother, the patient fell onto his forearm while standing, resulting in the fracture. He displayed pain and swelling of the left wrist, exacerbated by movement and palpation, but relieved by rest and immobilization. The patient had a history of a right foot fracture six weeks prior. Since the right foot fracture, the patient refuses to walk and had been carried everywhere. On physical examination, the child exhibited tenderness at the left wrist with limited range of motion due to pain. The left leg was not tender on palpation

with no obvious signs of acute trauma. There were no previous fractures documented prior to the two recent injuries. The patient states that he does not want to walk. Patient had left wrist immobilized and was told that he can no longer be carried. He was scheduled for repeat imaging in one week. Imaging studies revealed X-ray of the left wrist showed on going remodeling of the distal radial fracture with significant osseous bridging across the fracture line, indicating good healing. X-ray of the left foot revealed signs of osteopenia including a noticeable decrease in bone density in the tibia, fibula, and foot with no evidence of acute fracture. X-ray of the right foot demonstrated evidence of osteopenia that was not present at the initial fracture of the foot. Laboratory testing was notable for low-normal vitamin D levels at 27.5ng/mL (reference range >30 ng/mL). The patient’s history, including infrequent milk consumption and inadequate sun exposure, suggested a possible vitamin D defi ciency. Mother stated that the child still refuses to walk despite attempts to get child to walk on his own. The patient was diagnosed with osteo penia likely secondary to nutritional deficiency and physical inactivity. Treatment was initiated with vitamin D and calcium supplementation,

along with recommendations for weight bearing activities to improve bone strength and prevent further deconditioning. The patient was moni tored closely for additional fractures and referred to child physical therapy and psychiatry. Comments/Conclusion: This case highlights the importance of recognizing osteopenia in pediatric patients with recurrent fractures, especially in the context of poor nutrition and reduced physical activity. While osteopenia is often associated with secondary causes such as corticosteroid use or metabolic disorders, in this case, the child’s deficient vitamin D and prolonged period of non-weight-bearing like ly contributed to his bone demineralization. Literature supports that osteopenia in children can be multifactorial, with nutritional deficiencies and diseuse being key contributors. This case underscores the need for early intervention with dietary modifications, supplementation, and physical activity to prevent further bone loss in children with osteopenia.

Context: Mucoepidermoid carcinoma (MEC) is a rare but notable malignancy of the salivary glands (SGC), which is exceedingly uncommon in children and adolescents. MEC is characterized by a mixture of squamous cells, goblet-like mucin-secreting cells, and intermediate cells, which are arranged in various histological patterns. While MEC is the most common form of salivary gland cancer, it still represents a small proportion of all primary cancers, accounting for approximately 30 - 40% of all salivary gland cancers. Though MEC typically occurs as a secondary malignancy in patients who have undergone radiation therapy for Hodgkin’s Lymphoma (HL) or other cancers, the association with chemotherapy alone is much less well-established. Case Presentation: A 17-year-old female, with a history of Nodular Sclerosing Hodgkin’s Lymphoma and anemia, presents to the clinic with a painless hard lump between her mastoid process and mandibular process. Patient history revealed that at 11-years-old, the patient was diagnosed with stage IIIB Hodgkin’s disease and received the ABVE-PC chemotherapy regimen as treatment. The ABVE-PC regimen includes

Adriamycin, bleomycin, vincristine, etoposide, prednisone, and cyclophosphamide. Lack of bulk disease and complete response after two cycles of chemotherapy excluded this patient from receiving involved field radiation therapy (IFRT). Physical examination of the neck reveals a ~1.5 cm firm non-tender mass by the tail of the L. parotid. FNA biopsy results revealed spindle shaped cells and unusual mitoses- a superficial parotidectomy was recommended. During the parotidectomy, histologic findings revealed MEC of the parotid and a total parotidectomy was performed. The patient was then returned to anesthesia, was extubated in routine fashion and transported to the recovery room in good condition. During follow up, the patient reported pain upon beginning a meal potentially indicating First Bite Syndrome (FBS). Due to the second malignancy, genetic testing for major oncogenes and tumor suppressor gene mutations was conducted. Results were negative for any significant genetic mutations and chromosomal abnormalities. Six years later, the patient was diagnosed with a benign neoplasm of the shoulder.

Conclusion/Comments: The patient’s clinical course underscores the importance of vigilant long-term follow-up in childhood cancer survivors who undergo chemotherapy without IFRT regimens, as they may be at increased risk for developing secondary malignancies. Alkylating chemotherapy agents and immunosuppression increase the risk of secondary malignancies, though they have not been directly linked to MEC. This case suggests a potential association between chemotherapy treatment and the subsequent development of MEC, a rare but serious malignancy. Furthermore, raising the question of whether early detection and intervention guidelines are necessary for this vulnerable population.

106

107 2025 Research Recognition Day