Louisiana Research Day Program Book 2025

Case Studies: Section 2

Case Studies: Section 2

115 A RARE CASE OF NON-ASBESTOS RELATED PERITONEAL MESOTHELIOMA

116 UTERINE FIBROIDS WITH IVC COMPRESSION; A RARE CAUSE OF DEEP VEIN THROMBOSIS

Jeni Kandel, MD 1 ; Nisheem Pokharel, MD 1 ; Aaphtaab Dheendsa, MD 1 ; Navin Ramlal, MD 1 ; Pamraj Sharma MD 1 1 St. Francis Medical Center

Rahul Robaish Kumar, MD 1 ; FNU Arti, MD 1 ; Sham Kumar, MD 1 ; Harikrishna Bandla, MD 1 ; Navin Ramlal, MD 1 1 St. Francis Medical Center Internal Medicine Graduate Medical Education, Monroe, LA

Introduction: Peritoneal mesothelioma is a rare variant of pleural mesothelioma involving the mesothelial cells lining the peritoneum accounting for about 500 cases a year in the US. Mesothelioma is typically associated with asbestos exposure. Here, we describe a non-asbestos related case of peritoneal mesothelioma. Case Summary: A 61-year-old female with a history of breast cancer in remission had a workup done for elevated liver enzymes that revealed small liver nodules on MRI. Follow up MRIs in subsequent years revealed concerning spot near the left diaphragm, that prompted additional imaging with a nuclear medicine liver scan. It confirmed the presence of this potentially malignant nodule. Furthermore, PET/CT revealed concerning nodules near her left diaphragm and in her right lung. A biopsy of the diaphragmatic nodule was performed, which revealed a papillary epithelioid tumor, consistent with mesothelioma. She subsequently underwent surgery to remove the tumor and received heated chemotherapy (HIPEC). She reported no history of asbestos exposure. However, after 4 years, follow-up scans showed

signs of mesothelioma’s recurrence which was furthermore confirmed with biopsy and she underwent another surgery to remove the cancer, along with HIPEC. Discussion: Peritoneal mesothelioma is a rare and fatal cancer primarily caused by exposure to asbestos. Without treatment, patients typically survive about a year and around five years even with aggressive treatment. This cancer is difficult to diagnose early because of nonspecific symptoms such as abdominal pain, swelling, and digestive problems. Adding to the challenge is the long delay between asbestos exposure and the onset of symptoms, which can be decades. Furthermore, lower suspicion in patients not exposed to asbestos makes the condition difficult to identify and treat the cancer in its early stages. The primary treatment approach involves surgery to remove as much of the tumor as possible, followed by heated chemotherapy delivered directly to the abdomen (HIPEC). Despite the aggressive nature of this disease, research continues to explore more effective treatments. Understanding the unique aspects of this disease is crucial for patients, caregivers, and healthcare professionals alike,

as it underscores the importance of awareness, early detection, and personalized treatment strategies in managing this challenging cancer.

Introduction: A deep venous thrombosis (DVT) is a serious vascular condition that is typically associated with identifiable risk factors such as immobilization, surgery, or coagulation disorders. DVT’s can be classified as provoked when they occur secondary to identifiable risk factors or unprovoked when they occur without any clear triggers or underlying conditions. This case report details the unusual presentation of a patient who presented with a provoked left lower extremity DVT in the setting of extensive uterine fibroids leading to inferior vena cava (IVC) compression. Case Presentation: A 46-year-old female presented with left lower extremity swelling and pain that had been going on for 4 days. Initial blood work was significant for iron deficiency anemia and elevated D- dimer levels. Work up with a left lower extremity ultrasound was significant for a deep vein thrombosis (DVT) extending from the femoral to the popliteal vein. Initial management included therapeutic enoxaparin and mechanical thrombectomy, which she tolerated well. Notably, examination of the patient’s lower abdomen showed marked firmness and a palpable mass. Upon further questioning, it was discovered that the patient had a history of menorrhagia for

several months and over the course of this hospitalization, her hemoglobin levels dropped below 7 for which she required transfusion. This prompted further investigation with CT abdomen/ pelvis, which revealed marked enlargement of lobulated uterus with suspicion of mass effect on the IVC and iliac veins. MRI abdomen confirmed compression by her fibroids on the IVC. Decision was made to proceed with hysterectomy to address both the symptomatic fibroids and the associated DVT. Postoperative histopathology confirmed benign fibroids. Conclusion: This case emphasizes the intricate relationship between anatomical anomalies, like uterine fibroids that can potentially lead to IVC compression resulting in an increased risk for thrombosis leading to DVT formation in the absence of typical risk factors, emphasizing the need for thorough clinical assessments. The management strategy is variable, illustrating the importance of addressing underlying thrombotic risk factors and consideration of both atypical causes and anatomical factors in evaluating and managing DVT in women with unusual symptoms and other hematologic conditions.

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131 2025 Research Recognition Day