Louisiana Via Research Day Book 2026

Case Studies: Section 1

Case Studies: Section 1

Emily Hootsell, DO; Stephanie Aldret, DO VCOM-Louisiana 67 A PRESENTATION OF RENAL CELL CARCINOMA RECURRENCE POST NEPHRECTOMY: A CASE REPORT

Hannah Canter, DO 1 ; Paula Sharkey, MD 2 1 VCOM-Louisiana; 2 Department of Radiology, Opelousas General Health System, Opelousas, Louisiana 68 AN ANOMALOUS PRESENTATION OF BILATERAL FEMORAL HEAD AVASCULAR NECROSIS: A CASE REPORT

Context: Renal cell carcinoma (RCC) is the most predominant type of kidney cancer. Bilateral renal cancer is a rare presentation occurring in approximately 1-5% of people who are diagnosed with this condition.

or left nephrectomy. Intravenous antibiotics, hemodialysis, and bowel rest were initiated at the discretion of the surgical team. Medical management was to be continued following discharge from the hospital. Conclusions: This case of bilateral papillary renal cell carcinoma (pRCC) shows the importance of adequate surveillance post nephrectomy to monitor for recurrence and metastasis although rare. It involves a patient that had a suspected metachronous presentation with multifocal disease involving the presence of three tumor lesions within the left kidney post right nephrectomy. Given the patient’s age and recurrence of pathologic disease, it is thought she may be susceptible to a genetic mutation. Gene alterations of amplification or mutation of the MET protooncogene are seen with pRCC. This is usually in sporadic pRCC rather than familial pRCC. Presentation of renal cancer in a bilateral manner has been noted in up to 5% of patients with or without a hereditary disease. Bilateral RCC can present synchronously or metachronously within a few months or years after initial diagnosis. Additionally, a majority of

bilateral RCC patients also have a higher level of multifocal disease. The survival rate of patients diagnosed with pRCC versus non papillary is higher. Methods: WorldCat; Renal Cell Carcinoma, Papillary Renal Cell Carcinoma, Renal Cell Carcinoma Recurrence

Context: Avascular necrosis (AVN) of the femoral head is a debilitating condition caused by compromised blood supply to the proximal femur, often resulting in collapse of the femoral head, especially when not detected early. While risk factors for AVN include trauma, corticosteroid use, alcohol consumption, and sickle cell anemia, a significant percentage of cases present without identifiable risk factors, suggesting alternative etiologies such as a genetic predisposition. Report of Case: A 42-year-old male presented with the complaint of bilateral hip pain radiating to his groin, made worse with weight bearing. Initial imaging revealed bilateral degenerative arthrosis of the hips with no acute fractures, dislocations, or signs of osteonecrosis. Due to persistent symptoms and functional decline interfering with his occupation, a bilateral hip MRI was obtained, revealing significant bilateral avascular necrosis. Although he had no known risk factors for the disease, he had a maternal family history of bilateral AVN. He had undergone physical therapy and serial joint injections with minimal relief and ultimately opted for definitive joint replacement.

Conclusions: A literature review was conducted using WorldCat through VCOM online library to identify peer-reviewed journal articles utilizing the terms avascular necrosis of the femoral head, idiopathic avascular necrosis, and familial avascular necrosis. In addition, Radiopaedia was briefly utilized to provide radiology imaging support. The current research on avascular necrosis of the femoral head largely focuses on the diagnosis and management of well-established risk factors. Much of the literature focuses on the importance of early detection with MRI and treatment to prevent the progression requiring hip arthroplasty. In this case, his presentation, diagnosis and workup were consistent with those in the literature. The greatest contrast is his lack of known risk factors for AVN with a maternal history of bilateral AVN. Although literature supporting a genetic component remains limited, one article suggests a heterozygous c.3508G>A mutation in the COL2A1 with autosomal dominant inheritance.

Report of Case: A 49-year-old female presented with three days of new onset

abdominal pain, nausea, vomiting, and fatigue. She had a history of obesity, hypertension, and renal failure on hemodialysis, as well as papillary renal cell carcinoma of her right kidney which had been removed several years prior. She denied urinary complaints currently. She had been inconsistent with follow ups post nephrectomy although on hemodialysis for renal failure. In the emergency department, computerized tomography of her abdomen and pelvis showed acute diverticulitis of the mid-descending colon with a small, contained perforation as well as findings suggesting pyelonephritis. Additionally, incidental findings of heterogeneously enhancing masses in her anterior, medial, inferior left kidney concerning for renal cell carcinoma. She was admitted to the hospitalist team for medical management as she was not a surgical candidate for bowel resection

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2026 Research Recognition Day