Pseudohyperkalemia in the context of chronic lymphocytic leukemia (CLL) is becoming a common clinical presentation in our daily practice, yet the recognition and the overall approach to this condition remains a challenge as clinicians ponder on whether it's a true rise of serum potassium or not, weighing the riskbenefit ratio of giving the full anti-hyperkalemia measures, dreading the potential iatrogenic hypokalemia if it proves to be a pseudohyperkalemia instead.

Background: Struma peritonei is an extremely rare presentation of struma ovarii. Case: Here we report the case of a 38-year-old woman with a history of papillary thyroid cancer, left ovary struma ovarii, ruptured mature cystic teratoma of the right ovary, and endometriosis presenting with pelvic pain, dysmenorrhea, abnormal uterine bleeding, and infertility. A diagnostic laparoscopy was performed to evaluate for recurrence of endometriosis. However, multiple abnormal appearing lesions were found on her left hemidiaphragm and left abdominal wall. The tissue was identified as ectopic thyroid tissue identical to the patients ruptured mature cystic teratoma which occurred 15 years prior. A second subsequent laparoscopy was performed to excise the lesions. Eleven additional lesions were identified as ectopic thyroid tissue. This peritoneal dissemination was likely a result of tissue seeding post-mature teratoma rupture. Conclusion: Gynecologists should consider the possibility of struma peritonei in patients who have a history of papillary thyroid cancer and struma ovarii who present with significant pelvic pain and abnormal uterine bleeding.

Introduction/Objective Large B-cell lymphoma (LBCL) with IRF4 rearrangement is a new entity described in the 2017 WHO classification. It is characterized by a monotonous proliferation of medium to large sized cells with strong expression of IRF4/MUM1 and IRF4 rearrangement. It accounts for only 0.05% of all diffuse LBCLs and affects predominantly children and young adult with median age of 12 years. The reported sites of disease include lymph nodes of head and neck, Waldeyer ring and gastrointestinal tract. Here, we report two cases of Large B-cell Lymphoma with IRF4 rearrangement in two female patients, 73-year old and 71-year old respectively. The first patient presented with a lung nodule, while the second presented with right palatine tonsillitis. Hematoxylin and Eosin staining, immunohistochemistry and Fluorescence In-Situ Hybridization were used to characterize the lesions. H&E stained sections of the lung nodule biopsy from the first patient showed diffuse proliferation of medium- to large-sized cells (Figures A and B). Immunohistochemistry shows tumor cells are positive for CD20 (figure C), CD10, BCL6, and IRF4/MUM1(figure D). FISH study shows that tumor cells carry the IRF4 rearrangement but are negative for MYC, BCL2, and BCL6 translocations. To the best of our knowledge, this is the first case of LBCL with IRF4 rearrangement reported involving the lung in an older patient. H&E stained sections of the right palatine tonsil from the second patient shows effacement of the normal architecture which is replaced by sheets of large lymphoid cells. Immunohistochemistry shows tumor cells positive for CD20, CD10, BCL-6, BCL-2, MUM-1, C-MYC, and Ki-67 (80%). FISH study shows that tumor cells carry the IRF4 rearrangement which is consistent with a diagnosis of LBCL with IRF4 rearrangement. Methods/Case Report NA. Results (if a Case Study enter NA) NA. Conclusion NA.

BACKGROUND Uncertainty remains over the relationship between blood pressure variability (BPV), measured in hospital settings, and clinical outcomes following acute ischemic stroke (AIS). We examined the association between within-person systolic blood pressure (SBP) variability (SBPV) during hospitalization and readmission-free survival, all-cause readmission, or all-cause mortality at 1 year after AIS. METHODS In a cohort of 862 consecutive patients (age [mean ± SD] 75±15 years, 55% women) with AIS (2005-2018, follow-up through 2019), we measured SBPV as quartiles of standard deviations (SD) and coefficient of variation (CV) from a median of 16 SBP readings obtained throughout hospitalization. RESULTS In cumulative cohort, the measured SD and CV of SBP in mmHg were 16±6 and 10±5, respectively. The hazard ratios for the highest vs. lowest quartiles was 1.44 (95% confidence interval 1.04 – 1.81) for SD and 1.29 (95% confidence interval 0.94-1.78) for CV after adjustment for demographics and comorbidities. Similarly, incident readmission or mortality remained consistent between the highest vs. lowest quartiles of SD and CV (readmission: HR 1.29 [95% CI 0.90-1.78] for SD, HR 1.29 [95% CI 0.94-1.78] for CV; mortality: HR 1.15 [95% CI 0.71-1.87] for SD, HR 0.86 [95% CI 0.55-1.36] for CV). CONCULSIONS In patients with first AIS, SBPV measured as quartiles of SD or CV based on multiple readings throughout hospitalization have no independent prognostic implications for the readmission-free survival, readmission, or mortality. This underscores the importance of overall patientcare rather than a specific focus on BP parameters during hospitalization for AIS.