Gallbladder (GB) carcinoma is a rare carcinoma with a poor prognosis. The prevalence is 0.7-21/100,000 worldwide and 1-2/100,000 in the United States. Adenosquamous cell carcinoma is composed of glandular and squamous components. The overall five-year survival rate is less than 5%, with a median survival of fewer than six months. We are presenting a case of adenosquamous carcinoma of the GB in a 76-year-old female who presented with right upper quadrant abdominal pain and was found to have an enlarged GB, with thickened irregular wall likely inflammatory or malignant and mildly dilated common bile duct on ultrasound imaging of the abdomen. Core needle biopsy of GB showed findings compatible with adenosquamous carcinoma and immunohistochemistry was positive for P40, CK5,6. She was diagnosed with stage T4 N0 M0. She was started on chemotherapy with cisplatin and gemcitabine (25 mg/m2 and 1000 mg/m2), respectively, every three weeks but her condition worsened after the fifth cycle of chemotherapy and she decided to move forward with hospice care given her bad prognosis. Unfortunately, she passed away one week after being discharged home.

Introduction: Hemolytic Uremic Syndrome (HUS) is a condition characterized by progressive renal failure that is associated with microangiopathic hemolytic anemia and thrombocytopenia. It is a clinical syndrome which occurs as an immune reaction, most commonly after a gastrointestinal infection. Several studies have reported the prevalence of HUS among children but it is not well studied among adults. Studies have shown mortality rates ranging up to 20% and may go up to to 50% if HUS is complicated by end stage renal failure. There is limited data regarding HUS, especially among the adult population in regards to hospitalization trends and outcomes. In this study we aimed to describe the hospitalization trend, patient characteristics and in-hospital outcomes of HUS using a nationally representative database. Methods: Study cohort was from the Nationwide Inpatient Sample (NIS) for the years 2008-2017 for hospitalizations due to HUS by using International Classification of Diseases (9th/10th Editions) Clinical Modification diagnosis codes ICD-9-CM/ICD-10-CM). Other diagnosis and comorbidities were also identified by ICD-9/10-CM codes and Elixhauser comorbidity software. Our primary outcome was a discharge disposition following HUS hospitalization. We utilized multivariable survey logistic regression models to analyze and identify predictors of poor outcomes. Results: Between 2007-2018, a total of 8,043 hospitalizations occurred due to HUS. Hospitalization trend due to HUS increased from 528 (6.57%) in 2007 to 800 (9.95%) in 2013 and then reduced to 620 (7.7%) in 2018. Study cohort consisted of children <10 years of age (56.2%) followed by 18-65 years of age (24.7%). Out of total HUS patients, 74.4% were Caucasians and 59.3% were females. Overall in-hospital mortality of hospitalization due to HUS was 3.0%, and discharge to the facility was 15.7%. In trend analysis, the proportion of discharge to facility decreased from 23.1% in 2007 to 14.5% in 2018 but in-house mortality increased from 1% in 2007 to 3.2% in 2018. Median Length of hospital stay was 8-days (interquartile range 3-day to 15-days). Furthermore, in multivariable logistic regression analysis, age above 65 years (OR 2.5; 95%CI 1.4-5.8; p=0.0023), rural hospital (OR 17.9; 95%CI 8.9-36.1; p<0.001) and urban-non teaching hospital (OR 5.2; 95%CI 3.4-8.1; p<0.0001) and small-medium size hospitals were also associated with higher odds of discharge to facility among HUS patients. Conclusion: Our study estimates the epidemiology of hospitalizations due to HUS in the United States from a nationally representative database. In this study we observe that the burden of hospitalizations due to HUS has been increased over the study period. We also identified factors associated with poor discharge outcomes and some of which are modifiable. Further studies are warranted for developing strategies for better risk stratification of HUS patients to improve the overall outcomes. Disclosures No relevant conflicts of interest to declare.

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Ectopic breast tissue (EBT) is a rare entity and can present anywhere along the milk line, including the axilla, inframammary region, thighs, perineum, groin, and vulva. However, the axilla is the most common area of presentation. EBT can present as supernumerary breasts or aberrant breast tissue. Malignancy arising in EBT is rare, but the most common morphological variant is invasive ductal carcinoma. We report a case of a 43-year-old woman, a smoker with a family history of breast cancer, who presented to our clinic with a small mass in the right axillary area. After monitoring it for one year, the mass increased in size, so she returned to the clinic and decided with her care team to excise the mass. Histopathology showed invasive mammary adenocarcinoma arising in EBT and was diagnosed as right accessory stage I breast cancer. This case illustrates the imperative that any mass in the axillary region should be thoroughly assessed to rule out carcinoma in the accessory axillary tissue for timely management.

Mandal et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.