Injections of crosslinking reagents into lumbar intervertebral discs after simulated decompression surgery restored joint stability according to all parameters. Similar results were found for genipin and methylglyoxal reagents. Implementing exogenous collagen crosslinking as an adjunct to current surgical decompression procedures may be beneficial in preventing or delaying subsequent spinal instability and degeneration.

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A 66-year-old woman with no significant medical history presented with acute-onset abdominal pain for 10 days and diffuse jaundice involving the conjunctiva, oral mucosa, and skin for 3 to 4 days. Initial laboratory studies demonstrated total bilirubin of 12.1 mg/dL, aspartate aminotransferase of 179 U/L, alanine aminotransferase of 180 U/L, and alkaline phosphatase of 959 U/L. An abdominal ultrasound scan showed common bile duct dilatation of 1.4 cm and pancreatic duct dilatation of 3.0 cm. A computed tomography scan of the abdomen-pelvis was performed, which showed severe intrahepatic and extrahepatic biliary dilatation and pancreatic ductal dilatation as well as extensive periportal, retroperitoneal, and mesenteric lymphadenopathy suspicious for an occult periampullary malignancy, as no tumor was identified. A computed tomography scan of the chest showed numerous bilateral ground-glass and solid pulmonary nodules within all lung lobes measuring up to 5 mm in greatest dimension. An endoscopic retrograde cholangiopancreatography was performed, which demonstrated a giant periampullary diverticulum with a high-grade distal biliary stricture. A sphincterotomy was performed, cytologic brushings were obtained, and the stricture was stented. On pathology, the brushing demonstrated ductal epithelial cells with mild atypia.

Development of post-chemotherapy histiocyte-rich pseudotumor (PHP) is an underrecognized event following therapy in lymphoma patients and may mimic residual tumor using current therapy monitoring protocols. We report a series of 5 patients with PHP along with a review of the literature. In our series, we describe 3 patients with persistent hypermetabolic masses by positron emission tomography-computed tomography, one with persistent terminal ileal nodules on endoscopy, and one with bone marrow involvement, a site not associated with mass-like disease. Twenty-three patients with long-term follow-up were identified from our series and review of the literature. Forty-four percent of patients received additional therapy, and only 4% of patients died of lymphoma. This study illustrates that PHPs are not identified using current lymphoma therapy monitoring algorithms and may result in overtreatment with risk for additional therapy-related complications. The need for confirmatory tissue biopsy in this setting is recommended.