No abstract

Introduction: Hypercalcemia induced pancreatitis has a reported prevalence of 1.5-8%. Most reported cases have been secondary to hyperparathyroidism and few are secondary to malignancies or granulomatous diseases. Despite multiple myeloma (MM) commonly presenting with hypercalcemia, there are very few cases reported in literature of hypercalcemia induced pancreatitis in patients with MM. Case Description/Methods: A 70-year-old male with past medical history significant for MM and chronic kidney disease presented to the hospital with recurrent, constant dull epigastric abdominal pain, nonradiating, 6/10 in intensity, worsened by movement and deep inspiration with no relieving factors. He denied any associated factors. He has undergone a bone marrow transplant in 2017 for his MM but relapsed in 2019. On initial presentation workup was significant for pancytopenia, an elevated lipase level of 1170 and an elevated corrected calcium level of 15. Computed tomography (CT) of the abdomen and pelvis revealed no abnormality of the pancreas. MRCP ruled out choledocholithiasis and gallbladder US was negative for cholelithiasis. He denied alcohol use and triglyceride levels were not significantly elevated. Medication overview did not show any relevant medications that may induce pancreatitis. It was determined that the etiology of his pancreatitis was hypercalcemia in the setting of MM. Discussion: Hypercalcemia is present in 30% of patients with malignancy. MM commonly presents with hypercalcemia (19% of cases) but there are a handful of cases reported of calcium induced pancreatitis MM patients. Extensive workup is required to determine the etiology of acute pancreatitis starting from common to uncommon predisposing factors. In some cases it may remain cryptogenic. Multiple Myeloma patients may present with hypercalcemia in the setting of increased bone resorption caused by osteoclast activation. It is suggested that high serum calcium levels could be responsible for calcium deposit in the pancreatic ducts and activation of pancreatic enzymes, ultimately leading to pancreatitis. It is important as clinicians to keep in mind this rare presentation of hypercalcemia in MM patients in order to treat and manage the disease effectively and in a timely manner, improving patient outcomes. As calcium levels were normalized by hypercalcemia treatment, our patient's presenting symptoms significantly improved and later resolved.

No abstract

No abstract

INTRODUCTION: In 1975, the incidence of esophageal adenocarcinoma (EAC) was 0.4 cases per 100,000. In 2009, the incidence had risen by 5 fold to 2.58 cases per 100,000, making it one of the fastest growing cancers at this time. Esophagoduodenoscopy (EGD) is the gold standard for diagnosing Barrett’s esophagus (BE), which is a precursor to EAC. With the advent of new techniques of brush cytology sampling, there is potential to broaden our technology and our screening criteria for prevention. We present a rare case of a Latin female who was diagnosed with EAC after goblet cells were incidentally found on brush cytology. CASE DESCRIPTION/METHODS: A 73 year old Latin female with history of hiatal hernia, and H. Pylori presented with heartburn and abdominal pain. The EGD showed foveolar dysplasia at the gastric-esophageal junction. Wide Area Transepithelial Sample Biopsy With 3-Dimensional Computer-Assisted Analysis (WATS3D) showed goblet cell metaplasia. Repeat WATS3D confirmed these results and repeat forceps biopsy showed high grade dysplastic glands consistent with a well differentiated EAC. She underwent endoscopic ultrasound with biopsy and it was staged as T3N2Mx. She had a mucosal resection performed which showed poorly differentiated EAC and was referred to oncology. DISCUSSION: It is predicted that between 2011 and 2030, deaths related to EAC will double the number of those that died between 1991 to 2010. Some studies have shown increased detection rates of EAC precursors including those of BE and esophageal dysplasia (ED). For example, a 2010 study concluded that WATS3d brush biopsy allowed for substantial increases in the detection rates of BE by 39.8% and ED by 87.5%. Another 2017 study revealed an increase of 83% for BE and 88.5% for ED. Thus, cytology brush biopsies can help to diagnose high grade dysplasia and/or cancer with greater than 80% sensitivity and 95% specificity. It is also important to note that for women, the future incidence and mortality rates are also expected to rise in 2030 by approximately 9 times. The population we screen for BE is in white males over 50 who are symptomatic and with risk factors for BE or EAC. However, this is a rare case of a latin female that would not have fallen under these screening guidelines. Because of the rising incidence with worsening mortality contributing to the overall rise in EAC cases, we believe that it is imperative to broaden our screening criteria and to implement new tools such as brush cytology biopsies to a broader population as well.