Faculty Bibliography

BACKGROUND/UNASSIGNED:Although vertebral hemangiomas (VH) are relatively common, aggressive symptomatic VH are rarely reported (i.e. in up to 11% of cases). Multiple other benign and malignant primary bone tumors must be considered in the differential diagnosis. Here, we review the clinical diagnosis and surgical management for aggressive hemangiomas, while also presenting 2 patients with thoracic lesions requiring posterior surgical decompression/fusion, with/without vertebroplasty, embolization, and/or CyberKnife radiosurgery. METHODS/UNASSIGNED:The classification system for these tumors ranges from Types I-IV; I Occupy < 50% of a vertebral body (VB), II-Occupy > 50% VB (IIb Thoracolumbar - Symptomatic), III-Occupy 100% VB, and IV-Occupy 100% VB involved plus extension into the pedicles, laminae, spinous process, and epidural space. RESULTS/UNASSIGNED:Radiographically (i.e. X-rays, MR, CT) these lesions originate in the vertebral bodies, but aggressive VH extend into the pedicles, laminae, spinous processes, and epidural space causing both spinal cord/root (i.e., myelopathy/radiculopathy)) compression. Surgical options include anterior, posterior, or circumferential decompressions with/without fusions, percutaneous vertebroplasty, embolization, radiation, and/or chemotherapy. Early treatment maximizes neurological recovery and limits/avoids permanent injury. CONCLUSION/UNASSIGNED:Aggressive VH are rare lesions that most frequently occur in the thoracic spine. Notably, the subset of Type IV lesions that extend into the pedicles, laminae, spinous processes, and epidural space may cause symptomatic myelopathy/radiculopathy warranting early surgical intervention to optimize neurological outcomes.

Percutaneous transhepatic biliary drainage (PTBD) is a common interventional radiology (IR) procedure typically used in the treatment of biliary obstruction when an endoscopic approach has failed or is not technically feasible. PTBD has a low overall complication rate with the Society of Interventional Radiology suggesting adverse event thresholds of 10% for major complications, 5.7% for hemorrhage, 2% for hemobilia, and 3.3% for death, with the average reported rates of each of these being significantly lower. However, in rare instances serious complications such as vascular injury occur. The present report describes a case of a 62-year-old woman with Non-Alcoholic Steatohepatitis (NASH) cirrhosis and remote Whipple procedure who developed symptomatic choledocholithiasis with failed Endoscopic Retrograde Cholangiopancreatography (ERCP). Interventional radiology was consulted for PTBD, which was complicated by an iatrogenic portobiliary fistula (PBF). Diagnosis required sequential imaging and procedural evaluation, as initial non-invasive computed tomography (CT) and initial portal venography failed to clearly demonstrate the connection due to catheter occlusion of the fistula. This case report focuses on the management of this complication, which was successfully treated with balloon-expandable covered stent placement in the biliary system and dual-tract coil embolization.

Lynch syndrome and BRCA-mutation associated malignancies are fortunately rare. Affected patients have an increased risk of cancer diagnosis at a young age, often significantly overlapping with their reproductive years. In helping these patients, oncologists must navigate the following areas of care: cancer prevention, impact of cancer prevention strategies on fertility, impact of cancer treatment on fertility, effective cancer therapies, and preservation of fertility without compromising oncologic outcomes. This intersectionality between fertility preservation and effective cancer prevention/therapy makes the care of these patients extremely complex. With the utility of multidisciplinary care models, careful employment of evolving new treatment strategies, it is possible for patients to achieve their fertility desires while at the same time being protected from the risks imposed by their genetic mutations.

BACKGROUND:Mild autonomous cortisol secretion causes substantial cardiometabolic morbidity, yet evidence for benefits following adrenalectomy remains mixed. Prior studies are limited by small sample sizes and heterogeneous definitions. This study evaluates the metabolic impact of adrenalectomy compared with nonoperative management in mild autonomous cortisol secretion using standardized biochemical criteria from the Epic Cosmos database. METHODS:Mild autonomous cortisol secretion was defined biochemically using dexamethasone suppression test cortisol 1.8-10 μg/dL, dexamethasone, and adrenocorticotropic hormone levels. Surgical patients underwent unilateral adrenalectomy with biochemical resolution of hypercortisolism. Inverse probability of treatment weighting was performed, adjusting for demographics, baseline cardiometabolic parameters, dexamethasone suppression test cortisol level, and glucagon-like peptide-1 receptor agonist use. The starting time point was the adrenalectomy date or, for nonoperative patients, the dexamethasone suppression test date plus the median time to surgery. Follow-up outcomes (A1C, lipid profile, body mass index, and blood pressure) were assessed for categorical improvement at last follow-up within 3 years using a weighted logistic regression model. RESULTS:From 2018 to 2025, 395 patients met inclusion criteria (54 surgical, 341 nonoperative). Surgical patients had a higher adjusted likelihood of categorical improvements in A1C (25.6% vs 9.5%, odds ratio, 3.30; P = .002), total cholesterol (14.6% vs 3.9%, odds ratio, 4.25; P = .004), and body mass index (24.9% vs 12.1%, odds ratio, 2.42; P = .018). There were no differences in blood pressure between groups (28.4% vs 26.7%, odds ratio, 1.09; P = .803). CONCLUSION/CONCLUSIONS:This is the largest cohort study to date evaluating metabolic outcomes after surgery for mild autonomous cortisol secretion. Adrenalectomy was associated with categorical improvement in A1C, body mass index, and total cholesterol, supporting more widespread consideration for selective operative management.

OBJECTIVES/OBJECTIVE:To compare growth z-scores and prematurity-related comorbidities for preterm infants receiving Soybean Oil-Intravenous Lipid Emulsion (SO-ILE) versus Soybean + Medium-chain triglycerides + Olive + Fish oil ILE (SMOF-ILE). STUDY DESIGN/METHODS:A multicenter, retrospective cohort study of 347 preterm infants <32 weeks' gestational age with birth weight ≤1500 grams who received SO-ILE or SMOF-ILE for at least seven consecutive days. RESULTS:SO-ILE group (n = 179) demonstrated significantly improved growth for length (p ≤ 0.001) and head circumference z-scores (p = 0.015) at 36 weeks' postmenstrual age and significantly worse growth for weight z-scores at 1 month (p = 0.017) compared to the SMOF-ILE group (n = 168). SO-ILE group had significantly lower rates of bronchopulmonary dysplasia (BPD) (p < 0.001) and urinary tract infections (UTI) (p = 0.045). CONCLUSION/CONCLUSIONS:In this population, SO-ILE had better outcomes for growth, BPD, and UTI compared to SMOF-ILE. Therefore, SO-ILE remains a reasonable lipid emulsion for preterm infants until more evidence is available.

BACKGROUND:Bispecific T-cell-engaging antibodies against BCMA and GPRC5D demonstrate high efficacy in relapsed/refractory multiple myeloma (RRMM) but are associated with cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), traditionally prompting inpatient monitoring when commencing therapy. Contemporary step-up dosing and prophylactic strategies may enable safe outpatient administration. PATIENTS AND METHODS/METHODS:We conducted a single-center retrospective study evaluating outpatient step-up dosing (SUD) of teclistamab or talquetamab in adults with RRMM. Patients met institutional outpatient eligibility criteria and received standard pre-medications; prophylactic tocilizumab was administered at physician discretion. The primary endpoint was incidence and severity of CRS/ICANS. Secondary endpoints included SUD completion, healthcare utilization, and need for hospitalization. RESULTS:Thirty-eight patients underwent 43 outpatient SUD initiations (teclistamab n = 30; talquetamab n = 13). Median age was 72 years, and disease burden was high. SUD completion occurred in 93%. CRS occurred in 26% of initiations and was exclusively grade 1-2; no grade ≥ 3 CRS occurred. One possible grade III ICANS event (2%) occurred after completion of SUD. CRS incidence was similar with and without prophylactic tocilizumab (29% vs 32%). Most events occurred during the first two step-up doses. Hospitalization occurred in 5 (12%) SUD initiations for CRS/ICANS events and overall healthcare utilization was modest. CONCLUSION/CONCLUSIONS:Outpatient administration of teclistamab and talquetamab SUD in RRMM is feasible and safe with low rates of low-grade CRS. Toxicities occur early and are manageable with structured monitoring, supporting outpatient delivery in appropriately selected patients.

Contact dermatitis (CD) is the 5th most common skin disease1 and affects 15-20% of the general population over their lifetimes.2 Currently, the T.R.U.E. TEST® is the only FDA-approved diagnostic product to aid in the diagnosis of Allergic Contact Dermatitis. To address that diagnostic gap, the US Food and Drug Administration held a public workshop in October 2025. These proceedings summarize the workshop presentations and discussions.

MOTIVATION/UNASSIGNED:Ferroptosis is an iron-dependent regulated cell death process involving lipid peroxidation, redox imbalance, and impaired antioxidant defense. It is increasingly relevant to metabolic liver disease and non-alcoholic steatohepatitis. Existing ferroptosis resources mainly provide gene annotations and disease associations, but they do not offer an integrated workflow for user-uploaded transcriptome data, liver-focused enrichment, dataset-level scoring, and ferroptosis-senescence cross-talk analysis. RESULTS/UNASSIGNED:We developed FerroEnrich, an open-source web platform for analyzing ferroptosis and senescence programs in human and mouse liver transcriptome datasets. FerroEnrich supports count matrix upload, metadata-guided differential expression analysis, identification of ferroptosis-prone and ferroptosis-resistant genes, dataset-level ferroptosis index scoring, sample-level susceptibility estimation, curated liver module enrichment, interaction network visualization, and ferroptosis-senescence cross-talk analysis. Application to human advanced non-alcoholic steatohepatitis and mouse diet-induced liver disease datasets demonstrated cross-species utility and identified conserved remodeling, including reduced ferroptosis-protective signatures and increased senescence- and fibrosis-associated modules. AVAILABILITY AND IMPLEMENTATION/UNASSIGNED:FerroEnrich is freely available at https://ferroenrich.shinyapps.io/ferroenrich/. Source code, documentation, and demo datasets are available at the FerroEnrich GitHub repository.