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e16169 Background: Surgical resection can provide an increase in survival for incurable patients with cholangiocarcinoma (CCA); Since outcomes improve significantly with more aggressive intervention liver resection (LR) should be pursued together with common bile duct resection (CBDR). We aimed to analyze the trends of surgical management of hilar CCA also known as Klatskin tumor (KT) across 15 years in the U.S. Methods: We extracted two cohorts of hospitalizations from Nationwide Inpatient Sample (NIS) 2005-2019yy using ICD-9 and ICD-10 diagnosis and procedure codes for KT, CBDR and LR. First group of patients with KT had CBDR performed alone and the second group of KT patients received CBDR and LR during the same hospitalization. We compared mortality, performed socio-demographic analysis stratified by patient and hospital information and used length of stay (LOS) and mean charges (MC) as additional outcomes. Results: We extracted a total of 3,095 hospitalizations with KT that underwent CBDR alone or CBDR with LR. There was a transition in proportion of CBDR alone versus CBDR with LR across years, which we attribute to the change in coding from ICD-9 to ICD- 10, with the combined coding year 2015 demonstrating equalization of proportion of performed procedures prior to the flip in 2016. Since ICD-10 procedure coding was more specific for CBDR and LR, we as a result of this conclude that ICD-10 coding years 2016 and onward are more accurate and the latest trends demonstrate the increasing performance of only CBDR in KT patients rather than CBDR with LR (75% vs. 25% in 2019). Analysis of socio-demographics is presented in the Table. More than 2/3 of the patients were above age 60. Proportionally CBDR alone was more likely to be covered by public insurance than CBDR with LR (Public: 63.7% vs. 57.1%; Private: 34% vs. 40%). Even though it is a more invasive intervention, CBDR with LR had slightly less mean overall charges (MC=$223,903 for CBDR vs. $212,072 for CBDR with LR (P=0.5574)) and similar hospital resource utilization (LOS= 14 days for CBDR vs.14.7 days for CBDR with LR) compared to CBDR alone. Most of the procedures (>94%) were performed in teaching hospitals. Inpatient mortality was 5.5% for CBDR alone vs. 8.7 % for CBDR with LR. Conclusions: Our analysis demonstrated that for KT proportionally, CBDR performance is more prevalent than CBDR with LR in the latest years 2016-2019. Considering the comparable cost and hospital resource utilization with intent to cure, more aggressive surgical management should be pursued. Inpatient mortality was higher for more aggressive surgical management 5.5% for CBDR alone vs. 8.7% for CBDR with LR. Insurance type may play a role in the procedure choice. [Table: see text]

An 82-year-old woman admitted following a 4-week history of feeling unwell, abdominal pain and constipation. Initial investigations revealed severe hypercalcaemia with suppressed parathyroid hormone and elevated 1,25-dihydroxycholecalciferol. ACE was also raised. CT scans of the head, chest, abdomen and pelvis were normal. Fluorodeoxyglucose-positron emission tomography scan showed metabolically active right axillary lymphadenopathy which when biopsied under ultrasound guidance confirmed sarcoidosis. The patient was started on high-dose prednisolone with resolution of symptoms within 2 weeks. Isolated lymph node sarcoidosis is uncommon, and the reported usual sites are lymph nodes in the head and neck. Rarely has it been reported in the axillary lymph nodes.

An 85-year-old man was referred to endocrinology following the discovery of an incidental pituitary mass on cranial imaging which was thought to be a non-functioning adenoma during an admission with headaches, lethargy, confusion and hyponatraemia. He had a history of Hürthle cell carcinoma of the thyroid treated with total thyroidectomy, ablative radioiodine therapy and thyroxine replacement. Subsequently, he developed metastatic spread to the neck, lungs and skeleton. About 9 months later, the patient had deterioration of vision. MRI showed a rapidly expanding pituitary mass with compression of the optic chiasm. Biochemical investigations confirmed hypocortisolism and hypogonadism. The patient underwent trans-sphenoidal resection of the pituitary mass followed by external beam radiotherapy to the pituitary bed. Histopathology confirmed a metastatic deposit of Hürthle cell carcinoma, which is a rare and aggressive variant of follicular thyroid carcinoma.