Collins, C. Scott

ABSTRACT Introduction Introduction:: Chronic scrotal content pain (CSCP) is generally defined by persistent and bothersome pain present for > 3-months. This symptom complex leads to frustration for patients and providers alike, as the underlying etiology varies and in many instances is unknown. Scrotal pain may arise from outside the scrotal contents, as is seen with musculoskeletal conditions involving the hips, lower back, and pelvic musculature. Identifying those patients who have signs or symptoms of a musculoskeletal etiology earlier in their clinical course will allow for a more streamlined treatment pathway and minimize the need for unnecessary referrals. Objective To review historical and examination findings in patients presenting to a tertiary care center for evaluation of chronic testicular pain. Methods We reviewed our clinical experience with referrals for surgical intervention for “chronic testicular pain” at a tertiary care medical center between July 2019 and October 2020. Prior to scheduling an appointment, patients are queried via a list of questions to gather additional information in order to determine whether specialist consultation is indicated. Pertinent information was collected including historical patient data, physical examination findings, laboratory and imaging results, and treatment as recommended by the assessing physician. In addition, we gathered data on the number of prior consults and interventions performed by outside clinicians. The data was summarized to present a cross-sectional representation of patients presenting for CSCP. Results In total, 126 patients were seen for a primary chief complaint of CSCP. Mean patient age was 45 years [standard deviation (SD) 15]. 31 (24%), 55 (44%), and 40 (32%) were self-referred or referred by their primary care provider or a urologist, respectively. 88 patients (70%) had seen at least one prior urologist. 22/126 (17%) reported bilateral testicular pain. 29 patients (24%) had undergone a prior unsuccessful surgical intervention for their pain. On examination, reproducible testicular tenderness was present in only 57 patients (45%), despite 109 patients (87%) stating testicular pain as their primary chief complaint. Digital rectal examination of the pelvic floor musculature was positive for tenderness in 31/126 patients (25%), suggesting a possible pelvic floor contribution. After thorough assessment, musculoskeletal etiologies were suspected to underlie CSCP in 49 patients (39%), prompting additional evaluation and/or referrals. This included 35 patients (28%) who were specifically referred to a pelvic floor physical therapy specialist. Surgery was recommended in 68/126 patients (54%), including microdenervation of the spermatic cord in 22% (after successful diagnostic spermatic cord block), and epididymectomy in 13%. Conclusions CSCP presents with a wide array of concurrent symptoms. The history and physical examination must include assessments for concurrent abdominal, back, hip, and other genital/pelvic pain that may lend towards an alternative non-urologic treatment pathway. Disclosure No

Abstract Background: The biology, pathology and clinical course of CD5+ chronic B cell lymphoproliferative disorders (CD5+ B-CLPD) excluding chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL) and mantle cell lymphoma (MCL) are poorly defined. These patients could either have a leukemic variant of a known B cell malignancy or a novel disease entity. Objective: To define the clinical features and pathology of CD5+ B-CLPD, compare these features to CLL, and test the hypothesis that at least some of these patients have a unique B cell malignancy. Methods: The study was conducted with Institutional Review Board permission. We studied 231 patients evaluated in the Division of Hematology at Mayo Clinic Rochester between 1996 and 2008 who had CD5+ monoclonal B cell population in the peripheral blood and/or bone marrow, and in whom CLL and MCL was not diagnosed after flow cytometry, histology and interphase fluorescence in situ hybridization (FISH) examinations. Data were abstracted from patient records and from the Mayo Clinic CLL database. Statistical analysis: To compare differences in characteristics between CD5+ and CLL patients, χ2 statistics were used for qualitative variables (gender, treatment, vital status) and t-tests were used for quantitative variables (age). We performed survival and time to treatment analyses with results displayed using Kaplan-Meier curves and p-values calculated using a log-rank test. Results: We analyzed data on 231 CD5+ B-CLPD patients diagnosed between 7/1/1976 and 5/2/2008 and 1572 CLL patients diagnosed in the same time period. Median follow-up from diagnosis was 2.5 years (range 0 to 25.1 years) for the CD5+ patients and 5.2 years (range 0 to 29.9 years) for CLL patients. CD5+ B-CLPD patients had a median age at diagnosis of 68 years (range 30–94 years) with male predominance (61.5%). One hundred and nine of 231 (52.4%) patients received treatment for their CD5+ B-CLPD and 162 (70.1%) patients were alive at the time of last follow-up. As a group, CD5+ B-CLPD patients had a similar male predominance to CLL but were older at diagnosis. CD5+ B-CLPD patients required their first treatment significantly sooner than CLL patients (median 2.0 years vs. 6.8 years, (p< 0.001) and a higher percentage of CD5+ B-CLPD patients required treatment (52.4% vs. 37.5%, p<0.0001). In addition, CD5+ B-CLPD patients had a shorter survival from diagnosis than CLL patients (median 8.4 years vs. 12.5 years, p<0.001). In 60 patients the CD5+ B-CLPD disease was the leukemic phase of a known lymphoma (lymphoplasmacytic lymphoma, n=34; nodal marginal zone lymphoma, n=6; splenic marginal zone lymphoma, n=16; MALT lymphoma, n=4), 46 patients had incomplete data, and 125 patients did not have pathological and flow cytometry features of a known lymphoid malignancy. Next we compared clinical outcome among the 125 patients with unclassifiable CD5+ B-CLPD to the CLL patients. The unclassifiable CD5+B-CLPD patients were older at diagnosis (median 69 vs. 65 years, p=0.0003) but there were no significant differences in time to treatment (median 9.0 years vs. 6.8 years, p=0.93) or the proportion of patients receiving treatment (30% vs. 37.5%, p=0.11). The survival from diagnosis was shorter for unclassifiable CD5+ B-CLPD patients (median 6.3 vs. 12.5 years, p<0.001). Conclusions: In this large series of CD5+ B-CLPD patients we found that a large subset did not meet diagnostic criteria for known B-cell malignancies and could have a novel disease. This will need to be investigated further. We reviewed the pathology of all available archived tissue and intend to examine additional clinical and prognostic information including molecular prognostic markers. Our data provide a clinical rationale for the careful differentiation between patients with CLL and CD5+ B-CLPD.

INTRODUCTION: Learning styles among gastroenterology providers have not been reported and may have implications in improving continuing medical education (CME). This study aims to 1) evaluate learning styles among gastroenterology providers participating in a board review course, 2) assess self-reported burnout, and 3) determine if demographic information, practice style, or burnout was associated with specific learning styles. METHODS: Participants at the 2018 Mayo GI and Hepatology Board Review Course had the opportunity to participate in an anonymous, survey-based study evaluating learning styles and burnout. Demographic and practice information, reason for participating in the course, questions regarding burnout and callousness, and the Kolb Learning Style Inventory (KLSI) (v3.1, Korn Ferry Hay Group, Boston, MA) were collected. Associations between demographic data, burnout, and learning styles were assessed using Fisher’s exact test. RESULTS: A total of 71 of 230 participants elected to participate and 47 completed the KLSI. Median age range was 41-50 years, 31 (43.7%) were female, and 60 (84.5%) had MD or DO degree. All regions of the United States were represented and 4 participants were from outside of the US. Reasons for participation included new certification (12.7%), recertification (45.1%), not passing prior board certification (4.2%), and general knowledge (38%). Burnout was noted by 27 (38%), callousness by 19 (26.8%), and both by 9 (12.7%). Kolb learning styles were diverging in 27.7%, assimilating in 31.9%, converging in 27.7%, and accommodating in 12.8%. There were no associations with demographics, practice type or reason for taking the course with specific learning styles; however, more frequent markers of burnout were associated with the accommodating learning style (50% burnout only, 33% callous only, and 16.7% reporting both; P = .03). CONCLUSION: All learning styles are represented at the studied board review course and are dispersed throughout ages, sex, geography, and practice style. This highlights the importance of a transition from lecture-based CME to more varied education modalities. Indices of self-reported burnout are seen frequently in this cohort, and seem to have increased association with the accommodating learning style. Future study with more participants is needed to further understand learning styles and burnout in gastroenterology providers, with the aim of improving CME.