small sample, creating a specimen large enough to analyze. A gold standard for testing liquid and solid tumor samples, it had not been routinely used before to detect cancer from samples with the gel-like consistency of vitreous. “Michigan Medicine may be the only center in the U.S. routinely supplementing anatomic with molecular diagnostic testing to analyze diluted and undiluted vitreoretinal samples for lymphoma,” Dr. Rao says. “Some of the top ocular oncologists, retina surgeons, hospitals and labs across the country are now sending vitreous samples here for PCR testing.” With a definitive diagnosis of intraocular lymphoma, Johnson’s care team expanded to plan and manage his treat-
Hakan Demirci, M.D., Kenneth Johnson and Medical Assistant Bradley Arras
ment. Drs. Sassalos and Rao were joined by Hakan Demirci, M.D., Kellogg’s Director of Ocular Oncology. This type of lymphoma can start in the retina and spread
and posterior chambers of the eye,” he continues. “Very few
to the central nervous system, or vice versa. Initial brain and
centers perform this type of ‘liquid biopsy’ to diagnose and
spinal cord testing found no evidence of disease. Dr. Demirci
monitor treatment effectiveness.”
began treating Johnson’s eyes directly with chemotherapy injections, which lessens side effects elsewhere in the body. After the diagnosis, Dr. Rao performed a vitrectomy in the right eye, which also had indications of disease. “The tumor cells circulate in the vitreous,” Dr. Demirci
The journey from symptoms to diagnosis to treatment has not been easy for Kenneth Johnson, and he faces a difficult road ahead. But he is quick to credit the team from Kellogg, U-M and the VA for their persistence and professionalism. “From the start, Dr. Sassalos made it clear she wouldn’t stop until we had
explains. “The vitrectomies removed the majority of those
answers,” he recalls. “She and all of the doctors and staff who
cells, and we hope the chemotherapy will eradicate any
came together on my behalf made good on that commitment.”
remaining cancer.” U-M colleagues in the Neuro-oncology
“Complex cases like Mr. Johnson’s reinforce the value of
program will monitor Johnson’s central nervous system as
multidisciplinary collaboration, and the importance of a patient
treatment progresses.
who is willing to be part of that team,” says Dr. Sassalos.
“Another thing that helps set Kellogg apart is our ability to assess disease activity by sampling fluid from both anterior
“Through it all, his attitude has been truly inspiring. He reminds all of us why we do what we do.”
Steno North American Fellowship Thomas Gardner, M.D., M.S.,
U-M Professor of Ophthalmology and
their counterparts in Steno Diabetes Centers across Denmark. Their joint project brings together Dr. Gardner’s recent
Visual Sciences, Internal Medicine,
research on the impact of neural dysfunction on the retina and
and Molecular & Integrative Physiol-
Dr. Larsen’s studies of the role of vascular dysfunction. “The fel-
ogy, was awarded a fellowship to
lowship allows us to pursue our shared hypothesis that diabetes
collaborate with fellow retinal research-
disrupts the entire retinal neurovascular unit,” he explains.
er Dr. Michael Larsen at the University of Copenhagen, Denmark.
Also in 2021, Dr. Gardner received a Distinguished Clinical and Translational Research Mentor Award from the
The Steno North American
Michigan Institute for Clinical & Health Research. The award rec-
Fellowship program, made possible
ognizes his leadership of the Michigan Vision Clinician-Scientist
by a grant from the Novo Nordisk Foundation, fosters transat-
Development Program, a mentored training program at Kellogg
lantic collaboration in diabetes research between investigators
funded by an NIH K12 training grant. “I am honored by the
from three North American partner institutions – the University of
award,” he says, “but I’m sure I learn more from these talented
Michigan, Harvard University and the University of Toronto, and
young investigators than they learn from me.”
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