Arthritis Post-Immunotherapy for Endometrial Cancer: a case report and review of literature on the acute onset of inflammatory arthritis following PD-I inhibitor therapy in a patient with recurrent endometrial cancer

Since gaining FDA approval in 2014, pembrolizumab, a PD-1 immune checkpoint inhibitor, has been utilized in the management of cancers that progress following first-line therapy.While the pathological response to pembrolizumab is favorable, immune related adverse events (irAEs) can be elicited and require prompt diagnosis and management based on grading and severity, which can include discontinuation of immunotherapy.Our case concerns a 66-year-old female with recurrent endometrial cancer who was treated with pembrolizumab, and developed inflammatory arthritis following therapy. We provide a succinct review of the pathogenesis and risk factors associated with irAEs, as well as diagnosis and management strategies

Case Report: An Undiagnosed Bladder Diverticulum Resulting in Foley Catheter Perforation During Cesarean Section

A bladder diverticulum is diagnosed when herniated bladder mucosa forms an outpouching from the bladder. Bladder diverticula are uncommon and are significantly more common in males. The following case presents a patient with an undiagnosed bladder diverticulum which was incidentally perforated during foley catheter placement for a repeat cesarean section. The diagnosis can be difficult in those who are asymptomatic and lack risk factors, such as the following patient

Embryonal Rhabdomyosarcoma in the Pelvis of a 22-Year-Old Female: A Case Report

Embryonal rhabdomyosarcoma is a rare soft-tissue sarcoma that is responsible for less than 1% of malignancies in the adult population. We present a case of a 22-year-old female with a six-month history of abnormal uterine bleeding that was found to have an exophytic mass within the cervix. Magnetic resonance imaging was performed and revealed a large pelvic mass. Further workup included biopsies and surgical removal of the tumor, leading to the diagnosis of embryonal rhabdomyosarcoma. PET scan showed no FDG-avid malignancy, aiding in the decision-making process for adjuvant treatment to include vincristine, actinomycin D, cyclophosphamide, and mesna. This case is important to document due to the rarity of this disease and to serve as a reminder to gynecologists to consider the addition of rhabdomyosarcoma in the differential diagnosis when evaluating young adult females presenting with abnormal uterine bleeding and a cervical mass lesion

Incidental Retroperitoneal Castleman’s Disease Found in Patient with Renal Cell Carcinoma: a case report

This report briefly discusses a case of retroperitoneal Castleman’s disease in a 52 year old post-menopausal woman with renal cell carcinoma

Improving Postoperative Pain Control After Cesarean Delivery with Enhanced Recovery in Patients on Buprenorphine Therapy

Abstract: Introduction: Prescription drug abuse presents a significant challenge to the management of post operative pain.Pain control amongst the opioid addicted patient can be especially challenging. We aimed to improve pain control after caesarian delivery with enhanced recovery in patients who are on buprenorphine medication-assisted therapy for the treatment of opioid addiction. Materials and Methods: We conducted a pilot study by implementing a protocol using liposomal bupivacaine injected at the time of cesarean delivery. Patients were then given 500mg acetaminophen every 4 hours, 800mg ibuprofen every 8 hours and 0.3mg IV buprenorphine every 6 hours as needed. The patients’ maintenance dosing of buprenorphine was divided into doses throughout the day. In addition, patients were ambulated 4 hours after surgery and had their catheter removed from their bladder as soon as they could safely ambulate. Eleven patients were prospectively recruited and then compared to a retrospective sample of seventeen patients. Results: Patients in the treatment group reported 27% lower pain scores (p Discussion: Our enhanced recovery protocol is an effective alternative to traditional pain control and is associated with a significant reduction in both pain scores and use of breakthrough IV buprenorphine as well as lower charges

Robotic Hysterectomy: Surgical Approach and Outcomes Among a Large Institutional Cohort

Introduction The purpose of this report is to describe a technique for performing a robotic total laparoscopic hysterectomy (rTLH) with clinical outcomes on safety and efficiency. The rationale for our approach is based on a critical evaluation of the literature. Methods Data from all rTLH procedures performed on our gynecologic oncology service between January 2017 and December 2019 were retrospectively reviewed. Using this database, perioperative data including surgical times, intra- and postoperative complications, and length of hospital stays were evaluated. The steps used to perform the procedure were outlined and illustrated. Results 826 cases of rTLH were performed during the study period. 688 of these cases were included for analysis. Malignant diagnoses were found in 218 cases. The median time from skin-to-skin for the entire cohort was 28.43 minutes for benign rTLH +/- BSO (bilateral salpingo oophorectomy) and 30.23 minutes for rTLH/BSO/cancer staging. Surgical complications included vaginal laceration, vaginal bleeding, urinary tract infection, serous fluid leakage from the incision, abdominal wall abscess, pelvic abscess, surgical site infection, serosal tear, enterotomy, rectal injury, acute kidney injury, perforated diverticulitis, and incarcerated bowel through the ventral hernia. The median length of stay was 1 day. The surgical technique is illustrated step by step. Conclusion This paper describes a safe and efficient technique to perform rTLH and shows that surgical times, complication rates, and length-of-stays compare favorably to the literature. A description of the technique clarifies many of the details of this procedure which can be made routine to minimize error and surgeon discrepancies. We encourage readers to use this paper as a guide to modify their techniques for robotically assisted laparoscopic hysterectomy

Case Report: An Undiagnosed Bladder Diverticulum Resulting in Foley Catheter Perforation During Cesarean Section

A bladder diverticulum is diagnosed when herniated bladder mucosa forms an outpouching from the bladder. Bladder diverticula are uncommon and are significantly more common in males. The following case presents a patient with an undiagnosed bladder diverticulum which was incidentally perforated during foley catheter placement for a repeat cesarean section. The diagnosis can be difficult in those who are asymptomatic and lack risk factors, such as the following patient

Case Report on Leiomyosarcoma of the Vulva: A Rare Pathology

Leiomyosarcoma (LMS) of the vulva is rare. However it is the most common histologic subtype of vulvar sarcoma, accounting for approximately 1% of all vulvar malignancies. [1-8] Whether genetics and epigenetics play a role in pathogenesis is unclear. [1] The tumor is slow-growing with non-specific symptoms, has high metastatic potential, and follows a bimodal age distribution. [1-8] Diagnosis and prognosis are based upon immunohistochemical expression and criteria from early literature. [1,3,5-7] The most common therapeutic approach involves radical vulvectomy with lymph node resection. The value of adjuvant chemotherapy and radiation remains unknown. [1,3,5-8] Our case describes a 46-year-old Caucasian G2P2 female with LMS of the left labia

Severe Pelvic Endometriosis Involving the Rectum with Near Complete Bowel Obstruction: A Case Report

Endometriosis is a common gynecological disease among reproductive-age women that can result in chronic pain, severely decreased quality of life, and infertility. We present a case of a 44-year-old female with a known history of endometriosis who presented with constipation, decreased appetite, iron deficiency anemia, and unintentional weight loss for 6 months. Investigation with colonoscopy discovered a partially-obstructing mass in her proximal rectum and no evidence of malignancy on biopsy. The mass was subsequently removed during a combined robotic-assisted total hysterectomy with bilateral salpingo-ophorectomy and low anterior resection with reanastomosis. Surgical pathology determined that the mass was consistent with endometriosis and no malignancy was identified. This case calls attention to a unique manifestation of endometriosis and highlights the importance of maintaining a broad differential diagnosis while utilizing a multidisciplinary team in the management of a rectal mass in reproductive-age women