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Vaginal Cellular Angiofibroma with Heavy Bleeding: A Case Report

Open Journal of Obstetrics and Gynecology 2020年第11期10卷 1609-1615页

作者： Anh Q. Nguyen cassandra L. presti Graham Nelsen Francine McLeod Department of Obstetrics and Gynecology Inova Fairfax Hospital Falls Church VA USA Department Obstetrics and Gynecology School of Medicine University of Virginia Inova Campus Falls Church VA USA

Cellular angiofibroma is a rare mesenchymal tumor that most commonly presents as an asymptomatic well-circumscribed mass in the vulva. Very few cases have been found in the vagina and even fewer presented with vaginal bleeding. A 54-year-old female presented to the emergency department with five months of vaginal bleeding and symptomatic anemia requiring blood transfusion. Upon physical examination, she was found to have a firm 4 cm posterior vaginal mass, distinctly distal to the cervix. The mass was resected and diagnosed as a vaginal cellular angiofibroma on pathologic evaluation. The patient did well post-operatively with recommended follow-up every six months. The common differential diagnosis for a bleeding vaginal mass includes leiomyoma, angiofibroblastoma, aggressive angiomyxoma, squamous cell carcinoma, and adenocarcinoma. In this case, cellular angiofibroma presented as a vaginal mass with heavy bleeding leading to severe anemia. Early involvement of gynecologic oncology can help to optimize patients’ evaluation and management.

关键词： Vaginal Cellular Angiofibroma Vaginal Tumor Vaginal Bleeding

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Advanced Undifferentiated Endometrial Carcinoma with No Evidence of Disease after Neoadjuvant Chemotherapy: A Case Report

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Open Journal of Obstetrics and Gynecology 2020年第11期10卷 1573-1579页

作者： cassandra L. presti Payam Katebi Kashi Christopher M. Tarney Ruchi Garg Division of Gynecologic Oncology Department of Obstetrics and Gynecology Inova Fairfax Women’s Hospital Falls Church VA USA Walter Reed National Military Medical Center Department of Obstetrics and Gynecology Division of Gynecologic Oncology Bethesda MD USA Mid Atlantic Gynecologic Oncology and Pelvic Surgery Associates Fairfax Virginia USA

Background: Neoadjuvant chemotherapy is used in gynecologic malignancies as primary treatment for advanced disease and has demonstrated improvement in survival rates. However, the data for use in endometrial cancer is limited. Case: This is a case of stage IV endometrial undifferentiated carcinoma with complete response to four cycles of neoadjuvant chemotherapy (carboplatin/paclitaxel) and no evidence of disease during the interval debulking surgery (robotic-assisted total laparoscopic hysterectomy with bilateral salpingoophorectomy, pelvic and paraaortic lymph node dissection, and cystoscopy). Conclusion: Complete response to neoadjuvant chemotherapy prior to interval debulking surgery is only reported in a limited number of cases, and even less common in advanced stage high-grade endometrial cancers. The use of neoadjuvant chemotherapy may reduce tumor burden, increase opportunities for optimal debulking, and have an impact on survival. Further research is needed to understand the potential for neoadjuvant chemotherapy in these patients.

关键词： Neoadjuvant Chemotherapy Undifferentiated Endometrial Carcinoma

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Improving the Evaluation and Management of Cystotomy in Gynecologic Surgery with a Cadaver Surgical Curriculum

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Open Journal of Obstetrics and Gynecology 2021年第9期11卷 1202-1216页

作者： cassandra presti Conway Xu Chang Liu Larry Walker Lauren Scott S. Abbas Shobeiri Francine McLeod Department of Obstetrics and Gynecology Inova Fairfax Hospital Falls Church USA Department of Surgery Inova Fairfax Hospital Falls Church USA Advanced Surgical Technology and Education Center Inova Fairfax Hospital Falls Church USA Division of Female Pelvic Medicine and Reconstructive Surgery Inova Fairfax Hospital Falls Church USA

Objectives: Urinary tract injuries are a known complication of gynecologic surgery, occurring in 0.18% - 0.80% of procedures and most commonly involving the bladder. Appropriate identification, evaluation, treatment, and follow-up by gynecologic surgeons are important to reduce the associated long-term morbidities. The purpose of this study was to implement a comprehensive cadaver curriculum in cystotomy repair for OBGYN residents. Methods: This was a prospective observational cohort study including 10 OBGYN residents (PGY1-3) at a single institution in 2020 (56% of the 18 eligible residents). The curriculum consisted of a one-hour didactic lecture and one-hour hands-on surgical skills training with fresh frozen cadavers. Residents were evaluated in three domains: 1) knowledge, 2) surgical skills, and 3) confidence. Knowledge, confidence, and resident satisfaction were evaluated with pre- and post-surveys. The bladder model, derived from the ACOG Simulation Working Group, was used to evaluate surgical skills at baseline and at completion of the curriculum. Results: Across all three P

关键词： Bladder Injury Cystotomy Repair Cadaver Lab Resident Curriculum

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Distinct Placenta Increta and Percreta in the Setting of Dichorionic Diamniotic Twin Gestation: A Unique Histological Finding

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Open Journal of Obstetrics and Gynecology 2022年第7期12卷 610-615页

作者： Conway Xu cassandra presti Sebastian Nasrallah Saeid Movahedi-Lankarani John C. Elkas Alfred Khoury Ankit Shah Department of Obstetrics and Gynecology Inova Fairfax Hospital Falls Church VA USA Division of Maternal Fetal Medicine Department of Obstetrics and Gynecology Inova Fairfax Hospital Falls Church VA USA Department of Pathology Inova Fairfax Hospital Falls Church VA USA Mid Atlantic Gynecologic Oncology and Pelvic Surgery Associates Fairfax VA USA Perinatal Associates of Northern Virginia Fairfax VA USA

Multiple gestations have been reported as a risk factor for placenta accreta spectrum (PAS) but the evidence is limited. Previous reports showed that PAS degrees (creta, increta, percreta) were similar in multiple gestation placentas. To our knowledge, there have been no reports of PAS in dichorionic placentas with different degrees of invasion. Here, we report dichorionic diamniotic placentas with two different degrees of invasion, one increta and another percreta.

关键词： Placenta Accreta Spectrum Increta Percreta Differential Placental Invasion Twin

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