Faculty Bibliography

Prostate cancer is one of the most common cancers worldwide. We present a unique case of metastatic prostate cancer manifesting initially with a psoas muscle mass causing abdominal and hip pain. Computed tomography (CT) imaging revealed a large mass within the left psoas muscle with prominent pelvic and retroperitoneal lymphadenopathy, initially concerning for rhabdomyosarcoma. However, a biopsy of the psoas mass confirmed metastatic prostate adenocarcinoma. Interestingly, a nuclear whole-body bone scan and spinal MRI were negative for bone involvement or other metastases. The patient was treated with anti-androgen therapy along with abiraterone and docetaxel and had a positive serologic and radiologic response. He was also offered radiation as per the phase III Prostate Cancer Consortium in Europe-1 (PEACE-1) trial. This case underscores the importance of recognizing atypical metastatic sites, such as skeletal muscle, in prostate cancer, as they can complicate initial diagnosis and delay management. Understanding the mechanisms of rare metastatic patterns and the diagnostic approaches required is crucial for improving outcomes in prostate cancer patients.

We present an unusual case of complement-mediated thrombotic microangiopathy (formerly known as atypical hemolytic uremic syndrome) associated with inflammatory disease in a young patient. A 26-year-old male patient with no significant past medical history presented to our emergency department with a four-week history of diffuse, moderate, cramping, non-radiating abdominal pain with no known aggravating or relieving factors. Abdominal pain was associated with nausea, vomiting, and bloody stools. His physical examination revealed pale conjunctiva, tachycardia, and mild tenderness in the lower abdomen. The patient's laboratory results indicated severe anemia with a hemoglobin level of 2.9 g/dL, an elevated white blood cell count of 52.86 K/uL, a low platelet count of 107 K/uL, and evidence of acute kidney injury, with a blood urea nitrogen level of 87.0 mg/dL and a serum creatinine level of 8.32 mg/dL. Further work-up showed hemolysis, characterized by low haptoglobin levels, elevated lactate dehydrogenase, and a positive direct Coombs test for both anti-IgG and anti-C3 antibodies. A computed tomography angiogram (CTA) of the abdomen and pelvis showed pancolitis. Severe inflammation was noted during a flexible sigmoidoscopy, and pathology results revealed chronic inflammation/chronic colitis. A renal biopsy performed showed thrombotic microangiopathic changes with complement deposition. The patient was started on eculizumab, which ultimately resulted in improvements in anemia, thrombocytopenia, and renal function. Our case stands out as the complexity of the diagnosis warrants awareness of complement-mediated thrombotic microangiopathy (TMA). The introduction of eculizumab, a terminal complement blockade therapy, has revolutionized the management of complement-mediated TMA, as early initiation of eculizumab treatment has shown significant reductions in disease progression to end-stage kidney disease and its related complications.

A 58-year-old male patient with a history of Parkinson's disease and solitary cervical spinal sarcoma underwent corpectomy, a fusion of C3-C6 with cervical fixation plate placement, and stereotactic body radiation therapy, presented 18 months following surgery with dysphagia, concomitant with weakness, diplopia. The initial workup in cervical magnetic resonance imaging (MRI) revealed aerodigestive tract soft tissue enhancement. Dysphagia progressed during hospitalization, and the patient was intubated due to aspiration pneumonia and respiratory failure. Further evaluations with esophagogastroduodenoscopy (EGD) revealed posterior pharyngeal wall, upper cervical esophageal erosion, and the presence of a cervical fixation plate in the hypopharynx.

Cholecystectomy is one of the most commonly performed surgical interventions, and laparoscopic cholecystectomy is the standard intervention with open cholecystectomies having declined nowadays. Similar to other surgical procedures, cholecystectomy carries its own risks including sepsis, bleeding, damage to surrounding tissues, bile leakage, and abscess formation. Abscess formation can be due to a variety of reasons such as infection or gallstone spillage during surgery with the latter being more common to laparoscopic surgery. Here we describe a patient with an unusual presentation of gallbladder fossa abscess following open cholecystectomy.