Testosterone-Secreting Ovarian Tumor: A Rare Cause of Erythrocytosis and Pulmonary Embolus.

OBJECTIVE: To raise awareness of the clinical presentation of a testosterone-secreting steroid cell tumor, not otherwise specified, causing pulmonary embolus (PE) and erythrocytosis. METHODS: Report of the first known case of ovarian steroid cell tumor not otherwise specified leading to PE. RESULTS: A 67-year-old Caucasian postmenopausal woman was referred for endocrine evaluation of a 1-year history of hirsutism, weight gain, and elevated total testosterone level of 672 ng/dL (normal, <75 ng/dL). She reported increased hair growth on her chin for the past year, unintentional weight gain, and low energy levels. Laboratory data from the initial visit included a total testosterone level of 672 ng/dL (normal, <75 ng/dL), hemoglobin level of 18.0 g/dL (normal, 11.7-15 g/dL), and hematocrit level of 50.4% (normal, 35%-45%). Four months after initial presentation, the patient developed acute-onset chest pain and shortness of breath and was diagnosed with a right PE on computed tomography chest angiogram. Evaluation with imaging for an ovarian mass revealed a negative workup including computed tomography abdomen pelvis, transvaginal ultrasound, and pelvic magnetic resonance imaging. Despite negative findings during imaging, because of the markedly elevated testosterone levels, this presentation was thought to correspond to a testosterone-secreting ovarian tumor. The patient was referred for bilateral oophorectomy. Pathology of the right ovary revealed a 2-cm steroid cell tumor, not otherwise specified. CONCLUSIONS: PE and erythrocytosis can be presentations of a testosterone-secreting ovarian tumor, not otherwise specified. This case is the first known presentation of an ovarian steroid cell tumor, not otherwise specified, leading to PE and erythrocytosis.

Social Media in Minimally Invasive Gynecologic Surgery: What Is #Trending on Instagram?

STUDY OBJECTIVE: Patients share and obtain healthcare-related information on social media platforms. We aim to evaluate the authorship and content of, as well as engagement with, gynecologic topics posted on Instagram. DESIGN: Qualitative and quantitative retrospective content analysis. SETTING: Instagram. PATIENTS: Not applicable. INTERVENTIONS: Not applicable. MEASUREMENTS AND MAIN RESULTS: A query of endometriosis, adenomyosis, myomas, and hysterectomy yielded 237 hashtags. The top 10 and most recent 20 posts, as determined by Instagram's internal algorithm, were evaluated for 10 hashtags with the most posts. The most popular topic was endometriosis. Of the 300 posts evaluated, 97.3% were by authored by nonhealthcare individuals. The most common content for nonhealthcare authored posts was personal experience (30.67%). Educational content accounted for 4.6% posts and had the greatest average engagement by number of "likes;" 0 educational posts were authored by a healthcare provider. CONCLUSION: The majority of minimally invasive gynecologic surgery related Instagram posts are regarding endometriosis, are authored by patients, and discuss personal experience. Official healthcare presence was lacking.

Primary myxoid liposarcoma of the ovary in a postpartum female: a case report and review of literature.

A 36-year-old gravida 4, para 2 African-American woman, presented at three months postpartum with a right ovarian mass identified on a lumbar spine MRI as part of a neurology workup for persistent lower back pain. A follow-up pelvic ultrasound noted a 7.0 × 6.1 × 3.8 cm septated mixed cystic and solid mass. Exploratory laparoscopy and right ovarian cystectomy yielded a final pathologic diagnosis of intermediate grade myxoid liposarcoma, confirmed with DDIT3 gene rearrangement studies.

Electrocautery-associated vascular injury during robotic-assisted surgery.

BACKGROUND: The robotic surgical platform is increasingly used in gynecology and, similar to laparoscopy, it has risks of electrocautery-associated injury. CASE: We present three cases of injury caused by failures of the monopolar scissors' insulating sheath while coagulation and cutting currents were set at 35 W. In case 1, an external iliac vein injury required blood transfusion and emergent laparotomy. In case 2, a full-thickness external iliac artery injury was repaired robotically. In case 3, a partial-thickness external iliac artery injury also was repaired robotically. CONCLUSION: Unintended electrosurgical arcs can occur from monopolar instruments. Insulation failure is a common finding in this type of injury. Surgeons should avoid excessive instrument collisions and should change the monopolar scissors' insulating sheath if there are any concerns of a defect in its integrity.