AAGL Stump the Professors Score: Experts 1, Presenters 2

A panel of experts were bested only once at the “Stump the Professors” session at the 43^rd AAGL Global Congress on Minimally Invasive Gynecology in Vancouver. A sarcoma was the diagnosis that got away among three complex cases presented to a packed audience.

How did last year's 'Stump the Professors' go?

Moderated by Richard J. Gimpelson, the session was chaired by Jessica A. Shepherd, who emphasized that it was supposed to be a “light, fun” experience and urged the audience not to shout out answers.  Dr.  Shepherd said the goal was for audience members to “learn at least one key point from each case to take back” to their practices. Presenting the intriguing, mind-boggling cases were Emily Adams-Piper, Ali Akdemir, and Lucy Feng. The panelists were Drs. Victor Gomel, Nicholas Leyland, Anthony A. Luciano, and Dan C. Martin.

In Case #1, Dr. Adams-Piper described a 45-year-old G2P2 with a history of ductal carcinoma in situ treated with lumpectomy and tamoxifen who presented with urinary frequency and pelvic pressure during the premenstrual period. Urinalysis showed a urinary tract infection, which was treated with nitrofurantoin. The patient subsequently developed worsening symptoms and incomplete voiding and was treated with leuprorelin. Five months post-initial presentation, she went to the emergency room with constant urinary pain and was seen by a gynecologist. A post-void residual test revealed retention of 30 mL. Transabdominal ultrasound showed a vaginal mass. 

The professors posited in their differential diagnosis a metastatic or endometriotic lesion, prolapse, or a desmoid tumor. The ultimate diagnosis was an extraosseous metastatic Ewing sarcoma.

Presented by Dr. Akdemir, Case #2 involved a 45-year-old G3P3 with postoperative pain and abdominal distention following a myomectomy. Because of suspicion of a left ureteral injury, a ureteral stent and ureteral catheter were placed at the time of myomectomy. The professors questioned the stent placement and wondered whether the diagnosis was injury to the left ureter or the bowel. The audience affirmed that the panel had not been stumped by the ultimate diagnosis: ureteral injury of a duplicated left ureter.

A 26-year-old G1P0 with an 11-year history of dysmenorrhea that worsened after an abortion was the patient in Case #3, presented by Dr. Feng. The woman underwent ultrasound and a laparoscopic hysteroscopy. Based on the case details and the ultrasound, the panel  was stumped again and thought of differentials such as endometriosis, Müllerian agenesis and uterine septums. They did not, however, make the correct diagnosis: Robert’s uterus or asymmetric septate uterus, a rare malformation that presents with two cavities, one of which is blind.

The event was very well attended and the audience was pleased with the cases and the presentations.  Co-chair Amber Bradshaw was able to get the presenters to keep their wits about them as they presented the cases and Dr. Shepherd encouraged the attendees to submit more cases for next year as each year gets increasingly better. 

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