John H. Stroger Jr. Hospital of Cook County

Obesity is a recognized risk factor for developing pelvic organ prolapse and for perioperative complications. As the population ages, an increasing number of older, obese individuals with prolapse may opt for surgical repair. This study assesses the association between obesity and short-term perioperative adverse events (AEs) in women ≥ 70 years undergoing vaginal and laparoscopic prolapse surgery. This is a secondary analysis of a retrospective cohort study of older women undergoing vaginal and laparoscopic prolapse surgery at two medical centers from 2016 to 2023. Patients were classified as nonobese (< 30 kg/m2), class 1 obese (30–34.9 kg/m2), or class 2+ obese (≥ 35 kg/m2). The primary outcome was composite AEs within 8 weeks after surgery, and secondary outcomes included major AEs and individual AEs. Of 1507 older women, 20.8

Granular cell tumors (GCTs) are rare, typically benign Schwann cell neoplasms; within the gastrointestinal (GI) tract, the esophagus is the most frequent site. Eosinophilic gastrointestinal diseases are chronic immune-mediated conditions encompassing eosinophilic esophagitis, gastroenteritis, and colitis. We describe a 49-year-old man with prior testicular seminoma, follicular thyroid carcinoma, and cutaneous GCTs who developed multifocal esophageal and rectal GCTs alongside eosinophilic esophagitis, esophagitis gastroenteritis, and esophagitis colitis, plus an incidental sigmoid neuroendocrine tumor (WHO grade 2). To our knowledge, this is the first reported case of concurrent multisegmental eosinophilic gastrointestinal diseases, multifocal GCTs, and a neuroendocrine tumors (NET), highlighting the need for vigilant endoscopic surveillance.

Renal Cell Carcinoma (RCC) has a metastasis rate of approximately 33%, but metastasis to the breast is extremely rare1. The common sites of metastasis include lung, bone, lymph nodes, and liver2. Here we present a case of RCC that metastasized to the breast three months after radical nephrectomy. In September 2019, a 65 year old female was diagnosed with cT2bN0M0 RCC. She was treated with Cabozantinib due to her past history of heart failure. Five months after the initial diagnosis she underwent left radical nephrectomy and left adrenal gland resection due to metastasis. This surgery resulted in negative margins and no lymph node involvement. Three months later a 1.6cm breast mass was discovered and a biopsy confirmed RCC. After it was confirmed that she had no other sites of metastasis and after multidisciplinary discussion, a lumpectomy was performed. All margins were negative apart from a focally positive margin, however fascia was removed without any evidence of muscular invasion. Although it was discussed at a multidisciplinary conference, adjuvant radiation was not started due to a lack of data to support its use in RCC. Four months later a surveillance CT revealed recurrence with right adrenal gland metastases and multiple subcentimeter nodules in the left breast. She was then started on Axitinib with pembrolizumab. After nine cycles of this immunotherapy regimen a CT found equivocal standardized uptake value (SUV) on the right adrenal metastasis and a 6th rib lytic lesion, but the breast mass did not have an elevated SUV. She underwent repeat breast biopsy which showed RCC, and she continued on her immunotherapy regimen for 2 more cycles due to the presence of other metastatic disease. She underwent repeat breast imaging which showed known masses, 2 of which had increased in size (one from 11 mm to 23 mm and one from 7 mm to 10 mm) and osseous destruction of the sixth rib which was causing increased rib pain. She underwent palliative left mastectomy and radiation therapy to the affected rib and chest wall. The final pathology showed 3 foci of metastatic clear cell carcinoma (1.8cm, 2cm, and 0.3cm) with negative margins in the breast and the patient received adjuvant radiation therapy of the left chest wall and was restarted on pembrolizumab. A later CT showed soft tissue invasion on the left chest wall. The chest wall lesion demonstrated metastatic RCC, but the pembrolizumab was stopped due to lack of response and arthritis. Three months later she presented to the ED after a fall and was found to have metastases in the left anterior frontal lobe. After brain lesion resection she was started on Everolimus. Five months later there were no new lesions seen on imaging, and the brain lesion had decreased in size. This case demonstrates a rare breast metastasis of RCC to add to the small body of case reports that describe this phenomenon. Documenting these cases is important in order to direct treatment options for future cases of RCC metastasis to the breast. Although resection of oligometastatic disease has been described, data is insufficient to indicate that it has an effect on survival. 1. Flanigan, R. C., Campbell, S. C., Clark, J. I. & Picken, M. M. Metastatic renal cell carcinoma. Curr. Treat. Options Oncol. 4, 385-390 (2003).2. Bianchi, M. et al. Distribution of metastatic sites in renal cell carcinoma: a population-based analysis. Ann. Oncol. Off. J. Eur. Soc. Med. Oncol. 23, 973-980 (2012). M. G. Moulton, E. A. Marcus, J. S. Wecsler. A Rare Metastasis of Renal Cell Carcinoma to the Breast: A Case Report [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS5-06-10.

Background: Eosinophilic esophagitis (EoE) frequently coexists with atopic conditions, but the impact of atopy on inpatient outcomes and health care utilization remains unclear. This study evaluated national trends, hospitalization characteristics, endoscopic intervention rates, and the association between atopic comorbidities and clinical outcomes among adults hospitalized with EoE from 2016–2022. Methods: A retrospective analysis was conducted using the Nationwide Inpatient Sample (NIS) 2016 to 2022. Survey-weighted descriptive statistics, trend analyses, and multivariable survey logistic and linear regression models assessed associations between atopy and inpatient outcomes, including length of stay (LOS), total hospital charges, in-hospital mortality, and need for esophageal dilation. Subgroup analyses were performed for primary diagnosis EoE encounters and sex-stratified cohorts. Results: Among 41 million U.S. adult hospitalizations, 6,561 involved EoE, 24% had at least one atopic comorbidity. Atopic patients were younger but had slightly higher comorbidity burden. Atopy prevalence, LOS, and mortality rates remained stable over time, while hospitalization costs increased by approximately $2,825 per year. In adjusted models, atopy was not associated with mortality or charges. Comorbidity burden was the strongest predictor of mortality. Atopy was independently associated with shorter LOS, with a dose-response effect with increasing atopy burden. Among all EoE hospitalizations, 32.1% underwent inpatient EGD and 5.2% required esophageal dilation; atopy was not associated with dilation risk, whereas older age, lower socioeconomic status, and geographic region were significant predictors even when EoE is the principal reason for hospitalization. Conclusion: These findings improve understanding of inpatient EoE care and point to socioeconomic and regional disparities in management.

Background Endoscope tip angulation is a key determinant of procedural maneuverability, yet routine quantitative assessment is not standardized, and data are limited on how quickly new endoscopes fall below manufacturer-specified performance benchmarks during routine use. The aim of this study was to evaluate tip angulation performance in new, apparently functional endoscopes after a period of clinical use and to characterize the prevalence and pattern of below-tolerance findings by scope type. Methods We performed a quality improvement project to evaluate the tip angulation of newly issued endoscopes within nine months of clinical use. In phase 1, endoscopes were systematically assessed by three trained physicians using a reference chart. In phase 2, a company representative independently evaluated endoscopes using a calibrated instrument. Results In all, 32 new endoscopes (18 colonoscopes and 14 gastroscopes) were evaluated. All scopes were used for approximately 9 months. The mean procedure count for colonoscopes was 185.6 (±12.5, range 162-201) and for gastroscopes was 150.6 (±12.0, range 133-166). Totally, 5 out of 18 colonoscopes (27.8%) fell below manufacturer tolerance thresholds for maximal tip deflection in at least one direction. All 14 gastroscopes met manufacturer tolerance thresholds in all four directions. Conclusions This cross-sectional study found that a notable proportion of new colonoscopes fell below manufacturer tolerance thresholds after approximately nine months of clinical use, despite being considered apparently functional. These findings highlight the need for periodic, objective assessment of tip angulation, even in endoscopes without apparent defects. Longitudinal studies are needed to establish deterioration trajectories and inform maintenance guidelines.