The Three P's: Parotid, PD-L1, and Pembrolizumab.

We present a case of recurrent, platinum-refractory undifferentiated carcinoma of the parotid which was treated with checkpoint inhibitor, Pembrolizumab, and achieved a complete response to therapy. We review the literature of checkpoint inhibitor use in undifferentiated carcinoma of the parotid.

Liposarcoma of the spermatic cord masquerading as an inguinal hernia.

This is a case of a 70-year-old male who presented with a mass in his right testicle. He was treated with antibiotics for epididymitis while undergoing serial ultrasounds for one year due to testicular swelling and pain. His fourth ultrasound revealed a mild hydrocele with a large paratesticular mass of undescribed size, superior to the right testicle, thought to be an inguinal hernia. Preoperative CT scan demonstrated a large fat-containing inguinal hernia extending into the scrotal sac. An inguinal hernia repair was complicated by fatty tissue surrounding the testicle requiring a right orchiectomy. Pathology review of the tissue demonstrated well-differentiated liposarcoma with a small focus of dedifferentiation grade 2 tumor. Tumor was identified at the inked margins indicating an incomplete resection. It was decided that no further surgical intervention was needed and the patient would undergo surveillance for local tumor recurrence. Six-month follow-up MRI scan was negative for any recurrence of disease. A liposarcoma presenting as a paratesticular mass with spermatic cord involvement is rare, and imaging studies may fail to distinguish a liposarcoma from normal adipose tissue.

Idiopathic thrombosis of the inferior vena cava and bilateral femoral veins in an otherwise healthy male soldier.

Thrombosis of the inferior vena cava is less common than deep venous thrombosis of the lower extremities, particularly in the absence of an obvious congenital caval abnormality or hypercoagulable state. We present a case of IVC thrombosis in an otherwise healthy and active 28-year-old male soldier secondary to dehydration and venous webbing. IVC thrombosis is an uncommon and underrecognized condition; in this case, the patient's caval thrombosis was initially mistaken for acute back strain. Prompt recognition is necessary to minimize long-term sequelae.

A review of the literature on three extraintestinal complications of ulcerative colitis: an ulcerative colitis flare complicated by Budd-Chiari syndrome, cerebral venous thrombosis and idiopathic thrombocytopenia.

Extraintestinal manifestations are well described and recognized in association with ulcerative colitis. Immunologically mediated and thrombotic events are among the more rare manifestations associated with flares. These manifestations include Budd-Chiari syndrome, idiopathic thrombocytopenia, and cerebral venous thrombosis. A 22 year-old male with a three-year history of ulcerative colitis presented with worsening hematochezia, fatigue, headache and upper respiratory symptoms. Laboratory evaluation demonstrated a platelet count of 24 x 10(9)/L (normal baseline platelet count noted 3 months prior) and hemoglobin of 8.6 x 10(9)/L. Imaging demonstrated hepatic venous thrombosis consistent with Budd-Chiari syndrome and cerebral venous thrombosis. Based on peripheral smear analysis and eventual marked response to steroids, a diagnosis of idiopathic thrombocytopenia was made. He was started on prednisone 40mg daily with brisk improvement in both his ulcerative colitis flare and his platelet count increasing above 100 x 10(9)L. He was therapeutically anticoagulated for the cerebral venous thrombosis. He continued to do well and was discharged on therapeutic enoxaparin and a 40 mg prednisone taper without recurrent flare or idiopathic thrombocytopenia two weeks post-hospitalization. To our knowledge, this is the first report of all three known but rare complications diagnosed concurrently in the same patient. This review examines three extraintestinal complications of ulcerative colitis, including the presentation, diagnosis, and treatment.