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Re: GYN: Mouse antibodies/HCG -- Now choriocarcinomaFrom: Richard Chudacoff, MD (dean@thehuffpeople.net)Thu Jul 29 14:18:22 2004
.. Talk about treating without an established diagnosis ... About 12 years ago I had a patient transferred in with Legionnaire's Disease. She was pregnant. Chest x-ray failed to show any infiltrates, but it did show a very large tumor. With this being an otherwise healthy 30 year old 36 week pregnant patient, my first thought was that the names got mixed up on the x-ray plate. After seeing the tumor on a repeat chest x-ray, I concluded that the mass was real. A serum HCG was obtained and it was 1.5 million. This established a probable diagnosis. The patient went into spontaneous labor and we made no attempt to stop it. Since I was to be off call by the time of the delivery, I instructed the residents to be sure to send the placenta to pathology. She delivered that night. Two days later, I called pathology in the morning to find out what the report showed on the placenta. The pathologist said that it showed normal, unremarkable placenta. I commented that this was really strange since we had expected a choriocarcinoma. The pathologist responded that nobody told her to look for that diagnosis -- the pathology form said only "placenta". She told me that she would look further at the placenta and call me back later. About an hour later I got a call from her. She said that on close inspection, the surfact of the placenta had a sand-paper like feel and that she had taken multiple permanent sections and a few frozen sections. The frozen sections showed choriocarcinoma. I wonder whether or not the diagnosis would have been made if I had not been called. The placenta would have been disposed of in a few days. Maybe doing additional cuts of the sections that had been collected might have yielded the diagnosis. Maybe not. An important lesson here is that the interaction between pathologist and clinician is not a contest or a guessing game whereby the pathologist is given the absolute minimum of information and is expected to come up with the diagnosis. Something as simple as "suspect choriocarcinoma -- call me" might have made a world of difference in this case. - - - - Quoting "Garry E. Siegel, M.D." <garrys@mindspring.com>:
> One more thing--I've seen a few case reports (malpractice ones) about
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