pathologist

Pathologist Performing Autopsy Requests More Tissue

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BIRMINGHAM, AL – Internal medicine resident, Dr. Cynthia Talbot, was surprised to receive a call from pathology about her patient.  It had only been three months since she had requested an autopsy, surely they didn’t have the final report ready so soon.  As it turns out, their issue was even more confusing: “We need more tissue.”

pathologist
“Yeah, I’m going to need more tissue for this autopsy”

Dr. Talbot’s patient was an unusual case.  A lifelong smoker, who previously worked in a textile factory next to a nuclear power plant, and had not seen a physician in over thirty years.  Despite excruciating lower back pain, progressive paralysis, and urinary retention, he continued to refuse medical care.

By the time he sought medical attention, he had developed uroseptic shock.  Imaging showed several large masses compressing his spinal cord, presumed to be metastatic disease, but a primary tumor could not be identified.  Despite exhaustive efforts, his disease progressed, and he died shortly after admission.  At the request of his family, Dr. Talbot ordered an autopsy to determine the source of his disease.

Though the spinal masses were easily found, postmortem degenerative changes had rendered the histology useless.  “It’s a common problem in autopsy cases,” says pathologist Dr. Jeffery Nichols.  “The tissues start to die, and as a result the histology is obscured, and ancillary studies are unreliable.”

In the case of Dr. Talbot’s patient, circumstances delayed the autopsy, likely compounding the problem.  “The delays were unavoidable,” said Dr. Nichols.  “The patient died on a Wednesday afternoon, and it took most of Thursday to sort out the paperwork.  I was on vacation on Friday, and I don’t work on the weekends.  Monday was a holiday, of course, and on Tuesday, I just plain forgot about it.  That was my bad.  But we started the autopsy first thing Wednesday morning at 1030.  Unfortunately, by then a week had gone by, and there wasn’t much we could do.”

Despite a full workup, in the end no definitive diagnosis could be made.  “It was a poorly differentiated spindle-cell neoplasm, but that’s as far as I could go with it,” says Dr. Nichols.  “I couldn’t identify the source of the metastases.”  But then, he had a revelation.  “There are rare mesenchymal tumors with a hereditary etiology.  Perhaps one of his family members has an occult malignancy that holds the answer.”

Dr. Talbot explains the pathologist’s request.  “He asked for random biopsies of all first- and second-degree relatives.  It didn’t make sense at first, but when he explained his logic, it was irrefutable.  I mean, the family wanted answers as badly as we did.  We should try to get them involved.”

In all, thirteen family members received a total of eighty-four biopsies.  Though the results are still pending seven months later, Dr. Nichols is optimistic.  “I’m confident the answer is here if we look hard enough.  If not, we will extend our search to his neighbors, coworkers, and pets.  There is always more tissue to be obtained, but only if the clinicians are truly interested in a definitive diagnosis.”

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    James Miller

    No. You don’t even know. This is like EVERY autopsy. See, the resident actually does the autopsy, then the next week, when reviewing the slides with the attending, they will send us back to collect more tissue from what we have set aside.

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    Kenneth Latt

    That’s exactly what I was thinking about.

  • Avatar
    Amy Pritchard Arnold

    I wonder if the CBC clotted as well?

  • Avatar
    Amy Pritchard Arnold

    I wonder if the CBC clotted as well?

  • Avatar
    Jing-Jing Ju-Lin Wang

    LOOOOL!!!

  • Avatar
    Jing-Jing Ju-Lin Wang

    LOOOOL!!!

  • Avatar
    Michael Julian

    Victoria Piper

  • Avatar
    Mike Jay

    Casey Marie Inouye

  • Avatar
    Leah Heim

    James Miller thought you’d get a kick out of this!

  • Avatar
    Brenton Andrew Chambers

    Croser Emma

  • Avatar
    Mary Schafer Edgecomb

    Love this!

  • Avatar
    Sid Schwab

    Well, we used to say that the natural course of a vascular surgery patient was BKA, AKA, and enough other amputations that the autopsy report would come back “QNS.”

  • Avatar
    Melissa Stalling

    Lololol

  • Avatar
    Heather Stefanski

    Hilarious!!!!!

  • Avatar
    Eugenia Maiori

    Sebastián Fandiño

  • Avatar
    Stephen Norman

    More tissue always a good thing!

  • Avatar
    Andre Sookdar

    Fuck yeah, biopsy them all especially the smokers to show if their future lung cancer has a genetic origin.

  • Avatar
    Lora Ann Cullipher

    Clinical correlation requested

  • Avatar
    Khalid Manzoor

    Haha, thats brilliant

  • Avatar
    Su McKenzie

    Did they not know it was supposed to be sent as a frozen?!?!

  • Avatar
    Chris Stalling

    Hahaha Melissa Stalling

  • Avatar
    Ash Lee WinDom

    That was pretty awesome =p

  • Avatar
    Martin Fielder

    Ash Lee WinDom

  • Avatar
    Lindsey Radke

    Lol Tyler Radke

  • Avatar
    Mick Beige-Brown

    RT : “Pathologist Performing Autopsy Requests More Tissue – http://t.co/Tw1gmmE08n #hcsm #meded http://t.co/es9Ibw4X5Q”

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