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- 长春晚报：“谁来为我所失去的四个健康器官买单？”
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| 肉眼检查： | |||||
长春晚报：“谁来为我所失去的四个健康器官埋单？” | |
作者：不详 | |
| 病理报告出来后，她从医生的表情里看到了惋惜 李娟今年27岁，是长春市某电视台的节目主持人。2004年12月26日，因身体不适，李娟到长春市某医院作检查，结果发现左侧卵巢有一实质性不均质包块（肿瘤）。这个结果不免让李娟有些担心，为了不耽误工作，李娟赶回台里请了3天病假，并录制完成了以后半个月的节目。也正是这一天，李娟接到了节目组颁发的“十佳员工”证书。 2004年12月29日11时，在朋友王某的陪同下，李娟来到该院做肿瘤切除手术。手术前，李娟叮嘱王某，如果病理检测结果是恶性肿瘤，要赶紧通知她的家人，若是良性肿瘤就不要惊动他们了。 医生对李娟实施了局部麻醉，整个手术过程中李娟都很清醒。 快速病理结果出来后，李娟听到医护人员低声私语，医生对病理结果表示质疑，并提出再次检测。第二次的检测结果出来后，医生沉默了，从医生的表情里，李娟看到了一种惋惜。 李娟小声问护士：“是癌症吗?你告诉我吧！”护士点了点头，李娟的大脑瞬间一片空白，这个结果无异于对她宣判了“死刑”。 “你的病理检查报告结论为：（左侧卵巢）黏液性腺癌。手术方案有两种，你可以选择将双侧卵巢全部切除，或只切除一侧卵巢！”医生的话把躺在手术台上的李娟“拽”了回来。 李娟患癌症的消息不胫而走，台里的领导和同事经常去探望她、鼓励她，台里还为她解决了一部分医疗费用。以前李娟做节目时帮助过的人也来到病床边，一位盲人由于家境窘迫，扛来了一袋大米，表达自己的关心。 第一天化疗结束了，李娟什么东西都吃不下，王某把熬好的鸡汤端给她，她却连看都不看一眼。从这一天起，李娟很少再和王某说话，但王某却一直不离不弃始终伴她左右。 为了庆祝自己“劫后余生”，李娟和王某来到北京前门的一家烤鸭店，可王某比李娟还激动，一口东西没吃，一直坐在那里哭。回到家后，李娟紧紧地抱着父母，一家人哭成了一团。 | |
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本帖最后由 于 2009-01-18 12:55:00 编辑
- “人生没有彩排，每一天都是现场直播”
×参考诊断
I basically share the view with Dr. Joe Ma's comments. However, I think we as pathologists should learn something from this report, even though it may be exaggerated in the news report. One lesson we should learn from this case is the " proper or right phrase" of our frozen diagnosis. As the rule of thumb, when you encounter a mucinous tumor of the ovary, you should know the correct diagnosis relying on the thorough sampling following the rule of at least one section per centimeter of the tumor mass. Therefore, one frozen section of a 10 CM tumor is impossible to provide accurate diagnosis unless it is frankly malignant. Therefore, in many hospitals in US, we often use the term " At least mucinous borderline tumor, defer to permanent section evaluation for final diagnosis" for frozen section diagnosis. You need pick up phone and communicate with surgeon about the reason and concern of your diagnosis. I have been a student of many world-renown pathologists. One thing I learn from all of them is that we pathologists should know our own limitation. In this case, if a diagnosis of "At least mucinous boderlne tumor" was given, it will dictate surgeon for properly staging the patient, leave space for him or her to provide accurate diagnosis at permanent, without concerning of "amending previous over diagnosis, and will prevent patient suffering further chemotherapeautic treatment. We are getting smarter because we made mistakes. Hopefully we all learn sth from this report and keep improving ourselves in our pathology career. 共勉
- 不坠青云之志，长怀赤子之心
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学习mjma老师讲解并翻译如下：
新闻标题夸大并误导这一愤怒的年轻患者的创伤。我认为这种方式是为了获取公众的同情。我为原诊断医生难过，但希望他/她经历这种事情之后仍然有信心完成日常工作。病理医生常常被挑毛病，但没有人为我们每天对每个病例作出的正确诊断送上应有的赞誉。
卵巢粘液性肿瘤在术中会诊（冰冻切片）中不容易准确诊断。完全切除受累的卵巢是一必须程序以确保完整的组织学检查和提示肿瘤本质。对于交界性肿瘤或者更恶性的肿瘤，此病例切除阑尾、大网膜、小网膜是剖腹诊断肿瘤分期手术的一部分。因此，我不认为患者的“器官”是不必要地被切除的。这些观点应当通过病理学专家通过媒体向公众强调说明。
对卵巢粘液性交界性肿瘤的术后化疗可能是过治疗，但如果疾病分期较高（即，交界性粘液性肿瘤被发现累卵网膜伴腹腔冲洗细胞学阳性），化疗也是对控制疾病有效的选择。这些要点在新闻报道中没有得以澄清，需要被公众接受。我根据后来的第二次（以及第三、四次）病理报告推测，如果与阑尾有关，那么阑尾粘液性囊腺瘤累及一侧卵巢和网膜的可能性很大。这样的病例，是需要化疗的。
卵巢粘液性交界性肿瘤是非常难以对付的。众所周知，不同原发部位（结肠、直肠、阑尾、胃、胰）转移到卵巢粘液性腺癌可能假冒“交界性”肿瘤。在术中会诊处理卵巢粘液性肿瘤时，无论多么小心谨慎都不过分。
华夏病理/粉蓝医疗
为基层医院病理科提供全面解决方案，
努力让人人享有便捷准确可靠的病理诊断服务。
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媒体推波逐澜，唯恐天下不乱，真令人恶心！交界性肿瘤切除患侧卵巢有何错误？更何况这侧卵巢是否完全破坏也不一定；阑尾是个免疫器官，但免疫功能几何谁能肯定？小网膜、大网膜岂能完全切除？病理误诊是明确的，造成的后果尚需鉴定，也并非象媒体想象的那样...
但我辈身为病理医生一定要正视自己的错误，不能一错再错；同此案例，冰冻已经错了，但治疗尚未太过，如果能很好的承认过失，绝不会对薄公堂之上；为何要一错而再错，引起一系列的后续连锁反应，把自己逼上死路？
岂武断，岂逞能，岂发自己不理解的报告...
遇到搞不定的东西，别怕丢脸没面子，唧唧歪歪一点，别人虽感觉甚为不适，但你睡的踏实吃饭香，孩子有学上老婆有衣穿自己有电脑玩，呵呵，赛过活神仙！
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本帖最后由 于 2006-10-13 03:08:00 编辑
The title of this news article exaggerates and misleads the trauma of this young and angry patient. I assume this approach is to gain public sympathy. I feel sorry for the pathologist who made the initial diagnosis, but hope that he or she still has confidence to carry his or her daily work after this incident. Pathologists are singled out for our mistakes, but no one give us deserved credit for our correct diagnoses made each and every day.
Mucinous tumors of ovary are not easy to diagnose accurately during intraoperative consultation (frozen section). Complete removal of the affected ovary is a must-do procedure to ensure thorough histologic examination and tumor debulking. Resection of vermiform appendix, greater and lesser omentum in this case is part of the staging laparotomy for any ovarian tumor equal to or worse than borderline tumor. Therefore, I don't think the patient's "organs" were removed unnecessarily. These points need to be emphasized by the pathologiy authority to the general public via media.
The postoperative chemotherapy was probably over-treatment for a borderline ovarian mucinous tumor, but in a case with high stage disease (i.e., borderline mucinous tumor is found to involve the omentum with positive peritoneal washing cytology) chemotherapy is an available option for disease control. This important point was not clarified in the news article and needs to be confirmed. If the vermiform appendix is involved, which I doubt from the subsequent pathology second (and third and fourth) opinion, the possibility of appendiceal mucinous adenocarcinoma that has spread to one ovary and omentum is high. In such case, chemotherapy is needed.
Mucinous borderline tumors of ovary are very tricky. It is well known that metastatic mucinous adenocarcinomas of various primary sources (colon, rectum, vermiform appendix, stomach, pancreas) to ovary may mimic "borderline" tumors. One cannot be too careful when dealing with mucinous tumors of ovary during intraoperative consultation.
聞道有先後,術業有專攻
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