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Sinonasal malignancy: What to do with an unexpected pathology result?
Michael B Hall1, Marc R Rosen1, Kurren Gill1
1Thomas Jefferson University Hospital, Department of Otolaryngology-Head and Neck Surgery, Philadelphia, PA.
American Journal of Otolaryngology
|June 18, 2016
Summary
An unexpected squamous cell carcinoma (SCC) diagnosis during endoscopic sinus surgery (ESS) for sinusitis highlights the need for diagnostic verification. STR genetic analysis is crucial to rule out contamination in such rare cases.
Area of Science:
- Otolaryngology
- Pathology
- Genetics
Background:
- Endoscopic sinus surgery (ESS) is a primary treatment for chronic sinusitis and nasal polyps.
- Diagnostic discrepancies and specimen contamination are rare but documented risks in pathology.
- Accurate diagnosis and surgical indication are paramount before ESS.
Observation:
- A 40-year-old female patient undergoing ESS for chronic sinusitis unexpectedly yielded squamous cell carcinoma (SCC) fragments.
- The pathological findings were inconsistent with the patient's clinical presentation of sinusitis without nasal polyposis.
Findings:
- An algorithm is proposed to guide physicians when pathological findings contradict clinical scenarios.
- Strategies for preventing medical errors, including slide review and DNA analysis, are discussed.
Implications:
- Unexpected diagnoses necessitate pathology slide review for a second opinion.
- Short tandem repeat (STR) genetic analysis of tissue is recommended to confirm diagnoses and exclude contamination.
- This approach ensures diagnostic accuracy and patient safety in ESS procedures.
