For the beginning of this story, see Anatomy Mystery Part I. This is the story as it stands now, with the information we learned just a few weeks ago:
Months later we've studied the normal histology of the liver and the lungs. We know what skin cells look like under the microscope and what cells belong where. Our pathologist came back and showed us pictures of our old friends from anatomy. We saw lungs decimated by emphysema, a heart with swathes of necrosed muscle cells. And finally, although we haven't studied endocrinology yet, our beautiful adrenal glands.
First off, she said, it was the most exciting case she'd yet seen from our anatomy lab. After leaving us, she was terribly curious about what he'd actually had - what he'd died of. In a living sample a quick test with antibodies bound to the cancer tissue would have solved it, but in dead tissue that was impossible. She tried it - she was just too curious not to - but it didn't work well because of the fixatives used in the lab for dissection. So she just looked. She looked and asked other pathologists to look, too. She googled cases in which liver cancer metastisized to the adrenal glands - they exist. But everyone she consulted agreed: the tumors in the glands were pheochromocytomas, a cancer of the adrenal medulla. In the liver they also looked the same - tumors were blocking blood vessels and moving out into the tissues.
In a living patient, we could confirm with urine tests if there was a liver cancer. It's possible that endocrine cancers could have been left untreated because they don't always turn malignant. Our observations aren't definitive. Without knowing the whole diagnostic process, we can't say for sure if this is a misdiagnosis or not. So sitting listening to her explanations, I wondered: Should we tell his family? If he was misdiagnosed, does it matter to them? Or would it be too painful a reminder that students were cutting open their loved one? In about a month, we'll host a memorial service for him, and all our anatomy donors. Their families will be invited, I could meet them. What would I say?
As it turns out, there's more at stake then setting family history straight. I mentioned that bilateral tumors - tumors in the organs on both sides of the body - are unusual and often associated with genetic disease. Pheochromocytomas, the tumor type he probably had, are specifically associated with a number of genetic diseases leading to endocrine tumors. In several of them, if the defective gene is inherited, the individual has 100% chance of a thyroid tumor. Now the scales tip - if he had these mutations, his family needs to know.
Fortunately, it won't be up to us to figure this out. The anatomy professors will look at his medical records to see how he was diagnosed. If the diagnostic process was strong - there were urine tests indicating liver cancer, or there is a noted history of these genetic conditions there's no need to worry - after all his family may well be aware of their history. Or genetic disease could have been ruled out for other reasons. It's an incomplete picture to be sure, but a fascinating one.
There's a lot of talk, in anatomy, about your cadaver dissection being your first patient. For most of us, the day-to-day of dealing not just with anatomy but the onslaught of med school is too much to process already. We reflect as we can, but I can say that for me, he wasn't a patient until today. Until there were diagnostic choices to be made, family to consider. Maybe I'm more prepared to think beyond the next four hours now, or maybe I'm not meant to be a pathologist. Regardless, I was glad to have the reminder that there are always more layers to consider.
No comments:
Post a Comment