Sinonasal malignancy: What to do with an unexpected pathology result?
BACKGROUND
Endoscopic sinus surgery has become the mainstay in surgical treatment of sinusitis and nasal polyps. While rare, diagnostic discrepancies or pathological contamination during routine specimen analysis has been described. Thus, an accurate diagnosis and indication for surgery are mandatory before proceeding with surgical intervention.


METHODS
We present the case of a 40-year-old female patient who underwent endoscopic sinus surgery (ESS) for chronic sinusitis without nasal polyposis and fragments of squamous cell carcinoma (SCC) were found in the pathology specimen.


RESULTS
We propose an algorithm to help guide physicians presented with a tissue diagnosis that does not match the clinical scenario. Moreover, we discuss strategies to help prevent medical errors and the importance of DNA genetic analysis in this situation.


CONCLUSIONS
When an unexpected diagnosis occurs, the pathology slides should be reviewed for a second opinion. If the unexpected diagnosis is confirmed, the tissue should undergo STR genetic analysis to ensure against tissue contamination.
Thomas Jefferson University Hospital, Department of Otolaryngology-Head and Neck Surgery, Philadelphia, PA. Electronic address: Michael.B.Hall@jefferson.edu.
Michael B
MB
Hall
Thomas Jefferson University Hospital, Department of Otolaryngology-Head and Neck Surgery, Philadelphia, PA.
Marc R
MR
Rosen
Thomas Jefferson University Hospital, Department of Otolaryngology-Head and Neck Surgery, Philadelphia, PA.
Kurren
K
Gill
Thomas Jefferson University Hospital, Department of Otolaryngology-Head and Neck Surgery, Philadelphia, PA.
Gurston G
GG
Nyquist
D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000628:therapy; D002908:Chronic Disease; D004724:Endoscopy; D005260:Female; D006801:Humans; D033162:Incidental Findings; D010255:Paranasal Sinus Neoplasms / Q000175:diagnosis* / Q000628:therapy; D012852:Sinusitis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*