We had a 53 year old white male who presented to clinic 2 weeks ago with a chief complaint of pruritis of the left ear. (itchy ear) On examination a small nodule was noticed on the tympanic membrane. We performed an in office biopsy of the nodule and sent it to path. The biopsy came back from path a week later with an ambiguous diagnosis. Basically the pathologist hedged and said it did not appear to be cancer but he could not rule out cancer completely. This means that we had to operate and remover the entire nodule. Today we did the surgery which involved cutting the skin right behind the ear and completely peeling the ear off so that the inner ear was exposed. This was so cool. You could see the anatomy of the ear so well. Once we moved the ear out of the way the tympanic membrane was completely exposed. The nodule was completely removed which damages the tympanic membrane. To repair this we cut out some fascia from behind the ear and grafted it in as a replacement for the tympanic membrane. This was a great surgery.
If the patient does indeed have cancer in the ear we removed the entire nodule so this would be a potential surgical cure if there are no other areas in the body with cancer. Most likely the nodule was benign but the pathologist wanted to cover his tail so he hedged on the diagnosis. This same thing happens in radiology as well. This of diagnosis from a pathologist or a radiologist reduces their liability but it increases the liability for the treating physician. Sometimes the biopsy really is ambiguous and the pathologist is not hedging he / she truly can't tell from the biopsy what the diagnosis is so they have to give an ambiguous diagnosis.
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