Who Cares About The Diagnosis?
Posted: Monday, March 15, 201003-15-2010
Siouxsie is a 9-year-old female standard poodle who presented with dysuria and stranguria. Her diagnostic workup, which included an abdominal ultrasound, revealed an obstructive mass near the neck of the bladder.
Traumatic catheterization and cystoscopy were unsuccessful at getting diagnostic biopsies. Exploratory laparotomy was recommended to obtain both a diagnosis and a treatment.
The owner agonized about what to do. To make things worse, she had adopted the dog just three weeks before presentation.
She wondered about the rationale of spending “so much money” to find out that her brand new dog had transitional cell carcinoma. What else could it possibly be?
Granted, Siouxsie could do well for a while on piroxicam.
Ultimately, the owner decided that she had a responsibility toward Siouxsie when she rescued her, and she elected to do surgery.
Cystotomy revealed a pea-sized mass in the neck of the bladder. It was clearly impairing urine flow into the proximal urethra. Since aggressive surgery was likely to cause incontinence, the mass was debulked. A cystostomy tube was also placed. It was removed a few weeks later, once we were reassured that she could urinate normally.
We are happy to report that Siouxsie is still alive one year after surgery and is still urinating like a champion! The owner says that she is doing “terrifically well.”
As you probably guessed from the tongue-in-cheek title, histopathology revealed a benign inflammatory mass.
So yes, who cares about the diagnosis? Siouxsie could very well have been euthanized despite a benign process and a great prognosis. So in her case, what mattered is not really whether the mass was benign or malignant. What mattered is that it's tough to live with an obstructive urethral mass.
We could mention other similar cases: the benign obstructive pyloric mass, the benign obstructive intestinal mass, the benign obstructive pharyngeal mass. You get the idea.
Statistically, all of these masses should have been malignant. The odds were definitely against us. But all of these masses were benign.
Who cares about the diagnosis? If they were to live, these patients’ best option was surgery to first and foremost relieve the obstruction (and the symptoms) and second, to obtain a diagnosis and a prognosis.
Of course, submitting the mass for histopathology is mandatory after surgery.
Because you know, we really do care about the diagnosis.
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