Thursday, May 1, 2014

Tan that is just...tan

A while back I was triaging a kidney and one of the pathologists wandered by and asked if it had a
So tan!
mass. I said that it did and he asked me what it looked like. I told him that it was tan. He asked if it was yellow tan, maybe hemorrhagic? And I told him no, it was tan... Solid tan. Uniform and...tan, just tan and didn't look like an RCC at all.

Then the kidney gets grossed and the slides go out.  The pathologist is on vacation, the one filling in for him gets the case and pops his head into the gross room to ask me what color the tumor was (while holding a copy of the gross description??). I told him it was tan and expressed surprise because I thought I had dictated that (I'm terrified that the dictation system, which is occasionally glitchy, will not pick up some really pertinent information). He looked at the paper in his hand, underlined something, and said "oh yes, tan" but... then he stood there. I went ahead and told him that it wasn't tan yellow, it wasn't hemorrhagic, it wasn't cystic, and it wasn't mahogany. It was tan. He said thank you and left.

About half an hour later the other pathologist comes in and says he wants to ask me about the kidney tumor.... Oh goodness. He asked me what color the tumor was, if maybe it was more tan red or mahogany. I told him, sorry no. It was just tan and I said there wasn't a central white scar in it either, since I knew that was going to be a relevant follow up question. Then he said thanks, said he thought it was an oncocytoma anyway, and left.

It was funny. I know that things tend to be pink-tan, white-tan, yellow-tan, brown-tan, etc, etc, but this one was genuinely just tan, like a paint chip of uniform color. Patients don't read the text books so things often don't present as expected and you can't take it personally if the pathologists question and dig to see if they can't get the gross description to match up to expectations just a little bit better. But all you can do is describe what is in front of you and trust that the microscopic matches up better.

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