Advice on Surgical Pathology Report. Request Second Opinion??

Posted by 0909an @0909an, Mar 4 2:05am

Hello, so a quick summary in regards to my question... I experience chronic right upper quadrant pain, but over the last year or so it has turned into random flare up attacks. HIDA scan showed high ejection fracture and pain with CCK incorporation so we agreed to go ahead with a cholecystectomy to see if this would improve my pain rather than treating long term with pain medication. I am extremely confused by my surgical pathology report and I am wondering if anyone has any input deciphering. I'm also wondering if anyone has any advice on finding a source for second opinions on something like pathology.
These were my report findings:
At the gallbladder fundus, is an area of mucosal induration and heaping measuring 1.2 x 0.7 cm overlying the hepatic bed (inked blue). Upon further sectioning, the submucosa is fibrotic and thickened up to 0.3 cm in thickness.
Representative sections are submitted in formalin as follows:
A1, cystic duct margin and unremarkable gallbladder wall;
A2-A3, area of indurated mucosal heaping including hepatic bed margin, entirely.

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seniormed | @seniormed | Mar 4 7:03am

Communicate with your surgeon to go over the findings
of your biopsy. With their assistance you may have access to also confer with the reporting pathologist.
Usually microslides or digital photos can be provided
at your request for a second opinion or your primary
doctor to interpret. At times we can be left clueless
if reports are released before our physician explains
the result

0909an | @0909an | Mar 4 1:20pm

I've asked my provider and they couldn't really interpret the results either, other than telling me things were benign. The terminology used in the report just doesn't make much sense which is what I'm trying to interpret.

rashida | @rashida | Mar 4 6:29pm

@0909an I wish all medical students had to take a compulsory course on patient communication! 😒

cheryl46 | @cheryl46 | Mar 4 7:00pm

Not sure if you need a second opinion. When do you follow up with your surgeon?

cheryl46 | @cheryl46 | Mar 4 7:07pm

In reply to @cheryl46 "Not sure if you need a second opinion. When do you follow up with your surgeon?" + (show)

Actually disregard that post. I just saw where they couldn't explain it but it was benign.
I definitely agree with a 2nd opinion.
As a GI nurse we usually are the ones to diagnose gallbladder disease but not ones to follow up with. However I have some (limited) knowledge on pathology and when we see something like indurated mucosal heaping that is usually associated with raised thickened mucosa raises red flags.
I'm no doctor, pathologist or scientist so I don't want to alarm you but it never hurts to have a second opinion.

0909an | @0909an | Mar 5 4:32pm

I'm not sure how to edit my original post, but I should clarify that I went over the results of this report months ago with my provider. They were also unable to fully explain the findings as the terminology that the pathologist used as well as the final diagnosis do not make sense. I'm not looking for advice on any diagnostic information. I'm just trying to decipher the terminology that the pathologist used such as "heaping" "submucosa" "overlying hepatic bed entirely".
I truly have exhausted all of my outlets except for reaching out for a second opinion.
I also want to note that many other facilities that I have spoken to have agreed that the facility that completed the pathology is not very reputable which is another reason I am wanting a second opinion.

0909an | @0909an | Mar 5 4:36pm

In reply to @cheryl46 "Actually disregard that post. I just saw where they couldn't explain it but it was benign...." + (show)

The final diagnosis is quite confusing as well because I have had many ultrasounds, CT's, MRI's and a HIDA scan that all showed no abnormalities, no evidence of chronic/acute cholecystitis, yet the pathologist labeled it as "mild chronic cholecystitis" and "mild nonspecific mucosal and muscular hypertrophy".

cheryl46 | @cheryl46 | Mar 5 8:36pm

In reply to @0909an "The final diagnosis is quite confusing as well because I have had many ultrasounds, CT's, MRI's..." + (show)

Was it a surgeon who diagnosed you with gallbladder disease? Or primary who then referred you to surgeon?

lylii | @lylii | Mar 7 7:47pm

In reply to @rashida "@0909an I wish all medical students had to take a compulsory course on patient communication! 😒" + (show)

The pathology report is more for the physician than for the patient. The physician is the one who should be able to explain the meaning of the report to you. The pathologist's job is to analyze and give a detailed report to the doctor. Usually at the end of the report, there is a summary of the findings and sometimes a suggestion of other studies that can be done. For the most part, pathologists are not involved in direct patient care.