Medical Verdicts

Undetected lymphoma results in unnecessary mastectomy


 

<court>Maricopa County (Ariz) Superior Court</court>—A 35-year-old gravida in her sixth month of pregnancy noticed a pea-sized mass in her right axilla in March. By mid-April, the mass had grown to the size of a lemon.

The patient was referred to a general surgeon who performed a mammogram and a true-cut biopsy of the large mass. The initial pathology reading noted a malignant and anaplastic tumor. The local pathologist confirmed that the primary site of the mass was most likely the breast. However, metastasis from another site, other than the breast, could not be ruled out. The surgeon scheduled the patient for a modified radical mastectomy.

During the procedure, the surgeon excised a large tumor from the axillary tail of the breast, extending into the axilla and involving multiple lymph nodes. The entire tumor was not resected, as it was wrapped around some nerves.

The mastectomy specimen was then sent to a regional pathology center and a diagnosis of anaplastic large cell lymphoma was made by the consulting pathologist. The patient underwent 1 course of chemotherapy before her child was prematurely delivered via cesarean. Later, the woman underwent additional chemotherapy and 2 breast reconstruction surgeries.

In suing, the patient contended that had she been properly diagnosed with lymphoma, she would not have needed a mastectomy. The woman also maintained that the physician should have carefully reviewed the pathology report and that he should have known the mass was not resectable.

Further, she claimed that the pathologist should have asked for more tissue samples prior to the surgery so that a definitive diagnosis could be reached.

The surgeon and pathologist argued that the interpretation of the preoperative biopsy specimen was appropriate and within the standard of care. Further, regardless of the possible metastasis from another site, the surgeon was properly advised to proceed with the mastectomy.

The jury returned a verdict for the defense.

The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts. While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.

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