62-year-old black man with a two inch (that’s inch; not centimeter) lump under his left arm. It is determined that he needs to have it biopsied in order to tell for sure what it is. The differential diagnosis includes a simple reactive lymph node, lymphoma, leukemia, granuloma, sarcoidosis, and several other more esoteric entities, all of which require tissue for definitive pathologic diagnosis.
Patient Who Will Not be Reassured: What is it, Doctor Dino?
Me: We won’t know for sure until we get the report from the biopsy.
PWWNBR: But what do you think it is?
Me: I have no idea. We have to see what the pathologist says.
PWWNBR: Could it be cancer?
Me: It could be any one of several different things. Yes, cancer could be one of them, but there’s no way of knowing without the biopsy.
PWWNBR: Dr. Dino, do I have cancer?
Me: I don’t know. We can’t tell until we get the biopsy report.
PWWNBR: But what do you think?
Me: I really don’t know. There are some features about it that make me think one thing, but there are other features that make me think something else. So the only thing to do is get the biopsy and see what it shows.
PWWNBR: What do I have?
Me: You have a mass under your arm that needs to be biopsied.
PWWNBR: But what is it?
Me: There’s no way to know for sure until we talk to the pathologist.
PWWNBR: Dr. Dino, what do you think it is?
Me: I can’t tell just by feeling it. We need to get the biopsy and wait until the report is ready.
PWWNBR: Do you think it’s cancer?
Me: I have no idea what it is, and the only way to find out is to see what the tissue looks like under the microscope.
PWWNBR: But what is it, Dr. Dino?
and yet again…….
Or so it seems.