Crohn's disease, also known as granulomatous colitis and regional enteritis, is an inflammatory bowel disease (IBD) that may affect any part of the gastrointestinal tract from mouth to anus, causing a wide variety of symptoms. It primarily causes abdominal pain, diarrhea, vomiting, or weight loss (see: Crohn's disease). As any pathologist knows, the characteristic granulomas of the disease that distinguish it from ulcerative colitis may be difficult to spot, so a recent article (see: Teen diagnoses her own disease in science class) does make some sense. Below is an excerpt from the piece with boldface emphasis mine:
For eight years, Jessica Terry suffered from stomach pain so horrible, it brought her to her knees. The pain, along with diarrhea, vomiting and fever, made her so sick, she lost weight and often had to miss school....In her Advanced Placement high school science class, she was looking under the microscope at slides of her own intestinal tissue -- slides her pathologist had said were completely normal -- and spotted an area of inflamed tissue called a granuloma, a clear indication that she had Crohn's disease....[Her teacher], who has taught the Biomedical Problems class ...for 17 years, immediately went on the Internet to see whether Terry had indeed spotted a granuloma."I said, 'Jeez, it certainly looks like one to me,' " [he] remembered. "I snapped a picture of it on the microscope and e-mailed it to the pathologist. Within 24 hours, he sent back an e-mail saying yes, this is a granuloma." ...."This story carries a valuable lesson about how errors are found. It's very often by 'fresh eyes,' just like in Jessica's case," [a local pathologist] said. "Some specialty centers, recognizing the reality of perceptual error and the power of a second independent reading, are now requiring second reviews on certain types of smears and pathology specimens."
There are a few ideas that can carried away from this story. One of them is not that the average citizen can expect to second guess or reverse the diagnosis of a pathologist. Here are some of my first impressions:
- This is clearly a story about a highly motivated high school student with support from a talented science class teacher. Note above that her teacher "immediately went on the Internet" and searched for images of granulomas in Crohn's. A Google image search for "Crohn and granuloma" provided a large set of images showing the classic granulomatous lesion. It's an easy search once you get the hang of it but an option not readily available to a high school teacher a scant five years ago.
- Also interesting to note is that Jessica Terry or her parents had the presence of mind to request the slides from her biopsy from the hospital and she also thought to bring the slides to class to look at under the microscope.
- The story is also a powerful reminder of the value of seeking a second opinion for significant or ambiguous diagnoses. Many healthcare consumers don't know this, but most pathologists will be willing to request a second independent opinion for cases. The patient should not be shy in putting such a request to either the pathologist or through the treating clinician.
- Finally, I was impressed by the apparent lack of defensiveness on the part of the pathologists who were quoted in the story. Perhaps they had no other choice, but I could envision them reacting in a less positive way under the circumstances.