Question

A 55-year-old white man was seen 2 years ago because of upper airway obstruction due to large polyps in the right nasal cavity. On examination, a large polypoid mass was observed to fill most of the right nasal cavity. The mass originated in the middle meatus. With the use of a nasal snare, polypectomy was performed to remove several sections. There was a slight hemorrhage. On the next day, a 4x3-cm oval soft mass was excised from beneath the left submaxillary region, with the patient under local anesthesia. The mass was just beneath the superficial fascia and appeared to be an enlarged lymph node unconnected with the nasal disease.

The pathological diagnosis of the nasal growth was low-grade papillary carcinoma. The diagnosis of the lymph nodes was metastatic carcinoma. A chest film was taken that indicated the presence of pulmonary densities attributed to unresolved pneumonia. Also, a needle biopsy of the enlarged liver nodes yielded no results

After discharge from the hospital, the patient expired at home and no necropsy was obtained.

1.       When is a polypectomy indicated?

2.       Were the patient’s nasal polyps cancerous?

3.       What contributed to the patient’s death?

4.       Why was a biopsy of the liver performed?

5.       What does “patient expired at home” mean?

Answer 1

1. Polypectomy is indicated to remove the polyps in the gastrointestinal path during the procedure of colonoscopy. It is a surgical procedure. As in this case nasal polypectomy was performed to remove the several sections of the the large polypoid mass that filled most of the right nasal cavity of the 55 year old patient.

2. The pathological examination of the nasal polyps indicated a low grade papillary cancer in the patient.

3. The low grade papillary cancer, metastatic carcinoma, and an unresolved pneumonia contributed to the death of the patient.

4. Because the liver was enlarged, a biopsy of the liver was performed.

5. " Patient expired at home" means the patient died after he was discharged from the hospital, in his home.