Missed Diagnosis of Nasal Mass Ends in Metastatic Disease

This case involves a fifty-two-year-old male patient. He had a history of progressive left nasal obstruction and foreign body sensation that developed acutely. The patient underwent several endoscopic procedures to evaluate for possible obstruction. An endonasal excision of a left nasal polyp was conducted and a sample was sent to pathology for evaluation. For eleven months, the patient did not receive a follow-up and, during that time, a small mass went unrecognized and untreated. A year after the original presentation, the mass was finally resected, but the pathology reports showed that irregular margins were present and the mass fully invaded surrounding tissue. By the time the mass was identified and resected, the patient had developed metastatic squamous cell carcinoma.

Question(s) For Expert Witness

What is the standard of care in following a patient with a nasal polyp?

Expert Witness Response E-000023

This case hinges on what the pathology of the patient was after the initial endonasal excision of the left nasal polyp. If there were signs that this could be a malignant cancer, then a follow-up should have been done sooner and this would be a breach in the standard of care. After excluding malignancy, according to normal protocol, follow-up care in four to six month intervals should be sufficient, but it seems that protocol wasn’t followed here. These guidelines may be individualized according to the clinical progress of the patient and severity of disease prior to surgery.