Houston Methodist. Leading Medicine

Wrist FAQ

Question:

I had a lump removed from my hand that turned out to be an angiomyoma. The surgeon's report listed it as a discrepant diagnosis. What does that mean?

Answer:

There are actually many different names for diagnoses made in the realm of Western medicine. For example, a medical diagnosis refers to a label put on a disease, condition, or illness by a medical doctor. It is usually based on the patient's history and the physician's clincial exam. In the case of something like a lump that will be examined and removed, the medical diagnosis can be a clinical diagnosis. There can also be the surgical diagnosis and the postoperative pathologic diagnosis. The clinical diagnosis is what the surgeon thinks is wrong with the patient before surgery is done. Again, this opinion is based on the patient's history and physical exam (tests, measures, observations) conducted in the surgeon's office. The surgical diagnosis takes place in the operating room as the surgeon examines the tissue removed. Cysts are fairly easy to distinguish from tumors. A telltale sign that a cyst is a benign ganglion is the presence of a clear, jelly-like fluid inside the cyst. Something like an angiomyoma (a tumor that involves blood vessels), the appearance alone distinguishes it from a ganglion cyst. The final and most accurate diagnosis is the pathologic diagnosis. The pathologic diagnosis is made by the pathologist, a specially trained medical doctor who examines the tissue under a microscope and confirms what it is. Looking at the individual cells of the cyst while performing what's called a histopathologic exam, the pathologist is able to give the patient and surgeon the true diagnosis. Diagnoses can also be labeled as concordant, discrepant, or discordant. Concordant means the surgeon's clinical diagnosis was the same as the pathologist's postoperative diagnosis. Discrepant means the two diagnoses were different but treatment was the same. And discordant describes a difference between surgeon and pathologist diagnosis that required a change in treatment from what was originally planned based on the clinical diagnosis. So in your case, the mass turned out to be something other than what the surgeon expected but the treatment ended up being the same (surgical removal). Thierry G. Guitton, MSc, et al. Necessity of Routine Pathological Examination After Surgical Excision of Wrist Ganglions. In The Journal of Hand Surgery. June 2010. Vol. 35A. No. 6. Pp. 905-908.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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