The shed tissue cannot be lost

  A patient, in her 40s, had a medicated abortion after an early pregnancy several months ago and had incessant vaginal bleeding for several months thereafter. After taking a clear history, a gynecologic examination was performed, which concluded that a gestational trophoblastic tumor was less likely and more likely to be a submucosal fibroid, requiring a serum HCG test (which is a specific serologic marker for this tumor) and a repeat pelvic ultrasound.  The next week, the patient came in for a follow-up visit with the ultrasound report and lab results, and the ultrasound did not reveal the abnormal mass in the uterine cavity previously reported. It was then that the patient said that the night after the last visit, a mass had been discharged from the vagina and the vaginal bleeding had decreased after that, and the ultrasound had been done after that. When asked if the patient had shown the discharged tissue to the doctor, the patient looked confused and said, “I didn’t think to pick it up. In fact, this tissue mass was very important! The patient lost the opportunity to make a histopathological diagnosis, but fortunately her serological indicators were normal, so she was not considered malignant for the time being, which was a good thing.