Стр. 195 - 2

197
After three years, when the vast majority of patients with a glio-
blastoma are dead, I asked the pathologists to review the case, but de-
spite the tumour's unusual behaviour, they could not come up with any
other diagnosis.
Meanwhile, Sarah had married and was thinking of starting a
family. By this time, much more sensitive magnetic resonance imag-
ing had become more freely available, and the scan showed no recur-
rence. At six years, I asked the pathologist to re-review the case. By
now, immunocytochemistry was much more sophisticated and, despite
the mitoses and other seemingly malignant features, he was able to re-
classify the lesion as a much more benign pleomorphic xanthoastrocy-
toma.
When I told Sarah this exciting news, I was most surprised that it
seemed unimportant to her, almost to the point of disinterestedness.
She remains well almost ten years from diagnosis. Her scan is
clear, but she still worries about recurrence. I worry about the possi-
bility of radionecrosis which sometimes afflicts long-term survivors of
brain irradiation
I have learnt three things from Sarah's case. Firstly, that having
lived with the diagnosis of having had cancer but being free from re-
currence, being an unusual statistic with a semi-benign condition of
unknown behaviour lacks meaning. Secondly, when tumours behave
in highly unusual ways, keep Looking for a reason. Thirdly, do not
expect other patients' tumours to behave in a similarly unusual fashion
– a temptation that I fell into at least once.
Michael Powell, Consultant Neurosurgeon London
BMJ 2000;320:1187 (29 April)
2. Give the summary of the text
3. Extract the key words , then analyze them according to the
principles of thesaurus-making up.
4. Can you think of any reason why the patient saw the reclas-
sification of her lesion as unimportant?
5. Discuss whether this article has influenced the way you feel
about breaking bad news to patients with terminal illnesses.