This case presents a female patient in her 70s with pain in the right upper quadrant. An ultrasound showed pelviectasis bilaterally, right greater than left. It was noted that this might be due to a right utero-pelvic junction obstruction. On colonoscopy, there was a 6mm colon polyp present. This polyp was removed. The upper GI showed normal esophagus duodenum and mild erythema of the gastric antrum.
Ultimately, a pathologist has to commit to a diagnosis. Many trainees have difficulty committing to a diagnosis for fear of being wrong. Three years ago, Gary Keeney, M.D., Consultant in the Division of Anatomic Pathology at Mayo Clinic, started sending trainees interesting cases seen in Mayo's practice. For those committing to a diagnosis, Dr. Keeney provided detailed feedback. At first, it was written, but it has since evolved to a voiced-over presentation detailing the ancillary studies and discussing the differential diagnosis of the cases. Dr. Keeney upped his teaching game to achieve a personal goal of a 100% response rate from the trainees. While the trainee response rate has improved considerably, he has yet to reach his personal goal.