Diagnostic errors in surgical pathology

Santana, Monique Freire; Ferreira, Luíz Carlos Lima

doi:10.5935/1676-2444.20170021

Cited by 16 publications

(21 citation statements)

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“…Tracking the cause of error in the diagnostic process is very difficult. Interpretation Errors in the analytical phase can be categorized as failure to see a feature on the slides or failure to correctly interpret it (16). Misdiagnosis of condyloma acuminta, as a papillary carci-noma, was attributed to errors in histopathology interpretation.…”

Section: Discussionmentioning

confidence: 99%

Misdiagnosis of Primary Urethral Condyloma Acuminata with Papillary Cancer: a Case Report

Amirjannati

Akbari

Sane³

et al. 2018

Arch Clin Infect Dis

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Our purpose in this case report is to pay attention to an unusual presentation of HPV infection. A 27-year-old-male patient with the complaint of dysuria, hematuria, and urethral lesion was presented to the clinic. The first diagnosis was papillary urethral cancer based on the pathology report. We considered another expert's opinion from a pathologist point of view due to the report of a rare cancer for this young patient. The slides review showed no dysplastic change and confirmed condylomata acuminata. Primary urethral condyloma acuminata is rare and health care professionals should consider a thorough medical history, especially highrisk sexual behaviors of patients. Considering the risk of anogenital cancers, the type of HPV virus should also be determined in the patients.

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Section: Discussionmentioning

confidence: 99%

Misdiagnosis of Primary Urethral Condyloma Acuminata with Papillary Cancer: a Case Report

Amirjannati

Akbari

Sane³

et al. 2018

Arch Clin Infect Dis

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“…The most frequent type of error is related to interpretation with serious consequences on both patient and pathologist (10,12). The correctness of the final pathological report is closely related and depended by effectiveness of all pre-analytical steps: gross evaluation of the surgical specimen and sectioning of which requires special attention to sample the most representative fragments, embedding, sectioning and staining with either usual haematoxilineosin or special stains and immunohistochemical evaluation (2).…”

Section: The Analytical Phasementioning

confidence: 99%

“…Mistakes during tissue processing due to technical problems (power failure, incorrect was impregnation, different technical fault of automatic tissue processor or of cryostat, poor dehydration) Involving the patient Wrong identification data of the patient because of wrong labelling Mixing up the surgical probes Not having access to clinical data regarding the history of the patient or to different initial laboratory tests. Analytical phase (2,6,11,12) Intra-operative…”

Section: Identification Of Risks Exposurementioning

confidence: 99%

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Assessment of Quality and Risks Exposure in Histopathology Department

Deacu

Aşchie

Izabela

et al. 2018

ARS Medica Tomitana

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The role of histopathology department in establishing a correct and final diagnosis is essential, this leading to an effective treatment for the patient so its healing to be complete. In order to achieve this goal, it is necessary that all complex steps belonging to this department to be properly carried out because any mistakes in a pathology report may adversely affect the patient outcome. Therefore, it is mandatory the quality assessment of all procedures from the laboratory to be constantly done so that the report to be reliable and accuracy. All three main categories of activities specific to a pathological laboratory (pre-analytic, analytic and post-analytic phases) must undergo quality control. During the progress of these phases, it also must be identified the risks and safety problems regarding the personal staff. These may be different for each activity or procedure which is performed by the laboratory workers. All the physical, chemical or biological hazards must be identified to assess, appreciate the possible risks and to implement preventive measures. The aim of this study is to highlight the importance of quality management for all phases included in a surgical pathological laboratory based on the pathological errors observed, identify emerging risks exposure and necessary measures to prevent them.

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“…These data, along with specific microscopic features and ancillary studies, help the pathologist to form an accurate and complete diagnosis. 1 Rheumatoid arthritis (RA) is a chronic autoimmune disease that causes pain, swelling, and stiffness of joints. The characteristic feature is symmetrical and erosive arthritis of small peripheral joints.…”

Section: Introductionmentioning

confidence: 99%

<p>From Reactive Lymphadenopathy to Systemic Vasculitis, the Importance of Providing Sufficient Clinical Information to Optimize Pathological Interpretation, a Case Report</p>

Soleimani

Mokhtari

Mohammadzadeh

2020

IMCRJ

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Introduction: Pathology must aim at a correct diagnosis, which is complete and useful for clinicians. However, in routine practice, there are multiple sources of errors in the pathology results, which have several impacts on the patient's treatment and outcome. Case presentation: Our patient is a 66 years old man, case of rheumatoid arthritis with lymphadenopathy due to vasculitis, which was underdiagnosed due to lack of complete clinical data during pathologic examination. Since the patient was extremely ill, and the workup was inconclusive, the pathology slides were sent to our center for consultation and molecular study to rule out lymphoma. The slide review was done with complete access to the patient's history and status. In addition to reactive follicular hyperplasia, there was interfollicular/paracortical plasma cell infiltration and remarkable leukocytoclastic vasculitis of small vessels. Discussion: Most frequent errors in the laboratories are preanalytical, due to clinical failures (wrong clinical procedure, inappropriate ordering, erroneous, incomplete or misleading clinical information), and specimen transportation and delivery. Surgical pathology by its nature depends heavily on the input of clinicians and surgeons who are fully aware of patient condition. Conclusion: This case clearly shows the importance of communication between the pathologist and clinicians and the impact on patient care. Clinicians should also provide complete clinical data for the pathologist. Full access to clinical information improves the pathologist's ability to make an accurate diagnosis.

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Diagnostic errors in surgical pathology

Cited by 16 publications

References 0 publications

Misdiagnosis of Primary Urethral Condyloma Acuminata with Papillary Cancer: a Case Report

Misdiagnosis of Primary Urethral Condyloma Acuminata with Papillary Cancer: a Case Report

Assessment of Quality and Risks Exposure in Histopathology Department

<p>From Reactive Lymphadenopathy to Systemic Vasculitis, the Importance of Providing Sufficient Clinical Information to Optimize Pathological Interpretation, a Case Report</p>

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