Avoiding the Major Complication of Ophthalmic Pathology: Misdiagnosis. A Review of Three Common Diagnostic Challenges

Abstract

Diagnostic errors in ophthalmic pathology are not uncommon. Pathology is a very subjective specialty with several biases dependent on such factors as training, experience, practice patterns, personal anecdotes, and inevitable human error. In addition to these factors, there are many cases where difficulty in diagnosis lies in differentiating between two very closely related, or similar appearing, entities that may have vastly different prognostic consequences. In this paper, we review three challenging areas wherein diagnostic dilemmas may occur. We outline some of the lessons we have learned in arriving at a correct diagnosis, which includes an admission of one's own limitations requiring consultation with other pathology subspecialists, and the use of immunohistochemistry.

Sebaceous Gland Carcinoma with Misleading Clinical Appearance: A Case Report of an Eyelid Lesion

“…Many immunohisto-chemical stains and proteins have been recommended to aid in the diagnosis of SGC, of which EMA, Ber-Ep4, androgen receptor, and adipophilin appear to be useful [ 10 ]. Cytokeratin stains (with the exception of CK19) are not very helpful in differentiating SGC from SCC and clear cell variants of BCC, with a rate of misdiagnosis that may reach 77% [ 11 ]. It is even more challenging to distinguish SGC from BCC that has sebaceous differentiation, in which case, BCC cells would lack expression of EMA [ 11 , 12 ].…”

“…Cytokeratin stains (with the exception of CK19) are not very helpful in differentiating SGC from SCC and clear cell variants of BCC, with a rate of misdiagnosis that may reach 77% [ 11 ]. It is even more challenging to distinguish SGC from BCC that has sebaceous differentiation, in which case, BCC cells would lack expression of EMA [ 11 , 12 ]. The combination of p16 and p53 is particularly helpful in detecting intra-epithelial SGC and determining the extent of tumor spread [ 13 ].…”

Trachoma

“…For operational purposes, any modality of C. trachomatis diagnosis will have to be cheap and reliable and provide rapid results. It becomes apparent, therefore, that trachoma control programs overwhelmingly rely on clinical signs of trachoma for diagnosis [43][44][45][46].…”