title: Analysis of clinical misdiagnoses in children treated with enucleation.
abstract: OBJECTIVE
  To evaluate discordant clinical and pathological diagnoses leading to pediatric enucleations over time.
  
  
  METHODS
  All pathology reports of pediatric enucleation specimens (subjects aged 0 to 18 years) from 1960 to 2008 were reviewed. Specimens with discordant clinical and pathologic diagnoses were further analyzed. Formalin-fixed, paraffin-embedded sections of enucleated eyes of any misdiagnosed cases were reevaluated.
  
  
  RESULTS
  Of 729 pediatric patients (746 eyes) who had enucleation from 1960 to 2008, 29 patients (4.0%) and 30 eyes (4.0%) had discordant clinical and pathological diagnoses. The misdiagnosis enucleation rate decreased with each respective decade studied, with the highest rate of 6.5% (18 of 276 eyes) in the 1960s and no misdiagnoses from 1990 to 2008. Of the 369 eyes enucleated for the clinical indication of malignancy, 22 eyes (6.0%) were misdiagnosed in that no evidence of malignancy was found on histopathological examination. Of the 377 eyes enucleated for benign clinical indications, 7 cases (1.9%) were found to be malignant by histopathology.
  
  
  CONCLUSIONS
  Misdiagnoses leading to pediatric enucleation have decreased during the past 5 decades, likely owing to improved diagnostic techniques. Benign and malignant intraocular conditions can simulate each other, especially retinoblastoma, Coats disease, nematode and bacterial endophthalmitis, panuveitis, and persistent hyperplastic primary vitreous.
authors.affiliation: Department of Ophthalmology, University of California, San Francisco, 94143, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Huang
authors.forename: Tina
authors.initials: T
authors.lastname: Rutar
authors.forename: Michele
authors.initials: M
authors.lastname: Bloomer
authors.forename: J Brooks
authors.initials: JB
authors.lastname: Crawford
mesh_terms: D000293:Adolescent; D002140:California / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D003941:Diagnostic Techniques, Ophthalmological; D005128:Eye Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D015353:Eye Enucleation / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male