Recognise the unresolved question
Clinicopathological discordance means the available clinical findings and the tissue interpretation do not fit together satisfactorily. It is a reason for structured review rather than immediate attribution of fault.
University oral pathology teaching cases show why clinical relationships and histology must be considered together: a plausible radiographic diagnosis may be unsupported by the other findings. [1]
Recheck the information chain
My suggested first step is to confirm the patient, anatomical site, specimen label and clinical history. Establish whether the tissue came from the lesion of concern and whether the pathologist had the relevant imaging and examination findings.
This is a practical review sequence, not a claim that misidentification is the usual explanation. The purpose is to examine the whole pathway before choosing the next investigation.
Ask a focused question of the pathologist
Instead of requesting “Please change the diagnosis,” explain the mismatch: for example, a persistent clinically concerning area that remains unexplained by the sampled tissue. Ask whether the material supports the reported conclusion and what further information would help.
The discussion may lead to review of the original slides, additional assessment of the available material, specialist consultation or a recommendation for further sampling. The appropriate choice depends on the case.
Preserve the evidence and record the decision
Keep earlier reports and document the reason for review. If a diagnosis is revised, the communication should make the change and its implications clear to the treating clinician.
CAP specimen guidance also emphasises direct surgeon–pathologist communication in orienting and examining complex head and neck specimens. [2] Communication should continue when interpretation remains uncertain.
Explain the situation to the patient
State what is known, what remains unresolved and what is proposed next. Avoid either declaring the case settled prematurely or suggesting that uncertainty itself proves an error.
A useful review ends with responsibility assigned for the next action and a date for reassessment. The goal is an explanation that fits the complete case closely enough to guide care.
References
[1] University of Washington School of Dentistry. Case of the Month, April 2013 diagnosis. Read source
[2] College of American Pathologists. Protocol for HPV Independent Oropharynx and Hypopharynx specimens, specimen orientation commentary. Read source