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Query: UMLS:C0009676 (confusion)
 21,692 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Previous studies using immunohistochemistry have shown variable hormone production by carcinoid tumours of the appendix. In order to confirm the existence of a specific subset of these tumours, in situ hybridization using synthetic oligonucleotide probes to detect pre-proglucagon and pre-proinsulin mRNA was performed in formalin-fixed, paraffin-embedded material from eight tubular carcinoids, 12 insulin carcinoids, and two mucinous carcinoids. The results were correlated with standard silver and mucin stains. All tubular carcinoids but none of the insular or mucinous carcinoids contained proglucagon mRNA. Proinsulin mRNA was not detected in any of the tumours. Tubular carcinoids of the appendix constitute a definable subset of appendiceal carcinoids which have a similar distribution and prognosis to typical insular carcinoids and can be diagnosed on haematoxylin and eosin-stained sections confirmed by routine special stains. The main need for recognition is to avoid confusion with mucinous carcinoids, which have a worse prognosis and may require more aggressive treatment.
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PMID:The demonstration of a subset of carcinoid tumours of the appendix by in situ hybridization using synthetic probes to proglucagon mRNA. 140 57

Basal cell carcinoma (BCC) has characteristic clinical and histopathologic findings that facilitate accurate diagnosis. There are, however, many variants and simulants of BCC that may cause clinical and/or histopathologic confusion. These entities often have features in common with BCC, with nodular or sclerosing basaloid islands, peripheral palisading, stromal retraction, (pseudo)-glandular formation, and/or prominent mucin. Recently described BCC variants, including signet-ring BCC and granular cell BCC, are discussed. Less commonly appreciated basaloid simulants, including ameloblastoma, cloacogenic carcinoma, and mucinous carcinoma, are described. Distinguishing among these variants and simulants of BCC is important because treatment and prognosis of each may vary.
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PMID:Newer variants and simulants of basal cell carcinoma. 188 25

The creation of a pelvic ileal reservoir is associated with inflammatory changes in the reservoir mucosa. Chronic inflammation and villous atrophy are seen in most patients with both ulcerative colitis and familial adenomatous polyposis (FAP), the two prime indications for the operation. The mucosa undergoes a form of colonic metaplasia which is demonstrable by morphological, mucin histochemical, immunohistochemical and proliferation methods. Other pathological features such as mucosal ischaemia, mucosal prolapse, granulomas and pyloric metaplasia are seen in the pouch mucosa and these changes contribute to the confusion over definitions of pouchitis. The term pouchitis denotes a chronic relapsing inflammatory condition of the reservoir which occurs in 10-20% of patients and is one of the more severe long-term complications of reservoir construction. Useful definitions of pouchitis should include clinical, endoscopic and histopathological criteria. There are close associations between pouchitis and an original diagnosis of ulcerative colitis. The cause of pouchitis is currently obscure but there is evidence to suggest it may represent a recurrence of colitis in metaplastic mucosa and may provide a useful human model for colitis. The demonstration of markedly increased proliferative activity in association with colonic metaplasia has worrying connotations. However, dysplasia has not yet been described in colitic reservoirs and very few adenomas have been seen in polyposis reservoirs. Nevertheless the clinical and pathological evidence would indicate that long-term surveillance of the reservoir mucosa by endoscopy and mucosal biopsy is warranted.
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PMID:The pelvic ileal reservoir: pathology and pouchitis. 217 47

Deep cystic colitis is a benign affection closely related to solitary ulcers of the rectum and inversed hamartomatous polyps. Symptoms lack specificity and its interest resides mainly in its possible confusion with a mucin secreting colloid carcinoma. Failure to recognize the lesion resulted in mutilating operations in several cases reported in the literature confirmed from clinical, radiologic and pathologic data, and the treatment of choice is local excision of the lesion.
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PMID:[Deep cystic colitis. Apropos of a case simulating a neoplastic mass. Review of the literature]. 632 45

Two patients with discoid lupus erythematosus (DLE) had lesions exhibiting prominent atrophy and telangiectasia. At the time of biopsy, the skin specimens were grossly mucinous. Light and immunofluorescence microscopy findings confirmed the diagnosis of DLE in both cases. Abundant mucin deposition throughout the dermis was also seen microscopically in both cases. Although secondary mucinosis is known to occur in LE, cases with massive mucinous change, ie, those reported herein, have apparently not been recorded. Mucinosis is not considered important in the histologic diagnosis of LE but may create some confusion with other mucinous disorders.
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PMID:Dermal mucinosis in discoid lupus erythematosus. Report of two cases. 731 35

Clusters of atrophic prostatic acini that display proliferative epithelial changes are referred to as postatrophic hyperplasia (PAH). PAH is histologically similar to adenocarcinoma and may cause diagnostic confusion. Despite the importance of distinguishing PAH from carcinoma, the last systematic study of this lesion was reported > 40 years ago, and many contemporary pathologists are unfamiliar with this lesion. We reviewed 100 consecutive whole-mount radical prostatectomy specimens removed for carcinoma to determine the incidence of PAH. In addition, 11 prostatic needle biopsy specimens with PAH were evaluated to further characterize the lesion in limited specimens. PAH was identified in 18 radical prostatectomies (18%), including 10 unicentric and eight multicentric cases. It was found exclusively in the peripheral zone in all but two cases, which had additional involvement of the transition zone. PAH consisted of a microscopic lobular cluster of small acini with irregular atrophic-appearing contours lined by cuboidal cells with mild nucleomegaly and micronucleoli; mildly enlarged nucleoli were focally present in 39% of cases. Within the small acinar cluster, a larger dilated acinus was usually present centrally, which was lined by flattened to cuboidal epithelial cells. The basal cell layer at the periphery of each acinus was invariably present but often inconspicuous. Immunohistochemical staining for high-molecular-weight keratin (antibody 34 beta E12) showed the presence of an intact basal cell layer in seven of 10 cases and a focally fragmented basal cell layer in three other cases. PAH was associated with patchy chronic inflammation in 16 of 18 prostatectomy cases; stromal changes were present in all cases, ranging from smooth atrophy to dense sclerosis with compression of acini. No intraluminal basophilic mucin was identified, but two needle biopsies showed PAH with focal mucinous metaplasia. Crystalloids were not seen in any case. Focal partial acinar involvement by high-grade prostatic intraepithelial neoplasia was present in adjacent acini in two cases. Adjacent acini also invariably showed typical changes of atrophy. In the needle biopsy specimens, PAH showed the same features as those in prostatectomies, but often only a portion of the lesion was sampled. PAH is distinguished from carcinoma by its characteristic architecture, intact or fragmented basal cell layer, inconspicuous or mildly enlarged nucleoli, and adjacent acinar atrophy with stromal fibrosis or smooth muscle atrophy. Distinguishing PAH from carcinoma is most difficult in needle biopsy specimens in which only a portion of the lesion is sampled, and awareness of this entity assists in this distinction.
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PMID:Postatrophic hyperplasia of the prostate. A histologic mimic of prostatic adenocarcinoma. 754 58

A brief historic outline of the problem of mucin-producing pancreatic tumors is presented. Based on the authors' observations, clinical aspects and pathomorphology of these tumors have been described. The authors propose their own classification of this tumor type which is based on the literature published so far. Their classification also takes into account the localization of lesions. Reference is made to the concept described by the term "mucinous ductetatic/cystic lesions" (MDCL) and it is also pointed out that mucinous carcinoma may develop on the background of MDCL. Since the appearance of the term "mucus secreting pancreatic cancer" or "mucin-producing pancreatic tumor", many similar and/or related conditions have been described especially in Japan under the same or different names. However, there seems to be some confusion about the concept of this condition not only among clinicians but also among pathologists. In addition, another entity, mucinous cystic neoplasms of the pancreas, was proposed and may have provided some overlap with the former conditions in its concept. Furthermore, definitions of these two conditions varied according to the authors. In this paper, therefore, we review and critically analyze cases of mucin-producing pancreatic tumor (MPPT) as well as mucinous cystic neoplasm (MCN) of the pancreas, and intend to classify them under a generic term, i.e. "mucinous ductectatic/cystic lesions (MDCL) of the pancreas".
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PMID:Mucin-producing pancreatic tumors: historical review of its nosological concept. 794 30

Bronchial casts are characterized by the formation of obstructive airway plugs that may be large enough to fill the branching pattern of an entire lung. The condition is rare but can occur at any age. Casts may be secondary to underlying diseases such as asthma and cystic fibrosis, but there are often no predisposing factors. There is no accepted classification system for bronchial casts; but only a confusion of descriptive terms such as mucoid impaction, fibrinous bronchitis, and pseudomembranous bronchitis. Based on a review of nine well-documented cases and the available literature, we have separated bronchial casts into two well-defined groups: Type 1 (inflammatory), consisting of casts composed mainly of fibrin with a dense eosinophilic inflammatory infiltrate; and Type 2 (acellular), consisting of casts composed mainly of mucin with little or no cellular infiltrate and occurring only in children with congenital cyanotic heart disease. Acute mortality was high in both groups. Survivors of Type 1 casts seem to be well controlled with inhaled steroids. Optimal therapy for patients with Type 2 casts is not clear; the prognosis probably depends on underlying cardiac status. We hope that this simple classification will provide a framework for further study of this obscure condition.
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PMID:Bronchial casts in children: a proposed classification based on nine cases and a review of the literature. 900 37

The presence of normal anatomic structures may be a source of confusion to the pathologist examining prostatic needle biopsies. The morphologic features of Cowper's (bulbourethral) glands incidentally biopsied during transrectal sampling of the prostate have not been described. We reviewed seven cases of Cowper's glands found in prostatic core biopsy specimens. Sections containing Cowper's glands were stained with hematoxylin-eosin, mucicarmine, periodic acid-Schiff's-digest (PAS-D), and antibodies directed at high-molecular-weight cytokeratin (HMWCK), prostate-specific acid phosphatase (PSAP), prostate-specific antigen (PSA), Ulex europaeus agglutinin, and muscle-specific actin. Histologically, Cowper's glands resemble mucinous minor salivary glands entrapped within fascicles of muscle. Lobules of acini composed of cells distended with mucin (mucicarmine and PAS-D positive) were admixed with ducts and ductules composed of hybrid cells with both mucinous and ductular epithelial features. The HMWCK was strongly reactive with the ductular epithelium and demonstrated an attenuated cell lining at the periphery of lobules. The mucinous cytoplasm reacted with U. europaeus, whereas the ductal elements failed to stain. PSAP stains were negative, with PSA positive in most cases. Muscle-specific actin was positive in three cases. Cowper's glands occasionally may be sampled by transrectal needle biopsy. Recognition of this anatomic structure will allow discrimination from low-grade prostatic adenocarcinoma, foamy gland carcinoma, mucinous metaplasia of prostate glands, and atypical glands of undetermined significance.
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PMID:Diagnosis of Cowper's glands on prostate needle biopsy. 915 79

Three patients who underwent surgery for cancer showed Alcian blue positive cells in the sinusoids of the regional lymph nodes and, in one case, extensive infiltration in the soft tissues around the tumor. The cells contained variably sized vacuoles that occasionally indented the nuclei, imparting a signet-ringlike appearance. They were interpreted as muciphages based on morphology, reactivity with mucin stains, positive immunohistochemical staining for KP-1 and Mac-387, and negative staining for cytokeratin, S-100, and leukocyte common antigen (LCA). The material contained in these cells was Alcian blue positive at pH 2.5 and pH 1, and was strongly periodic acid-Schiff positive after diastase digestion. Hyaluronidase only slightly reduced the intensity of the Alcian blue stain. These results indicate that the bulk of the material was epithelial-type mucin. To our knowledge, this is the first report of muciphages in lymph nodes. Careful attention to morphology and immunohistochemical findings is necessary to avoid confusion with metastatic or infiltrating signet ring or mucinous adenocarcinoma.
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PMID:Peritumoral and nodal muciphages. 1052 35


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