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Diagnostic Confusion (diagnostic + confusion)
Selected AbstractsBenign myoepithelioma of the breast: Origin and developmentPATHOLOGY INTERNATIONAL, Issue 6 2009Hajime Hikino A case of benign myoepithelioma of the breast in a 55-year-old woman is described. The tumor was a well-circumscribed solid mass, measuring 13 × 12 mm. Histopathology indicated that the tumor was composed of entirely myoepithelial cells, which was confirmed by immunoreactivity to calponin and S-100. There was no ductal differentiation in the tumor, and staining for pan-cytokeratin and epithelial membrane antigen was weak and negative, respectively. Although the biological behavior of the tumor remains to be ascertained, the tumor was considered to be myoepithelioma with benign features due to mild nuclear pleomorphism, sparse mitotic figures, low Ki-67 labeling index and low S-phase fraction. Diagnostic confusion between benign myoepithelioma and other myoepithelial-rich cell tumors is possible. Considering the classification of myoepithelial tumor in the salivary glands, benign myoepithelioma of the breast may possess a different development process from adenomyoepithelioma. [source] The Effect of Insomnia Definitions, Terminology, and Classifications on Clinical PracticeJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue S7 2005Andrew D. Krystal MD There is a need for newer, more clinically useful classifications for insomnia. Identification of specific subtypes of insomnia helps anchor research, allows for prediction of prognosis/course of the condition, and may allow for individualization of treatment. Existing classifications differ, and many terms remain inadequately defined, which leads to diagnostic confusion. Historically, insomnia has been classified according to symptom type, symptom duration, and underlying cause, but these classifications have not been based on evidence of their utility, and newer research suggests the need for change. Symptoms may include difficulty falling asleep, trouble staying asleep, and not feeling restored by sleep, although it has not been clear that it is possible to identify distinct subtypes of patients by symptom or that distinguishing symptom type affects the course of clinical treatment. Classification of insomnia by duration most commonly involves three categories: transient (no more than a few days), short-term (up to 3 weeks), and long-term (more than 3 weeks). This categorization is of uncertain utility and has been primarily based on nonempiric concerns about treatment with sedative-hypnotic medications for periods longer than several weeks. The subtyping of insomnia in terms of whether there is an identifiable underlying cause such as a psychiatric or medical illness was based on an unproven assumption that in most instances other disorders caused insomnia. Recent studies suggest the need to revisit these classification strategies. Evidence that symptom types typically overlap and change over time complicates the categorization of subjects by whether they have difficulty falling asleep or staying asleep or have nonrestorative sleep. New studies of the treatment of chronic insomnia change the perspective on duration of treatment and, as a result, classification of duration of disease. Two studies of nightly pharmacotherapy for insomnia including more than 800 insomnia patients have not identified any increase in the risks after 3 to 4 weeks of treatment. In addition, nonpharmacological treatments demonstrate long-lasting efficacy in patients with chronic insomnia, and the development of abbreviated cognitive-behavioral therapies, which are particularly well suited to primary care practice, have improved their applicability. Newer studies of the relationships between insomnia and associated medical and psychiatric conditions undermine the notion that insomnia is always a symptom and caused by an underlying condition. They suggest that, although it is important to identify and treat these conditions, this may not be sufficient to alleviate the insomnia, which may adversely affect the course of the associated disorder. As a result, treatment targeted specifically to the insomnia should be considered. All of these developments point to an increasing ability to tailor therapy to the particular needs of patients and to optimize the clinical management of insomnia. [source] Focus on dysplastic nodules and early hepatocellular carcinoma: An Eastern point of viewLIVER TRANSPLANTATION, Issue S2 2004Masamichi Kojiro Although increasing numbers of equivocal nodular lesions have been detected in patients with liver cirrhosis with the development of various diagnostic imaging modalities, the pathological diagnosis of small, well-differentiated hepatocellular carcinoma (HCC) in the early stage and of high-grade dysplastic nodules (DNs) is a controversial issue among both Japanese and Western pathologists. In particular, many of the vaguely nodular HCCs of well-differentiated HCC diagnosed by Japanese pathologists tend to be interpreted as high-grade DNs rather than HCC by Western pathologists. In contrast, many of the high-grade DNs diagnosed by Western pathologists are interpreted as well-differentiated HCC by Japanese pathologists. The reasons for the discrepancy between Japanese and Western pathologists can be explained by the following: for Western pathologists, most information comes from the study of HCC and advanced cirrhosis explanted at liver transplantation without detailed clinical information about the nodules; for Japanese pathologists, most information comes from the examination of surgical and biopsy materials together with detailed clinical information that includes meticulous follow-up data on the clinical course of the nodular lesions. To resolve the diagnostic confusion concerning equivocal nodular lesions in the cirrhotic liver, it is necessary to promote the active exchange of clinicopathologic information between Japan and Western countries. (Liver Transpl 2004;10:S3,S8.) [source] Double immunostaining with p63 and high-molecular-weight cytokeratins distinguishes borderline papillary lesions of the breastPATHOLOGY INTERNATIONAL, Issue 3 2007Shu Ichihara Papillary breast lesions remain a source of diagnostic confusion because the full range of epithelial proliferations may arise within, or secondarily involve, papilloma. The expression of p63 and high-molecular-weight cytokeratins (HMWCK) was studied simultaneously in 33 papillary lesions including intraductal papilloma (IP, n = 10), atypical papilloma (AP, n = 8) and intraductal papillary carcinoma (IPC, n = 15) by double immunostaining. The myoepithelial cell nuclei were stained dark brown whereas the cytoplasms of usual ductal hyperplasia (UDH) and myoepithelium were stained purple. The myoepithelial layer was recognized as a dark brown dotted line at the epithelial stromal junction in all IP (10/10), most AP (7/8) and some IPC (7/15), suggesting that the retained myoepithelial layer in the papillary processes does not necessarily guarantee benignity. However, the malignant epithelial cells in AP and IPC were typically recognized as monotonous populations unstained with either chromogen. These monotonous cells contrasted with the proliferating cells of UDH in papilloma, which had intense purple cytoplasm in a mosaic-like fashion. The present data suggest that the double immunostaining with the two popular antibodies p63 and HMWCK is a useful tool for reproducible classification of papillary breast lesions. [source] Pathological and clinical significance of increased intraepithelial lymphocytes (IELs) in small bowel mucosa,APMIS, Issue 6 2005Review article Intestinal intraepithelial lymphocytes (IELs) belong to a unique T-cell population interspersed between epithelial cells of both the small and large intestine. It is becoming increasingly recognised that an increased number of IELs with a normal villous architecture is within the wide spectrum of histological abnormalities observed in coeliac disease. An increased number of IELs is the earliest pathological change following gluten challenge and a high IEL count may be the only sign of gluten sensitivity. Therefore, the finding of a raised IEL count with normal villous architecture is of sufficient clinical importance to be reported in routine small bowel biopsies. However, it is evident that not all small intestinal biopsy specimens showing increased IELs are explained by gluten sensitivity. Increased IELs in small bowel mucosa have also been associated with autoimmune disorders, tropical sprue, food protein intolerance, Helicobacter pylori -associated gastritis, peptic duodenitis, parasitic and viral infections, as well as the development of intestinal lymphoma. Histological examination of a biopsy specimen of the small bowel remains the diagnostic gold standard for coeliac disease. There will be an ever increasing demand for histological confirmation of gluten sensitivity in patients in whom the classic microscopic appearance of flattened villi may not have fully developed. The more widespread recognition by histopathologists of the pattern of injury manifested by increased numbers of IELs in intestinal biopsy specimens will certainly help in early diagnosis of coeliac disease, lessen diagnostic confusion and influence the modern practice of gastrointestinal tract medicine. This review discusses some of the recent developments in clinical pathology pertaining to increased IELs in small bowel mucosal biopsies. [source] Evaluation of the diagnostic utility of spinal magnetic resonance imaging in axial spondylarthritisARTHRITIS & RHEUMATISM, Issue 5 2009A. N. Bennett Objective Magnetic resonance imaging (MRI) is increasingly used for the diagnosis of axial spondylarthritis (SpA), but it is unknown whether characteristic lesions are actually specific for SpA. This study was undertaken to compare MRI patterns of disease in active SpA, degenerative arthritis (DA), and malignancy. Methods Fat-suppressed MRI of the axial skeleton was performed on 174 patients with back pain and 11 control subjects. Lesions detected by MRI, including Romanus lesions (RLs) and end-plate, diffuse vertebral body, posterior element, and spinous process bone marrow edema (BME) lesions, were scored in a blinded manner. An imaging diagnosis was given based on MRI findings alone, and this was compared with the gold-standard treating physician's diagnosis. Results The physician diagnosis was SpA in 64 subjects, DA in 45 subjects, malignancy in 45 subjects, other diagnoses in 20 subjects, and normal in 11 subjects. There was 72% agreement between the imaging diagnosis and physician diagnosis. End-plate edema, degenerative discs, and RLs were frequently observed in patients with any of the 3 major diagnoses. Single RLs were of low diagnostic utility for SpA, but ,3 RLs (likelihood ratio [LR] 12.4) and severe RLs (LR infinite) in younger subjects were highly diagnostic of SpA. Posterior element BME lesions of mild or moderate grade were also highly diagnostic of SpA (LR 14.5). The most common diagnostic confusion was between SpA and DA, since both had RLs present and the presence/absence of degenerative discs did not change the diagnostic assessment. Conclusion This study confirms the high diagnostic utility of MRI in axial SpA, with severe or multiple RLs evident on MRI being characteristic in younger patients and mild/moderate posterior element lesions being specific for SpA. However, MRI lesions previously considered to be characteristic of SpA could also be found frequently in patients with DA and patients with malignancy, and therefore such lesions should be interpreted with caution, particularly in older patients. [source] Conditions masquerading as infantile haemangioma: Part 2AUSTRALASIAN JOURNAL OF DERMATOLOGY, Issue 3 2009Ilona J Frieden ABSTRACT Infantile haemangiomas are among the most common growths during infancy. Their rapid growth during infancy and vascularity can easily cause confusion with other, less common growths. Part I focussed on other vascular anomalies that can mimic infantile haemangiomas. Part II emphasizes benign growths and malignant conditions that can also cause diagnostic confusion. [source] 1241: Failure of pattern recognitionACTA OPHTHALMOLOGICA, Issue 2010V PURVIN Purpose This course focuses on areas of frequent diagnostic confusion in neuro-ophthalmic diagnosis. Methods The course uses a case-based format. Cases are presented as unknowns, each illustrating the specific clinical feature or features that should point to the correct diagnosis. Results We hope that highlighting common errors in this way will help inspire the clinician to master the material so that such "pitfalls" can be avoided. Conclusion The common theme among the cases is that most neuro-ophthalmic diagnoses derive from the history and careful examination rather than the results of ancillary testing. [source] 1242: Over-reliance on negative test resultsACTA OPHTHALMOLOGICA, Issue 2010V PURVIN Purpose This course focuses on areas of frequent diagnostic confusion in the field of neuro-ophthalmology. Methods The course uses a case-based method. Cases are presented as unknowns, each illustrating the specific clinical feature or features that should point to the correct diagnosis. Results Certain tests may provide misleading information, apparently "ruling out" a particular disorder, when in fact that is the correct diagnosis. Examples include serologic tests for ocular myasthenia, falsely negative temporal artery biopsy for giant cell arteritis and MRI scans in certain some disorders. Conclusion In order to interpret the results of ancillary testing we must know the clinical features of the disease in question and the limitations of the tests we use. [source] 4345: Confusion and controversies in diagnosis and treatment of myastheniaACTA OPHTHALMOLOGICA, Issue 2010E EGGENBERGER Myasthenia gravis is an afferent ocular motor mimic. The disease may appear with any pattern of pupil-sparing, painless ocular misalignment with or without ptosis; accordingly, common mistaken diagnoses included CN3 palsy or internuclear ophthalmoplegia. Variability adds to diagnostic confusion, as patients may be asymptomatic and have a normal exam at certain stages in the disease. Clinical context remains the first diagnostic key, however, lab and electrophysiology are very helpful. Acetylcholine receptor antibodies are present in approximately 50% of ocular MG, but are highly specific. Single fiber EMG is perhaps the most sensitive test, being abnormal in approximately 90% of cases. Treatment is symptom dependent; pyridostigmine is often used as initial therapy and quite effective for ptosis and dysphagia, while additional immunosuppressives are often required for diplopia. We often initiate therapy with low dose every other day prednisone, and have a low threshold to add mycophenolate mofetil. [source] Erroneous testosterone assay causing diagnostic confusion in a newborn infant with intersex anomaliesACTA PAEDIATRICA, Issue 7 2004C Tomlinson No abstract is available for this article. [source] | ||||||||||