Definitive Differential Diagnosis Research Articles

Diagnostic Approach and Differences between Spinal Infections and Tumors.

A systematic review of the literature about differential diagnosis between spine infection and bone tumors of the spine. The differential diagnosis between spine infection and bone tumors of the spine can be misled by the prevalence of one of the conditions over the other in different areas of the world. A review of the existing literature on suggestive or even pathognomonic imaging aspects of both can be very useful for correctly orientating the diagnosis and deciding the most appropriate area for biopsy. The purpose of our study is to identify which imaging technique is the most reliable to suggest the diagnosis between spine infection and spine bone tumor. A primary search on Medline through PubMed distribution was made. We identified five main groups: tuberculous, atypical spinal tuberculosis, pyogenic spondylitis, and neoplastic (primitive and metastatic). For each group, we evaluated the commonest localization, characteristics at CT, CT perfusion, MRI, MRI with Gadolinium, MRI diffusion (DWI) and, in the end, the main features for each group. A total of 602 studies were identified through the database search and a screening by titles and abstracts was performed. After applying inclusion and exclusion criteria, 34 articles were excluded and a total of 22 full-text articles were assessed for eligibility. For each article, the role of CT-scan, CT-perfusion, MRI, MRI with Gadolinium and MRI diffusion (DWI) in distinguishing the most reliable features to suggest the diagnosis of spine infection versus bone tumor/metastasis was collected. Definitive differential diagnosis between infection and tumor requires biopsy and culture. The sensitivity and specificity of percutaneous biopsy are 72% and 94%, respectively. Imaging studies can be added to address the diagnosis, but a multidisciplinary discussion with radiologists and nuclear medicine specialists is mandatory.

Cytogenetic findings in Polish patients with suspected Fanconi anemia.

The high sensitivity of cells of Fanconi anemia (FA) patients to DNA cross-linking agents (clastogens), such as mitomycin C (MMC), was used as a screening tool in Polish children with clinical suspicion of FA. The aim of the study was to compare chromosome fragility between 3 groups, namely non-FA, possible mosaic FA and FA patients. The study included 100 children with hematological manifestations and/or congenital defects characteristic of FA, and 100 healthy controls. Blood samples obtained from participants were analyzed using an MMC-induced chromosomal breakage test. Patients with clinical suspicion of FA were divided into 3 subgroups based on the MMC test results, namely FA, possible mosaic FA and non-FA. Thirteen out of 100 patients had a true FA cellular phenotype. The mean value of MMC-induced chromosome breaks/cell for FA patients was higher than for non-FA patients (6.67 ±3.92 compared to 0.23 ±0.18). In addition, the percentage of cells with spontaneous aberrations was more than 9 times higher in FA patients than in non-FA patients. Our results confirmed that the MMC sensitivity test distinguishes between individuals affected by FA, those with possible somatic mosaicism, and patients with bone marrow failure for other reasons, who were classified as non-FA in the first diagnostic step. However, a definitive differential diagnosis requires follow-up mutation testing and chromosome breakage analysis of skin fibroblasts.

Unusually aggressive primary testicular diffuse large B-cell lymphoma initially presenting as systemic disseminating metastases in older adult men: a case report.

Herein, the authors describe the case of a 64-year-old man with the chief complaint of a painless unilateral scrotal mass. Computed tomography scans of the abdomen and a pelvic examination demonstrated a left testicular tumor with multiple lymphadenopathies partially aggregated in the para-aortic area and disseminated to multiple soft tissues and organs. Subsequently, the patient underwent a left radical orchiectomy. Pathological and immunohistochemical examinations confirmed the diagnosis of left PT-DLBCL with systemic disseminating metastases. PTL often aggressively spreads to other extranodal organs, such as the contralateral testis, central nervous system, lung, pleura, Waldeyer's ring, and soft tissues. In men over 60 years of age, PT-DLBCL is the most common testicular malignancy. However, extensive systemic metastasis as the initial presentation is extremely rare. PT-DLBCL has a dismal prognosis and requires radical orchiectomy followed by multimodal therapy and central nervous system prophylaxis or systemic intervention to improve survival. The diagnosis of PT-DLBCL through preoperative and imaging examinations is often challenging. Thus, histopathology and immunohistochemical markers play a crucial and valuable role in the definite diagnosis and differential diagnosis of PTLs.

Neurological, Cognitive, and Clinical Biomarkers of Lewy Body Dementia Subtypes: A Literature Review

Introduction: Diagnosing the etiology underlying dementia symptoms can be difficult because of the broad nature of shared cognitive impairments across dementia subtypes. Therefore, we sought to differentiate the cognitive profiles of Alzheimer’s disease (AD) from vascular dementia (VaD) and Lewy body dementia (LBD). Methods: PubMed, ScienceDirect, Web of Science, Google Scholar, and PsychINFO were searched for studies comparing the cognitive profile of AD to those of VaD and LBD along the domains of memory, language, and executive function. Results: Short-term and episodic memory were more severely impaired in AD than VaD and LBD. Semantic memory was more impaired in AD than LBD, but it was similarly impaired in AD and VaD. Semantic fluency was worse in AD than in VaD, and phonemic fluency was worse in AD compared to VaD and LBD. Naming was more impaired in AD compared to VaD and LBD. Executive function impairments were similar or less severe in AD relative to VaD and LBD. Discussion: Findings may be explained through neuropathological correlates of each disease. Tau proteins targeting the medial temporal lobes and synaptic loss in prefrontal cortices in AD may explain greater memory deficits in AD relative to VaD and LBD. In those with AD, the temporal lobes undergo greater atrophy than in those with VaD and LBD, possibly contributing to the greater semantic fluency impairments in AD. Greater white matter loss in frontal lobes in VaD may be a reason for a worse phonemic fluency in VaD relative to AD. Executive function impairments may be attributable to more deep white matter hyperintensities in those with VaD and more dopaminergic dysfunction of the basal ganglia in those with LBD relative to those with AD. Conclusion: Understanding the cognitive profiles that differentiate AD from VaD and LBD would aid in more efficient and accurate diagnoses of dementia etiologies. Diagnoses could be further improved by using cognitive assessment in addition to neural and physiological measures. This knowledge may help identify individuals at risk of developing dementia, helping clinicians intervene early and prevent progression to severe stages.

Giant intermuscular lipoma of hip: A case report.

IntroductionLipomas are one of the most common benign tumors, but deep tissue and huge lipomas are rare.Presentation of caseA 59-year-old middle-aged woman was admitted to hospital for right hip mass resection because of numbness and pain in her right lower limb for 6 months. Ultrasound and nuclear magnetic resonance imaging (MRI) showed irregular mass. On the assumption of malignancy, the patient underwent a right hip mass resection and returned to normal with no short-term or long-term response. HE (hematoxylin-eosin) staining of the tumor showed the characteristics of a benign tumor.DiscussionThe pathogenesis of myolipoma is not clear, and it may be related to brown adipose tissue. When lipoma is huge, it needs interventional treatment. Complete encapsulated myolipoma can usually be completely removed, with low recurrence possibility and good prognosis.ConclusionGiant intramuscular lipoma of hip and its clinical manifestations are relatively rare. And the results of ultrasound imaging are similar to those of the surrounding normal adipose tissue. No significant difference was observed by naked eye. In particular, postoperative pathological examination is needed to make a definite diagnosis and differential diagnosis. Clinically, surgical treatment is often used, and the prognosis is good, but recurrence is possible. The following report discusses the experience of one of our patients, with literature review.

Role of Vascular Ultrasonography in Patients with Leg Swelling

There are many causes of leg swelling or edema. Leg edema due to systemic condition or disease demonstrates chronic, bilateral features, whereas leg edema caused by vascular disease shows more complex clinical features including secondary skin changes and ulcerative lesion, resulting in more complicated clinical outcomes with less frequent early diagnosis and appropriate management. Definite differential diagnosis might not be possible by medical history, clinical features, and physical findings. Vascular ultrasonography (Duplex ultrasound) can be used easily as a bedside diagnostic procedure and is a recommended diagnostic tool for differentiation of a non-vascular from vascular etiology in patients with leg swelling.

Demographic, clinical and laboratory characteristics for differential diagnosis of peripheral lymphadenopathy (LAP) and the etiologic distribution of LAP in adults; a multicenter, nested case-control study including 1401 patients from Turkey.

Peripheral lymphadenopathy (LAP) is an important and common abnormal finding of the physical exam in general medical practice. We aimed to reveal the LAP etiology and demographic, clinical and laboratory variables that may be useful in the differential evaluation of LAP. This multicenter, nested case-control study including 1401 patients between 2014 and 2019 was conducted in 19 tertiary teaching and research hospitals from different regions in Turkey. The ratio of infectious, malign and autoimmune/inflammatory diseases was 31.3%, 5% and 0.3%, respectively. In 870 (62%) of patients had nonspecific etiology. Extrapulmonary tuberculosis (n: 235, 16.8%) was the most frequent cause of LAP. The ratio of infective etiology of LAP was significantly lower in patients older than 65years-old compared to younger patients with the rate of 66.67% and 83.84%, respectively (p 0.016, OR 0.386, 95% Cl 0.186-0.803). The probability of malign etiology was higher both in patients who are older than 45years-old (p < 0.001, OR 3.23, 95% Cl 1.99-5.26) and older than 65years-old (p 0.002, OR 3.36, 95% Cl 1.69-6.68). Age, localization and duration of LAP, leukocytosis, anemia, thrombocytopenia, CRP and sedimentation rate were important parameters to differentiate infections. Size of lymph node and splenomegaly in addition to the parameters above were useful parameters for differentiating malign from benign etiology. Despite the improvements in diagnostic tools, reaching a definite differential diagnosis of lymphadenopathy is still challenging. Our results may help clinicians to decide in which cases they need an aggressive workup and set strategies on optimizing the diagnostic approach of adulthood lymphadenopathy.

Rediscovery of Obeliscus agassizi Pilsbry, 1906 (Gastropoda, Subulinidae, Obeliscinae), annotated checklist of species of Obeliscus Beck, 1837 and first description of the anatomy for the genus

Obeliscus agassizi Pilsbry, 1906 was described from specimens collected in Brazil, by J. G. Anthony, during the Agassiz expedition, in 1865. The type locality of the species was given simply as Brazil, without further information. More than a century after its description, this species was rediscovered during an expedition to the Biological Reserve of Pedra Talhada, Alagoas/Pernambuco states, Brazil. In the present study we provide detailed description of the anatomy of the soft parts of O. agassizi specimens, collected during this expedition, besides more precise data concerning the species occurrence. This work presents the first anatomical description for the genus. An annotated checklist of Obeliscus Beck, 1837 species is also provided. The species of Obeliscus have been traditionally distinguished by shell characteristics, mainly the general shell shape, number of whorls proportionally to the shell size, shell ornamentation, the shape of the protoconch and aperture size and shape. The distinction between species is often subtle. Considering that shell traits may be not sufficient as single taxonomic characters, other evidence for species boundaries, especially anatomical characters, is needed. Presently, it is not possible to discuss the taxonomic meaning of the set of anatomical characters described for O. agassizi, at the intra-genus level, as there is no information on the anatomy of the soft parts of other species of Obeliscus. The comparative analysis of the genital system of O. agassizi, Neobeliscus calcareus (Born, 1780), Stenogyra terebraster (Lamarck, 1822) and Rectobelus birabeni (Hylton-Scott, 1946) pointed out anatomical characters with potential diagnostic significance for the genus Obeliscus. However, the establishment of a definitive differential diagnosis for this genus, based in both conchological and anatomical traits, depends on the analysis of a greater number of species of Obeliscus, as well as species of other genera of Obeliscinae Thiele, 1931.

Fine needle aspiration cytology (FNAC) of cystic soft tissue lesions and end tissue metamorphosis-a three year study

Objective: Superficial soft-tissue masses may be seen in clinical practice, but a systematic approach may help to achieve a definitive diagnosis or differential diagnosis for soft tissue lesions. The cystic lesions constitute a heterogeneous group with highly varied etiology, cytology and diversified histopathology. The aim of this study is to investigate the accuracy of FNAC diagnosis of varied cystic lesions of soft tissue lesions by comparing with the radiological and histopathology diagnosis. Materials and methods: Fine needle aspirations were done using a 22-24 gauge disposable needle and a 5cc to 10 cc disposable syringe for suction. Wet-fixed smears with isopropyl alcohol were stained with hematoxylin and eosin (HxE). Dry-fixed smears were stained with Leishman Giemsa along with Papanicolaou stains (PAP) were studied for cytological details and diagnosis. The excised surgical specimen and biopsy samples of the cases were processed routinely and stained with HxE and immunohistochemistry (IHC) panel was applied. Results: Examined cystic soft-tissue masses were found as superficial (82%) and deep (18%). Superficial lesions were categorized into mesenchymal tumors, skin appendage lesions, tumor like lesions, pseudoudo tumoural soft tissue lesions or parasitic /inflammatory lesions. Deeper lesions with cystic presentation were mostly (74%) malignant. The differential diagnosis was done according to the age of the patient, anatomic location of the lesion, salient imaging features and clinical manifestations. Conclusion: Although the fine needle aspiration cytology of the cystic lesions, imaging characteristics of the lesions discussed are not always corresponding to the histopathologic findings what we assume, combining them with lesion location and clinical features may allow the diagnosticians to suggest a specific diagnosis in most cases.

Correlation of Liver Enzyme Levels and Insulin Resistance in Patients with Non-Alcoholic Steatosis

Objectives: To compare non-alcoholic steatosis patients according to liver enzyme levels, and to establish whether glucose metabolism and insulin resistance differ with liver enzyme levels. Materials and Methods : Patients with non-alcoholic steatosis aged between 18-65 years were included in this study. The patients were divided into two groups as steatotic patients with normal liver enzymes (NLE), and those with increased liver enzymes (ILE). The groups were compared as for parameters of glucose metabolism, and insulin resistance. Results: A total of 66 steatotic patients (40 NLE, and 26 ILE) were included in our study. Mean insulin values in the steatotic NLE, and ILE groups were 12.92±5.61, and 16.22±5.43 μU/mL respectively (p=0.012). Insulin resistance was detected in 23 (60.50%) patients in the steatotic NLE, and in 22 (88%) patients in the steatotic ILE groups (p=0.018). Metabolic syndrome was detected in 31 (77.50%) patients in the steatotic NLE, and in 15 (57.70%) patients in the steatotic ILE groups (p=0.058). Conclusion: In conclusion, we have concluded that the steatotic group with ILE had higher insulin resistance. These patients should be meticulously taken into consideration as for drug treatments which will especially decrease insulin resistance, increase both weight loss, and sensitivity to insulin resistance. Liver biopsy still retains its essential place in definitive differential diagnosis.

Association of Preoperative Diagnosis with Clinical Yield of Muscle Biopsy.

Background: Muscle biopsy is a common diagnostic marker for myopathy assessment; however, it has a relatively low pathologic yield of less than 60%. Additionally, both diagnostic and non-diagnostic muscle biopsies can provide guidance for treatment, i.e, provide therapeutic usefulness.Purpose: We designed a study to determine if having a documented definitive preoperative differential diagnosis would affect the pathologic yield and therapeutic usefulness of muscle biopsies for myopathy. Methods: This was a retrospective, single institution chart review of 106 consecutive muscle biopsies in adult patients, which looked at the presence or absence of a definitive preoperative differential diagnosis and relation to diagnostic yield and therapeutic usefulness of muscle biopsies. Results: Of 106 muscle biopsies, 50 biopsies (47%) had a definitive preoperative differential diagnosis, 52 biopsies (49%) returned definitive pathology, and 93 biopsies (88%) provided therapeutic information. The presence of a documented differential diagnosis increased the odds of pathologic yield by 3.73 (p-value < 0.01) and therapeutic usefulness by 3.40 (p-value 0.08). If pathology was diagnostic then the therapeutic usefulness of the biopsy was 4.54 times more likely (p-value < 0.01). Conclusion: Documentation of a definitive preoperative differential diagnosis, when pursuing muscle biopsy for myopathy, is associated with an increased pathologic diagnostic yield. Definitive pathology was associated with an increase in the therapeutic usefulness of the muscle biopsy.

Is it Useful to Classify Progressive Supranuclear Palsy and Corticobasal Degeneration as Different Disorders? No.

http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)2330-1619/homepage/mdc312582-sup-v001.htm.

Differential protein expression in exosomal samples taken from trauma patients.

Traumatic brain injuries (TBI) are among the most misdiagnosed and underreported types of head trauma. The potential long-term impact of undiagnosed or incorrectly identified concussions and other head injuries are potentially devastating, as evidenced by the increasing societal burden exhibited by soldiers returning from combat and athletes in contact sports. Concussions and TBI are notoriously difficult to correctly diagnose and prognosis for these injuries is poorly understood. In order to increase the likelihood of successful diagnosis, treatment, and prediction of outcomes, a definitive differential diagnosis will need to be established. The establishment of a "trauma-specific profile" or a panel of known trauma markers will significantly aid in this goal. Small membrane vesicles called exosomes have been shown to contain proteins and injury-specific biomarkers. In the future it is possible that they could become an important tool, utilized for their diagnostic and therapeutic potential.

Sclerosing angiomatoid nodular transformation of the spleen: A case report and literature review.

Sclerosing angiomatoid nodular transformation (SANT) is a rare benign splenic vascular lesion. Since it was first defined in 2004, a total of 132 cases of SANT have been reported in ~50 studies in the English literature. However, it remains difficult to form a definitive pre-operative differential diagnosis of SANT compared with other splenic tumors or malignant lesions. The present study reports a pathologically proven case of SANT in a 29-year-old man who initially presented with left upper quadrant and back discomfort. The study also provides a review of the current knowledge on the condition, including the clinical profile, imaging features, cytological features, differential diagnosis and treatment of SANT. The most important distinguishing features of SANT are its typical vascular character and lack of other features that are typical of a granuloma. A splenectomy is required and the diagnosis is based on pathological analysis.

Contrast-enhanced ultrasound of the spleen

Abnormalities in the spleen are less common than in most other abdominal organs. However, they will be regularly encountered by ultrasound practitioners, who carefully evaluate the spleen in their abdominal ultrasound studies. Conventional grey scale and Doppler ultrasound are frequently unable to characterise focal splenic abnormalities; even when clinical and laboratory information is added to the ultrasound findings, it is often not possible to make a definite diagnosis. Contrast-enhanced ultrasound (CEUS) is easy to perform, inexpensive, safe and will usually provide valuable additional information about splenic abnormalities, allowing a definitive or short differential diagnosis to be made. It also identifies those lesions that may require further imaging or biopsy, from those that can be safely dismissed or followed with interval ultrasound imaging. CEUS is also indicated in confirming the nature of suspected accessory splenic tissue and in selected patients with abdominal trauma. This article describes the CEUS examination technique, summarises the indications for CEUS and provides guidance on interpretation of the CEUS findings in splenic ultrasound.

Voluminous Myoepithelioma of the Minor Salivary Glands Involving the Base of the Tongue.

Myoepithelioma is an extremely rare tumour subtype and diagnosis is based on a wide variation of cellular morphology. FNAC specimens do not always suffice for a definitive differential diagnosis which depends on histology and immunohistochemistry of the lesion. Case Presentation. A 54-year-old female came to our attention with dysphagia and dyslalia of 6-month standing. Ear, Nose, and Throat (ENT) examination revealed a voluminous mass on the right portion of the base of her tongue, where postcontrast T2-weighted Magnetic Resonance Imaging (MRI) evidenced a hyperintense lesion. The fine-needle aspiration specimen taken for cytology was not diagnostic, as a differential diagnosis between myoepithelioma and a malignant neoplasm of the salivary glands necessitates parameters that cytology alone cannot provide. Therefore, the whole lesion was excised by diode laser through a transoral approach. Histology and immunohistochemistry of the completely excised lesion confirmed a myoepithelioma.

Pulmonary Hilar Tumor: An Unusual Presentation of Sclerosing Hemangioma.

Pulmonary sclerosing hemangioma is an uncommon benign tumor of the lung; however, on rare occasions it can arise from the pulmonary hilar region. Herein, we report a 53-year-old female patient who presented with a round opacity in the right upper lung field on a radiograph. Chest computed tomography scanning revealed a 3.1 cm mass in the right pulmonary hilum. Thoracoscopic tumor excision was subsequently performed. On pathohistologic study, the tumor was well defined and composed of round stromal cells and surface cells arranged in a papillary, sclerotic, solid, and hemorrhagic pattern. In immunochemical study, the round cells were positive for thyroid transcription factor-1 (TTF-1) and epithelial membrane antigen (EMA) and negative for cytokeratin. The surface cells were positive for TTF-1, EMA, and cytokeratin. Therefore, a final diagnosis of sclerosing hemangioma was confirmed. In conclusion, pulmonary sclerosing hemangioma is uncommon and rare in the pulmonary hilar region. CT scanning is useful to determine its benignity, although imaging features are not specific for a definite differential diagnosis from other pulmonary tumors. Therefore, tissue diagnosis is usually necessary, and pulmonary sclerosing hemangioma should be listed in the differential diagnoses of pulmonary hilar tumors.

Importância da prova de Synacthen no diagnóstico diferencial de pubarca precoce

IntroductionIn patients with precocious pubarche (PP), the gold standard for the differential diagnosis between idiopathic PP (IPP) and nonclassical congenital adrenal hyperplasia (NCCAH) is the ACTH stimulation test (ST); this test also estimates the adrenal cortisol reserve in NCCAH patients. ObjectivesTo compare the clinical characteristics and baseline hormonal profile of patients with PP; to determine the importance of ST in the differential diagnosis between IPP and NCCAH and in the evaluation of the adrenal production of cortisol. MethodsCross‐sectonal study of patients with PP who underwent ST. Results43 patients were included; median age at diagnosis was 7.5 years [range: 3.5‐9.4], 37 (86.0%) were female. After ST, 37 (86.0%) were classified as IPP and 6 (14.0%) as NCCAH. No significant differences could be found in the clinical characteristics and baseline determination of ACTH, cortisol and adrenal androgens between the groups. Both basal and stimulated 17‐OHP levels were significantly higher (p=0.001 and p<0.001, respectively) in NCCAH patients (basal: 4.62±3.70ng/ml [0.80‐10.50]; stimulated: 35.41±24.87ng/ml [12.0–80.2]) than IPP patients (basal: 1.04±0.77ng/ml [0.22–3.80]; stimulated: 4.18±1.71ng/ml [1.0–8.96]). Nevertheless, the proposed basal cut‐off level (<2.0ng/ml) for the distinction between the groups, did not allow for this in 2 NCCAH patients that were only diagnosed after ST. Two NCCAH patients (33.3%) had stimulated cortisol levels <18μg/dl, showing the need for glucocorticoid stress therapy. NCCAH patients with higher initial 17‐OHP value had lower cortisol after stimulation (p=0.004; r=‐0.43). ConclusionThe ST was useful to distinguish between patients with NCCAH and IPP, for no basal 17‐OHP level could allow for a definitive differential diagnosis in the individual patient. In some NCCAH cases, it also showed inappropriate cortisol secretion under stress, contributing to the therapeutic decision.

Pancreatic head mass: what can be done? Classification: the clinical point of view.

Surgeons frequently find pancreatic head mass when operating. The obvious difficulty is to make the correct preoperative differential diagnosis between chronic pancreatitis and pancreatic tumor. The first step is to reach a diagnosis, with some certainty, prior to the operation. The second step in the case of a tumor is the accurate staging and deciding whether or not it is resectable. On the one hand, time and cost must be considered; on the other hand, the therapy must be decided. Obtaining information about the characteristics of the pancreatic disease (nature, size, exact location) and establishing the tissue diagnosis preoperatively may simplify the decision to operate and the operation itself. In the case of chronic pancreatitis, the aim of the operation is to eliminate pain and other symptoms, while in the case of cancer, the purpose is to remove the malignant tissue. In most patients, it is possible to identify the disease on the basis of previous examinations together with preoperative diagnostic techniques such as exploration, palpation and fine-needle aspiration biopsy. Chronic pancreatic head mass should be operated upon with Beger s or Frey s procedure while pancreatic head tumors should be treated by means of head resection with the aim of preserving the pylorus or the Whipple procedure may be used. When the diagnosis is in doubt, a radical approach is thought to be best. Our conclusion is that there is no diagnostic method capable of making a definitive differential diagnosis as to the nature of the pancreatic head mass. Further study is required as to the extent to which differential diagnosis should be investigated.

A retrospective study of prostate cancer cases mimicking urothelial cell carcinoma of the bladder

BackgroundProstate cancer (PCa) originating from the prostate base may intrude into the urinary bladder and may be misdiagnosed as bladder cancer. In this retrospective study, we reviewed the clinic data on PCa cases which were initially misdiagnosed as bladder cancer in order to identify diagnostic methods that would allow a better differential diagnosis for PCa.MethodsOut of a total of 455 patients treated for PCa at our hospital between April 2003 and June 2011, 14 patients (3.1%) had been initially misdiagnosed as urinary bladder urothelial cell carcinoma. The clinical data on these 14 cases was retrieved and analyzed.ResultsOf the 14 patients, 11 patients were eventually diagnosed with PCa after MRI examination, and seven out of these had PCa with bladder neck invasion. Prostate needle biopsy or transurethral resection of prostate (TURP) revealed that all 14 patients had adenocarcinoma of prostate with Gleason scores ranging from 7 to 9. Nine patients received TURP for hematuria or lower urinary tract blockage. The mean follow-up was 37 months, during which six patients survived.ConclusionsAs clinical presentation and in emergency settings, prostate cancer originating from the prostate base can be confused with bladder cancer originating from the neck or the triangle region of the urinary bladder. Serum prostate specific antigen (PSA) levels and digital rectal examination, in combination with transrectal ultrasound (TRUS), MRI, and prostate needle biopsy are valuable tools for definitive differential diagnosis of the basal prostate cancer.