Glandular inclusions in XXXX : morphologic and immunohistochemical distinction from epididymis and @entity12108 .

@entity1 @entity2282 @entity12108 @entity547 @entity169
Glandular inclusions in @entity169 may bear a striking resemblance to the epididymis or @entity12108 . Misinterpretation as a transected functional structure may raise significant concerns regarding reproductive capability, even if encountered unilaterally. In a @entity1 , resolution of these concerns may be years away with the onset of puberty and documentation of normal sperm counts. @entity2282 has been shown to be present in Wolffian-type epithelium and to be absent in Mullerian-type epithelium. We hypothesized that an antibody to @entity2282 would react with vas @entity12108 and fail to react with @entity547 sac inclusions, most of which we thought were Mullerian duct-derived structures. Glandular inclusions in 29 @entity547 sacs from prepubertal males were classified histologically according to their resemblance to normal structures and analyzed for @entity2282 by immunohistochemistry. Inclusions resembling @entity12108 had their external diameters measured and were also stained for smooth muscle actin. Thirty-one examples of normal @entity12108 and 13 examples of normal epididymis were included for comparison. The inclusions were classified as @entity12108 -like (9), epididymis-like (13), and Mullerian-like (7). @entity2282 reactivity was lacking in all @entity12108 ; their median external diameter was 0.6 mm. Of the epididymis-like inclusions, 7 of 13 were @entity2282 positive. The @entity2282 -negative cases consisted of glands with well-defined stromal coats distinct from adjacent stromal coats. @entity2282 -positive cases were more numerous, more tightly aggregated, and surrounded by less well-developed stromal coats that blended with adjacent coats. All seven Mullerian-like remnants were @entity2282 negative. All normal vas @entity12108 showed at least focal @entity2282 reactivity. @entity2282 positivity in all cases had a luminal membranous staining pattern. Both the @entity12108 and the normal @entity12108 showed strong smooth muscle actin positivity in their stromal coats. @entity2282 negativity and external diameter <1 mm are highly useful to distinguish @entity12108 from true @entity12108 . Epididymis-like inclusions are more problematic. Some react for @entity2282 and may represent aberrant Wolffian ductules. Others are @entity2282 negative, distinct from true epididymis, and may be of Mullerian differentiation. Mullerian-like remnants can be diagnosed on the basis of their limited number and scattered distribution. Lack of @entity2282 immunostaining corroborates this interpretation.
