As the UMLS integrates multiple source vocabularies, the integration process requires that certain adaptation be applied to the source. Our interest is in examining the relationship between the UMLS representation of a source vocabulary and the source vocabulary itself. We investigated the integration of the Minimal Standard Terminology (MST) into the UMLS in order to examine how close its UMLS representation is to the source MST. The MST was conceived as a “minimal” list of terms and structure intended for use within computer systems to facilitate standardized reporting of gastrointestinal endoscopic examinations. Although the MST has an overall schema and implied relationship structure, many of the UMLS integrated MST terms were found to be hierarchically orphaned, and with lateral relationships that do not closely adhere to the source MST. Thus, the MST representation within the UMLS significantly differs from that of the source MST. These representation discrepancies may affect the usability of the MST representation in the UMLS for knowledge acquisition. Furthermore, they pose a problem from the perspective of application developers. While these findings may not necessarily apply to other source terminologies, they highlight the conflict between preservation of authentic concept orientation and the UMLS overall desire to provide fully specified names for all source terms.