0:00:07.093,0:00:10.299
zero waa
0:00:10.299,0:00:12.239
resolved
0:00:12.239,0:00:13.003
monday we'd
0:00:13.003,0:00:15.759
uh... laid out for you
0:00:15.759,0:00:20.499
many of the general concepts about meal[br]places
0:00:20.499,0:00:22.029
and malignant
0:00:22.029,0:00:23.025
and vote today
0:00:23.025,0:00:26.619
uh... were a lot of them for the most[br]part of his finish up here in a
0:00:26.619,0:00:28.899
direction the neoplasms
0:00:28.899,0:00:31.619
fighting the look of a lack of once[br]topic
0:00:31.619,0:00:32.095
pictures show
0:00:32.095,0:00:36.051
of a variety of not a man woman and[br]stuff
0:00:36.051,0:00:39.055
tumors so that you can appreciate the
0:00:39.055,0:00:42.082
polyimide president clinton please
0:00:42.082,0:00:44.036
attorneys are really
0:00:44.036,0:00:46.159
and kind of the uh...
0:00:46.159,0:00:49.061
broad array of things that can happen
0:00:49.061,0:00:54.091
to give you an beginning him along the[br]lancaster neoplasms lasted goal for
0:00:54.091,0:00:55.589
today
0:00:55.589,0:00:57.019
as the florida
0:00:57.019,0:01:00.149
begin until and i think we we are told
0:01:00.149,0:01:01.099
asked that question
0:01:01.099,0:01:03.074
so it doesn't get lost
0:01:03.074,0:01:06.069
is ok we got all the cells
0:01:06.069,0:01:08.011
benign or malignant
0:01:08.011,0:01:12.059
what differences that make to the host[br]in other words what is the impact of
0:01:12.059,0:01:15.027
bridge america is taking what is the[br]impact
0:01:15.027,0:01:16.087
of uh...
0:01:16.087,0:01:19.094
neoplasm anomalous
0:01:19.094,0:01:21.012
this outline
0:01:21.012,0:01:24.005
is a good way to go out at the
0:01:24.005,0:01:27.719
let's take perfectly benign neoplasms[br]they're not
0:01:27.719,0:01:29.061
invasive
0:01:29.061,0:01:31.015
metastatic
0:01:31.015,0:01:32.007
questionnaires
0:01:32.007,0:01:35.369
raghavan i neoplasm what going to do the[br]host
0:01:35.369,0:01:38.082
for most of the facts are going to be[br]local
0:01:38.082,0:01:41.035
if you receive the cartoon that i sure[br]do
0:01:41.035,0:01:45.619
it's just a next like an expanding[br]balloon locally in some areas
0:01:45.619,0:01:47.006
then you would predict that
0:01:47.006,0:01:52.001
there are the first thing at a benign[br]neoplasm lewis's produce some local
0:01:52.001,0:01:53.043
mechanical effects
0:01:53.043,0:01:57.549
now these very from trivial to lethal
0:01:57.549,0:01:58.079
if you had a
0:01:58.079,0:02:01.011
a marble sized
0:02:01.011,0:02:04.049
benign neoplasm one-year love handles[br]here
0:02:04.049,0:02:08.002
there'd be a couple of you in the world[br]i would know about it
0:02:08.002,0:02:11.009
maybe two more than that but
0:02:11.009,0:02:13.259
ferrier area where it would be trivial
0:02:13.259,0:02:18.179
uh... i and the other hand it could be[br]other cosmetic importance you wouldn't
0:02:18.179,0:02:23.189
want to benign neoplasms sizable walnut[br]than the tip of your nose
0:02:23.189,0:02:26.019
biologically not terribly threatening[br]but uh...
0:02:26.019,0:02:27.139
bad anyway
0:02:27.139,0:02:28.719
uh...
0:02:28.719,0:02:30.027
i mentioned result
0:02:30.027,0:02:35.005
this is something to keep your eye and[br]you can buy of a benign neoplasm sounds
0:02:35.005,0:02:36.459
like a black see more
0:02:36.459,0:02:41.839
but think of an expanding the nine-year[br]plasma confines of the cranial
0:02:41.839,0:02:43.041
there's no room in there
0:02:43.041,0:02:45.319
as it starts growing as consumers
0:02:45.319,0:02:49.059
related press on something vital in the[br]brain and you could produce if it's not
0:02:49.059,0:02:51.499
interrupted could produce death
0:02:51.499,0:02:55.067
so benign neoplasms can kill generally
0:02:55.067,0:02:58.007
by something going on
0:02:58.007,0:02:59.709
mechanically
0:02:59.709,0:03:01.469
ka
0:03:01.469,0:03:02.889
nine-year plasmids
0:03:02.889,0:03:06.919
as it's expanding locally again you[br]think just about cartoon
0:03:06.919,0:03:10.469
it's going to press on adjacent[br]structures
0:03:10.469,0:03:14.019
as it expands in that made the strongly
0:03:14.019,0:03:18.002
adjacent structures just by sitting on[br]it
0:03:18.002,0:03:21.819
knock off the function of over one[br]tissue or another selection b
0:03:21.819,0:03:25.349
uh... quite significant and that's all
0:03:25.349,0:03:26.639
based on our
0:03:26.639,0:03:29.029
adjust the expansion of the benign[br]neoplasm
0:03:29.029,0:03:32.849
now i have mentioned local complications[br]here
0:03:32.849,0:03:34.015
these are sort of
0:03:34.015,0:03:37.239
secondary things that may occur and they[br]may be very important
0:03:37.239,0:03:41.349
a benign neoplasm growing under a[br]surface may expand to the point where
0:03:41.349,0:03:43.889
the surface all straight silver
0:03:43.889,0:03:45.859
then there may be hemorrhage
0:03:45.859,0:03:48.649
could be trivial could really thought[br]that they could be hemorrhage from such
0:03:48.649,0:03:49.099
an australian area
0:03:49.099,0:03:51.979
or there might be infection
0:03:51.979,0:03:54.009
these are sort of secondary
0:03:54.009,0:03:58.859
uh... complications of of the local[br]mechanical situation
0:03:58.859,0:04:01.849
uh... or the other thing is the
0:04:01.849,0:04:04.819
uh... benign you pleasant unplug the[br]plumbing
0:04:04.819,0:04:08.709
so the wall of a doctor pressing on a[br]vessel or something of that sort it can
0:04:08.709,0:04:11.299
produce obstruction is very significant
0:04:11.299,0:04:13.949
these are all sort of local effects
0:04:13.949,0:04:18.979
there's one x sort of exception to this[br]and i've listed systemic and the crying
0:04:18.979,0:04:20.209
effects
0:04:20.209,0:04:22.589
their runs something like this
0:04:22.589,0:04:27.009
you had a good remember i told you the[br]benign neoplasms are
0:04:27.009,0:04:29.389
almost invariably very well[br]differentiated
0:04:29.389,0:04:32.279
mhm means they resemble a parental[br]tissue
0:04:32.279,0:04:36.729
you have a benign neoplasms arising from[br]an end to the crime that is from the
0:04:36.729,0:04:37.065
hormone
0:04:37.065,0:04:39.789
secreting tissue
0:04:39.789,0:04:44.639
it may well be so well differentiated[br]that it mimics the adult issued by
0:04:44.639,0:04:45.043
secreting
0:04:45.043,0:04:47.071
a particular hormone
0:04:47.071,0:04:50.065
that ordinarily comes from that issue
0:04:50.065,0:04:53.004
the difference though is
0:04:53.004,0:04:55.389
being autonomous
0:04:55.389,0:04:57.037
and out of control of the body
0:04:57.037,0:05:01.028
this tumor will produce gobs of that[br]hormone
0:05:01.028,0:05:04.002
and then the patient may present
0:05:04.002,0:05:07.008
little really tiny tumor somewhere may[br]present
0:05:07.008,0:05:12.639
tremendous number of signs and symptoms[br]due in excess of a particular hormone
0:05:12.639,0:05:17.689
so in that regard even a local benign[br]neoplasm could produce
0:05:17.689,0:05:18.709
systemic
0:05:18.709,0:05:22.071
and the crime effects
0:05:22.071,0:05:24.005
now
0:05:24.005,0:05:28.025
when we go over to the to the other side[br]and we say what to malignant neoplasms
0:05:28.025,0:05:29.008
do
0:05:29.008,0:05:33.989
the first answer is very loudly all of[br]the above
0:05:33.989,0:05:34.096
except now
0:05:34.096,0:05:36.559
instead of just
0:05:36.559,0:05:40.879
serb pressing the adjacent tissue[br]malignant neoplasm which is cable
0:05:40.879,0:05:41.065
invasion can
0:05:41.065,0:05:44.799
can destroy the reputation by invading n
0:05:44.799,0:05:50.074
and compress it can can violate ducks[br]and other structures by invading
0:05:50.074,0:05:55.003
many malignant neoplasms grow much more[br]rapidly this is not rulebook grow more
0:05:55.003,0:05:56.075
rapidly than benign ones
0:05:56.075,0:05:58.009
so it really does
0:05:58.009,0:06:01.052
all of the above with a vengeance
0:06:01.052,0:06:05.004
and also any given much castesystem[br]there could be dozens or hundreds of the
0:06:05.004,0:06:08.069
past the seized in any given the task[br]forces can raise
0:06:08.069,0:06:09.065
local health
0:06:09.065,0:06:11.065
wherever it happens to be
0:06:11.065,0:06:13.199
so you can see that ah...
0:06:13.199,0:06:15.084
that all of the above is where the real
0:06:15.084,0:06:17.000
exclamation point
0:06:17.000,0:06:18.669
um...
0:06:18.669,0:06:20.249
and crime
0:06:20.249,0:06:20.919
cancers
0:06:20.919,0:06:25.199
can also secrete excess hormone just[br]like the nine and the crime
0:06:25.199,0:06:26.067
so any of those things
0:06:26.067,0:06:28.729
that are listed up here you can see
0:06:28.729,0:06:32.379
now there is there a couple of other[br]things uh...
0:06:32.379,0:06:36.319
unless i want to go understandably said[br]a conceptual level
0:06:36.319,0:06:37.049
that uh...
0:06:37.049,0:06:42.013
malignant neoplasms may be associated[br]with some very very significant systemic
0:06:42.013,0:06:44.004
changes
0:06:44.004,0:06:47.899
and uh... one of them that you may be[br]familiar with from
0:06:47.899,0:06:51.619
for milliliter answer or friends of[br]friends of friends
0:06:51.619,0:06:52.094
these are the
0:06:52.094,0:06:54.539
buff
0:06:54.539,0:06:56.056
twinkly cancer patients
0:06:56.056,0:06:58.619
will answer phase of disease
0:06:58.619,0:07:00.759
where they lose their appetites
0:07:00.759,0:07:02.061
we begin to lose weight
0:07:02.061,0:07:05.099
the weight comes highly awesome
0:07:05.099,0:07:08.939
and they get weaker and weaker and[br]weaker and just
0:07:08.939,0:07:10.409
do windows
0:07:10.409,0:07:13.079
and very often
0:07:13.079,0:07:17.989
so we could their beds have some in the[br]final event in their lives is nemo near
0:07:17.989,0:07:22.419
which overtakes typically will only take[br]a belfast patient like that
0:07:22.419,0:07:26.539
we refer to their way sort of wasting[br]syndrome
0:07:26.539,0:07:28.999
as cake x_-ers
0:07:28.999,0:07:30.539
there's the spelling for it
0:07:30.539,0:07:34.087
as a general term but here we're talking[br]about cancer coq xy and other words are
0:07:34.087,0:07:39.259
talking about a patient becoming a[br]nation and wasted because of the cancer
0:07:39.259,0:07:40.099
being there
0:07:40.099,0:07:45.056
when i was a kid in pathologies that[br]teach that this is simply a caloric
0:07:45.056,0:07:49.389
matter we had a rapidly growing tumor[br]which isn't enough calories competing
0:07:49.389,0:07:53.129
with the host the host lost appetite[br]along the way
0:07:53.129,0:07:54.084
and that was that
0:07:54.084,0:07:58.004
we just lost weight on behalf of the[br]jury
0:07:58.004,0:08:02.011
we now know that that's the only a small[br]part of the story
0:08:02.011,0:08:06.599
how this is a rather complex business[br]related and i would lead to a cytochrome
0:08:06.599,0:08:09.539
site a kind secretion on the part of the
0:08:09.539,0:08:11.169
as a gross
0:08:11.169,0:08:15.779
but be aware that very often in patients[br]with cancer you see this as syndrome of
0:08:15.779,0:08:18.509
cake axia
0:08:18.509,0:08:19.006
there are
0:08:19.006,0:08:23.067
also in this is an important general[br]concept that i want to get lost in the
0:08:23.067,0:08:25.819
specifics but there are other
0:08:25.819,0:08:28.081
symptom complex is that is a syndromes
0:08:28.081,0:08:30.729
in patients with cancer
0:08:30.729,0:08:32.065
that you cannot explain
0:08:32.065,0:08:35.078
uh... by local effects
0:08:35.078,0:08:36.085
mechanical effects
0:08:36.085,0:08:40.049
that you can't that they're not[br]explainable on the basis of a
0:08:40.049,0:08:44.021
predictable and the crying secretion in[br]other words it's not that this is a
0:08:44.021,0:08:45.011
cancer that's
0:08:45.011,0:08:49.069
we know is making insulin and therefore[br]beginning insulin sometimes it's not
0:08:49.069,0:08:50.005
that
0:08:50.005,0:08:51.054
uh...
0:08:51.054,0:08:54.399
we find some very weird
0:08:54.399,0:08:57.044
syndromes affecting a variety of organ[br]systems
0:08:57.044,0:08:59.073
that are june should be
0:08:59.073,0:09:02.048
presence of the cancer's not[br]mechanically but the president cancer in
0:09:02.048,0:09:04.098
the body and these are referred to is
0:09:04.098,0:09:07.053
para neil plastic syndromes
0:09:07.053,0:09:12.025
and i want you to to get an idea that[br]concept not the details of the various
0:09:12.025,0:09:13.087
syndromes
0:09:13.087,0:09:17.027
they're important because first of all[br]they may be a greater problem to the
0:09:17.027,0:09:18.036
patient
0:09:18.036,0:09:22.016
than the mechanical aspect of the tumor[br]itself
0:09:22.016,0:09:27.015
and another thing is that the patient[br]may present
0:09:27.015,0:09:31.065
the manifestations of a particular[br]perinatal plastic syndrome
0:09:31.065,0:09:35.025
at the time the cancer is still are cold
0:09:35.025,0:09:39.015
behooves you to be able to recognize[br]that all my goodness this mixture
0:09:39.015,0:09:42.006
symptoms may mean
0:09:42.006,0:09:46.066
getty just a couple of examples along[br]with the rest of your skimming reading
0:09:46.066,0:09:49.007
don't try to memorize any of this stuff[br]but one economist
0:09:49.007,0:09:50.091
uh...
0:09:50.091,0:09:55.039
para neoplastic syndromes is hyper cal[br]senior elevation in blood
0:09:55.039,0:09:58.051
calcium
0:09:58.051,0:10:02.086
you might think if you think he[br]mechanically think well cancer spreading
0:10:02.086,0:10:06.018
to the bone will destroy both liberate[br]calcium
0:10:06.018,0:10:07.005
that happens
0:10:07.005,0:10:11.004
that's not apparently plastics into[br]lesson mechanical thanks
0:10:11.004,0:10:17.037
but some tumors will secreted[br]parathyroid like hormone
0:10:17.037,0:10:20.034
in other words are not related to[br]parathyroid glands of tumor of this
0:10:20.034,0:10:21.031
error that
0:10:21.031,0:10:25.027
but it's a create something that has a[br]paris i read hormone like activity in a
0:10:25.027,0:10:28.003
race is the serum calcium
0:10:28.003,0:10:30.048
that's not at all uncommon
0:10:30.048,0:10:33.071
uh...
0:10:33.071,0:10:37.041
other examples of parent neoplastic[br]syndromes are from
0:10:37.041,0:10:39.006
what we call ext topic
0:10:39.006,0:10:42.056
hormone production where particular[br]tumor
0:10:42.056,0:10:46.005
is producing a hormone that has no[br]business coming from there we see for
0:10:46.005,0:10:47.011
instance
0:10:47.011,0:10:49.015
lung tumors
0:10:49.015,0:10:50.066
that produce
0:10:50.066,0:10:55.034
cortical trochmann and other ways that a[br]pituitary hormone that drives the
0:10:55.034,0:10:56.061
adrenal gland
0:10:56.061,0:10:58.067
this may produce all kinds of hell
0:10:58.067,0:11:02.063
because it real is overactive because of[br]the that topic
0:11:02.063,0:11:04.075
hormone production
0:11:04.075,0:11:07.026
some tumors
0:11:07.026,0:11:08.003
provoke
0:11:08.003,0:11:11.027
hyper coagulate ability in other words[br]make the flood
0:11:11.027,0:11:12.094
more likely to plop
0:11:12.094,0:11:16.000
when the study that in december but
0:11:16.000,0:11:20.059
suffice it to say i have seen patients[br]that present with
0:11:20.059,0:11:22.058
delay saying collapsed
0:11:22.058,0:11:26.033
not spontaneously as unusual ambulatory[br]patients with a comment
0:11:26.033,0:11:28.095
uh... clocks in their leg means
0:11:28.095,0:11:33.005
and after all the dust settles it turns[br]out they've got an internal cancer
0:11:33.005,0:11:35.319
pancreatic cancer ovarian cancer
0:11:35.319,0:11:37.039
what have you
0:11:37.039,0:11:40.023
it's doing too
0:11:40.023,0:11:44.055
pro quo ideal in substances associated[br]with the tumor
0:11:44.055,0:11:46.016
now i'll
0:11:46.016,0:11:48.043
drop-dead at this
0:11:48.043,0:11:52.021
and i'd suggest that you take a look at[br]the uh... the appropriate pages in the
0:11:52.021,0:11:52.068
book
0:11:52.068,0:11:57.002
and just to see the variety apparently[br]isp neoplastic syndrome stop tryin
0:11:57.002,0:11:58.709
memorized just be aware
0:11:58.709,0:12:00.063
that general concept
0:12:00.063,0:12:03.048
affair neoplastic syndrome
0:12:03.048,0:12:06.064
part one more matter
0:12:06.064,0:12:07.999
quick pictures show
0:12:07.999,0:12:11.009
as a matter of moments sure
0:12:11.009,0:12:15.063
neoplasms and i want to emphasize that[br]this is not a trivial matter it may seem
0:12:15.063,0:12:18.054
trivial to you know namely tumor so what
0:12:18.054,0:12:19.096
uh...
0:12:19.096,0:12:22.052
this is very very important
0:12:22.052,0:12:23.017
because
0:12:23.017,0:12:25.096
um...
0:12:25.096,0:12:27.065
if we
0:12:27.065,0:12:28.949
name the tumor
0:12:28.949,0:12:30.083
precisely and accurately
0:12:30.083,0:12:32.759
it transmits a lot of
0:12:32.759,0:12:36.459
information i was away as you worry more[br]about on college if someone says it's
0:12:36.459,0:12:38.056
such and such kind of tumor this'll
0:12:38.056,0:12:42.034
bring up a a little rolodex card have a[br]whole bunch of information
0:12:42.034,0:12:45.009
so it's important to be precise
0:12:45.009,0:12:46.066
in the terminology
0:12:46.066,0:12:51.269
and you've got to become familiar with[br]this has got to be just reflex with u
0:12:51.269,0:12:53.025
you'll use it throughout your career
0:12:53.025,0:12:56.066
in the time to learn is right now[br]because of the on your exam
0:12:56.066,0:12:58.067
this weekend
0:12:58.067,0:13:03.001
i'd promised you upstairs is that[br]important and look what i want to be
0:13:03.001,0:13:06.011
able to do is take
0:13:06.011,0:13:07.073
the description
0:13:07.073,0:13:09.085
of a neoplasm
0:13:09.085,0:13:14.279
and only new picture taken description[br]other and say okay with those elements
0:13:14.279,0:13:18.015
this is exactly how i'm going to name it
0:13:18.015,0:13:21.004
you've should be able to use after you[br]leave the room today
0:13:21.004,0:13:22.041
but uh...
0:13:22.041,0:13:26.049
certainly by this weekend and it's it's[br]very important to you throughout your
0:13:26.049,0:13:28.006
career
0:13:28.006,0:13:28.088
resilient
0:13:28.088,0:13:33.007
table in your book i think that page two[br]seventy three of them are wrong
0:13:33.007,0:13:37.062
that shows you benign this anomaly the[br]counterpart of the nine this animal
0:13:37.062,0:13:39.000
wouldn't come apart and so forth
0:13:39.000,0:13:42.038
i want to memorize that
0:13:42.038,0:13:43.879
you know thirty seconds
0:13:43.879,0:13:45.043
without doing that chart
0:13:45.043,0:13:51.003
and it will give you an idea of how we[br]go about naming things
0:13:51.003,0:13:51.073
basically
0:13:51.073,0:13:54.033
it's it's not rocket science
0:13:54.033,0:13:57.008
we name tumors on the on the basis of[br]two things
0:13:57.008,0:13:59.009
the tissue are joan
0:13:59.009,0:14:01.095
words benign or malignant
0:14:01.095,0:14:03.096
in other words uh...
0:14:03.096,0:14:07.034
try and looking at the neoplasm and[br]you'll be able to do this this coming
0:14:07.034,0:14:08.086
spring
0:14:08.086,0:14:10.054
you'll be able to decide
0:14:10.054,0:14:12.085
its historic genesis white
0:14:12.085,0:14:16.034
tissue is springs from
0:14:16.034,0:14:18.097
an important part of the name
0:14:18.097,0:14:22.048
you'll see is in just a moment
0:14:22.048,0:14:27.008
depending on whether it's been nine or[br]malignant we tack on a different suffix
0:14:27.008,0:14:29.078
in the kind of make a compound word
0:14:29.078,0:14:31.099
transmits an awful lot of information
0:14:31.099,0:14:33.094
so learn
0:14:33.094,0:14:35.074
to do this
0:14:35.074,0:14:38.027
now let's
0:14:38.027,0:14:40.000
dive right in
0:14:40.000,0:14:44.037
and and talk about first of all efforts[br]the lil neoplasm
0:14:44.037,0:14:46.074
now the end of the net a c liam
0:14:46.074,0:14:49.055
you have become very familiar with this[br]is a sort of tissue
0:14:49.055,0:14:52.081
that covers a surface like the epidermis
0:14:52.081,0:14:53.054
deadlines
0:14:53.054,0:14:56.022
them out for the gi tract
0:14:56.022,0:14:58.021
lines cavities
0:14:58.021,0:14:59.569
by convention
0:14:59.569,0:15:01.056
we considered
0:15:01.056,0:15:04.099
liver tissue to be epithelium
0:15:04.099,0:15:09.037
kenny tissue of the two meals in[br]particular to be to be at the funeral
0:15:09.037,0:15:15.015
and so forth so we're talking about the[br]serial neoplasms
0:15:15.015,0:15:18.058
the plot seconds a little bit
0:15:18.058,0:15:21.074
different kinds of epithelia as you will[br]learn
0:15:21.074,0:15:25.046
their glandular epithelium they're not[br]glandular epithelium there is something
0:15:25.046,0:15:28.094
we call transitional epithelium etcetera
0:15:28.094,0:15:30.039
don't worry about it
0:15:30.039,0:15:34.024
but concentrate first-time glandular[br]epithelia
0:15:34.024,0:15:37.036
in other words uh... this is these are[br]from structures
0:15:37.036,0:15:38.089
we're talking about tumors
0:15:38.089,0:15:44.048
that arise from epithelia lhs structures[br]that are glandular or to be more ductile
0:15:44.048,0:15:47.074
those are those of the call glandular[br]type
0:15:47.074,0:15:49.007
the rooms
0:15:49.007,0:15:51.056
and unknown
0:15:51.056,0:15:53.073
means gland
0:15:53.073,0:15:56.032
and the suffix beaumont
0:15:56.032,0:15:58.096
refers to uh... to amass
0:15:58.096,0:16:03.088
and by convention if we have a benign
0:16:03.088,0:16:04.005
neoplasm
0:16:04.005,0:16:06.093
of glandular epithelium
0:16:06.093,0:16:12.004
it is an adenoma
0:16:12.004,0:16:15.067
that along transmits a lot of[br]information that says to your listener
0:16:15.067,0:16:19.085
if his name something that no one says[br]well asap cereal
0:16:19.085,0:16:22.419
it is in the connective tissue tumors in[br]the field
0:16:22.419,0:16:27.046
and it's glandular and it's benign
0:16:27.046,0:16:30.049
choice and adenomas
0:16:30.049,0:16:31.047
this is uh...
0:16:31.047,0:16:32.057
a cut
0:16:32.057,0:16:34.041
through the adrenal gland
0:16:34.041,0:16:38.069
managerial glance its deep enough at[br]above the kidney waiting here
0:16:38.069,0:16:40.024
few inches in here
0:16:40.024,0:16:42.051
it's about about that big
0:16:42.051,0:16:43.027
normally
0:16:43.027,0:16:45.089
not done here is cut through the adrenal[br]gland
0:16:45.089,0:16:48.086
this is a cut through the normal plan
0:16:48.086,0:16:50.043
the yellow
0:16:50.043,0:16:52.075
part of the sandwiches the cortex
0:16:52.075,0:16:55.053
that makes various steroid hormones
0:16:55.053,0:16:56.097
and this is the mud all over
0:16:56.097,0:16:59.005
that makes catecholamines
0:16:59.005,0:17:00.076
i've got an effort and so forth
0:17:00.076,0:17:02.094
right in that dark spot
0:17:02.094,0:17:04.026
here we have
0:17:04.026,0:17:06.035
india plaza
0:17:06.035,0:17:11.065
first of all is very well circumscribed[br]just shout louder there
0:17:11.065,0:17:14.037
clearance sale of probably benign[br]doesn't look invasive
0:17:14.037,0:17:17.091
i can tell you that under the microscope[br]this was
0:17:17.091,0:17:21.057
perfectly differentiating himself[br]herself all their arranged a little
0:17:21.057,0:17:22.007
differently
0:17:22.007,0:17:24.189
they look like the cells here
0:17:24.189,0:17:27.839
you came to get a hint of that and that[br]it's the same a yellow
0:17:27.839,0:17:29.031
sort of stuff
0:17:29.031,0:17:30.093
comprising then at that
0:17:30.093,0:17:33.052
of which this is made
0:17:33.052,0:17:37.091
so this is an added no ma
0:17:37.091,0:17:42.299
arising from the adrenal cortex so we[br]call it a bit and give it the whole in
0:17:42.299,0:17:45.043
adrenal cortical adenoma
0:17:45.043,0:17:46.065
now the question
0:17:46.065,0:17:49.089
is well how did that patient coming in[br]this a doc
0:17:49.089,0:17:51.004
i've got a
0:17:51.004,0:17:53.799
walnut sized mass in my super arenal
0:17:53.799,0:17:56.023
uh... fat pad
0:17:56.023,0:17:59.053
then is obviously buried in there and[br]you know when you feel that
0:17:59.053,0:18:00.094
uh...
0:18:00.094,0:18:06.034
the way this presented was because it[br]was making an access of hormone
0:18:06.034,0:18:10.051
knows this is a patient belonged to his[br]or her life
0:18:10.051,0:18:14.041
developed a series of symptoms in this[br]particular case i can tell from looking
0:18:14.041,0:18:16.044
at this and other history
0:18:16.044,0:18:18.002
this tumor was making
0:18:18.002,0:18:20.086
gobs and gobs of a vast room
0:18:20.086,0:18:25.005
and the patient came in with i'd will[br]bore you with a bit of syndrome
0:18:25.005,0:18:29.139
relating to blood pressure and changes[br]in certain cervelo delights and so forth
0:18:29.139,0:18:31.029
and the
0:18:31.029,0:18:32.094
smart physicians seven
0:18:32.094,0:18:36.419
flipping see these things together[br]something is making too much
0:18:36.419,0:18:39.023
oven adrenal cortical hormone
0:18:39.023,0:18:41.082
simply a matter of imaging finding out[br]which side
0:18:41.082,0:18:44.043
out icons and you got a cure
0:18:44.043,0:18:48.011
because that's perfectly benign very[br]well differentiated
0:18:48.011,0:18:49.036
here's one for you
0:18:49.036,0:18:50.097
have to explain us a little bit like
0:18:50.097,0:18:53.082
this is a pancreas has been sliced
0:18:53.082,0:18:57.098
in the two has a look at matching this[br]is what the normal pancreas
0:18:57.098,0:19:01.059
pancreas pratama looks like it's a lobby[br]local angular tissue
0:19:01.059,0:19:04.027
and has a marble
0:19:04.027,0:19:06.006
very well circumscribed marble
0:19:06.006,0:19:07.087
in the middle of it
0:19:07.087,0:19:09.047
this was benign
0:19:09.047,0:19:13.013
can tell that by looking at exactly but[br]it's it's benign
0:19:13.013,0:19:14.046
it arose
0:19:14.046,0:19:19.003
from the island salon their hands
0:19:19.003,0:19:20.046
with that in mind
0:19:20.046,0:19:22.639
how do you suppose is patient presented
0:19:22.639,0:19:26.889
again that's a that's a little marble[br]military christening lately in their
0:19:26.889,0:19:31.007
representation presenter y
0:19:31.007,0:19:33.051
removed
0:19:33.051,0:19:35.043
hypoglycaemia
0:19:35.043,0:19:39.017
another words that tumor was producing[br]insulin without regard
0:19:39.017,0:19:41.064
to the needs of the body
0:19:41.064,0:19:44.009
lose patience though there are[br]variations on this end of the basically
0:19:44.009,0:19:47.073
if they did not just beaten
0:19:47.073,0:19:52.002
insulin levels high and there's the[br]serum glucose goes down
0:19:52.002,0:19:57.037
you get a variety of symptoms all the[br]way to convulsions and coma
0:19:57.037,0:20:00.039
units that's the most dramatic part of[br]this and
0:20:00.039,0:20:01.008
sexual
0:20:01.008,0:20:03.809
has effected by removing
0:20:03.809,0:20:06.023
sort of thing
0:20:06.023,0:20:09.085
all right here's another sort of that no[br]one want to talk about this in detail
0:20:09.085,0:20:12.066
this afternoon so i'm not going to be a[br]labor it now
0:20:12.066,0:20:14.085
but this is a melanoma
0:20:14.085,0:20:15.083
arising
0:20:15.083,0:20:18.031
from the lining of the colon
0:20:18.031,0:20:20.005
which is a glandular lining
0:20:20.005,0:20:24.026
so an isbn nine so well circumscribed
0:20:24.026,0:20:25.014
non-invasive thing
0:20:25.014,0:20:27.061
so this is a calm on iq
0:20:27.061,0:20:30.088
adenoma
0:20:30.088,0:20:34.001
sort of growing on the stand here this[br]is normal
0:20:34.001,0:20:36.009
collage mucosa sort of pulled out
0:20:36.009,0:20:40.037
uh... won't be another name for that[br]england and idea
0:20:40.037,0:20:42.039
right pollock
0:20:42.039,0:20:44.062
but i warn you
0:20:44.062,0:20:49.042
you got to be taken precise because the[br]term pollack is just a topographical
0:20:49.042,0:20:50.054
term
0:20:50.054,0:20:54.055
anything that hangs like a dingell barry[br]off of
0:20:54.055,0:20:57.009
him you coastal services apollo
0:20:57.009,0:21:01.009
now some polyps are in fact neoplasms[br]like this one
0:21:01.009,0:21:05.043
but summer simply inflammatory masses[br]some of you who have nasal allergies may
0:21:05.043,0:21:09.036
have been told that you have nasal[br]polyps
0:21:09.036,0:21:12.077
is things that says sorta look like that[br]up there
0:21:12.077,0:21:17.057
but they're not neoplasms urges bags[br]into gmail fluid in the few inflammatory
0:21:17.057,0:21:18.039
cells
0:21:18.039,0:21:20.001
so anything else
0:21:20.001,0:21:23.009
off on the surface you call a polyp[br]alone while you know that's a pollack
0:21:23.009,0:21:25.043
with their other kinds of politics and[br]the colon
0:21:25.043,0:21:27.004
they're not all at a moment's
0:21:27.004,0:21:31.003
so if you want to be precise you could[br]say this is an ad anomalous pollock
0:21:31.003,0:21:34.309
or simply
0:21:34.309,0:21:36.038
some of them ron stems like that
0:21:36.038,0:21:39.097
we call that eight people insulated
0:21:39.097,0:21:42.001
adenoma
0:21:42.001,0:21:43.007
some of them are
0:21:43.007,0:21:46.063
sort of attached to the surface without[br]much of his family are a couple of
0:21:46.063,0:21:47.032
little
0:21:47.032,0:21:50.036
an anomalous just doesn't budding right[br]off
0:21:50.036,0:21:52.076
the surface
0:21:52.076,0:21:56.079
these things are generally a symptomatic
0:21:56.079,0:21:59.081
it would take a helluva lot
0:21:59.081,0:22:02.001
adenoma to produce any symptoms
0:22:02.001,0:22:05.025
usually associate with a little a cold[br]leading
0:22:05.025,0:22:07.007
but basically they're they're hidden[br]there
0:22:07.007,0:22:10.042
the significance is
0:22:10.042,0:22:12.009
some of these
0:22:12.009,0:22:13.023
dilemmas time
0:22:13.023,0:22:17.179
turn of the cancer and that's the news[br]that the other theme of our
0:22:17.179,0:22:21.083
presentation this afternoon so i won't[br]belabor it at this point
0:22:21.083,0:22:23.179
try and what about it
0:22:23.179,0:22:25.429
and you can go back on that chart i gave[br]you
0:22:25.429,0:22:29.036
the next step down on my cell on the[br]left side of the nine
0:22:29.036,0:22:31.000
man glandular epithelia
0:22:31.000,0:22:32.071
this is a cartoon
0:22:32.071,0:22:34.053
of a benign neoplasm
0:22:34.053,0:22:39.098
of the lining of the bladder happens to[br]be what we call transitional epithelium
0:22:39.098,0:22:43.009
very often these sorts of things grow[br]out
0:22:43.009,0:22:44.093
and i think they
0:22:44.093,0:22:50.009
this does a good job as a series of[br]finger like projections
0:22:50.009,0:22:52.019
pointing at you
0:22:52.019,0:22:56.007
in each one of these is that it is a bit[br]of stromal covered by a layer of
0:22:56.007,0:22:59.022
neoplastic transitional epithelium
0:22:59.022,0:23:03.059
and we refer to his finger like[br]projections is painfully
0:23:03.059,0:23:05.082
so this becomes a
0:23:05.082,0:23:07.087
papilloma
0:23:07.087,0:23:11.389
this is a transition hands because it's[br]a transitional epithelium
0:23:11.389,0:23:13.005
the transitional cell
0:23:13.005,0:23:16.001
papilloma
0:23:16.001,0:23:20.033
lala just mentioned passing that these[br]can be a symptomatic or these peculiar
0:23:20.033,0:23:26.041
break off a little bit and then you get[br]some blood in the year in you materia
0:23:26.041,0:23:29.058
i'll show you a real like real life
0:23:29.058,0:23:30.031
papilloma
0:23:30.031,0:23:31.046
uh...
0:23:31.046,0:23:36.006
these these little thing that these[br]things presenters so little tiny bulbs
0:23:36.006,0:23:42.001
very often in the oral mucosa or the the[br]back of the throat the oral pharynx
0:23:42.001,0:23:46.088
this was one of those about the size of[br]peace
0:23:46.088,0:23:51.099
this is the normal swimmers epithelium[br]lining the aural pharynx
0:23:51.099,0:23:56.072
and what this says is a series of these[br]finger like projections
0:23:56.072,0:23:58.019
growing
0:23:58.019,0:24:01.061
out of this epithelium we don't see the[br]precise point attachment in each one of
0:24:01.061,0:24:05.016
these is a little finger cutting[br]cross-section
0:24:05.016,0:24:07.639
covered by this swing this epithelium
0:24:07.639,0:24:08.076
perfectly benign
0:24:08.076,0:24:12.025
so this would be called a swimmers[br]itself
0:24:12.025,0:24:14.009
papilloma
0:24:14.009,0:24:15.051
these are
0:24:15.051,0:24:19.069
well the variety of variation in this[br]team i'm not on the skin surface is a is
0:24:19.069,0:24:21.077
a common wart
0:24:21.077,0:24:24.036
and they're all sorts of variations in[br]this
0:24:24.036,0:24:28.076
generally caused by one or another[br]string of the human papilloma virus hp
0:24:28.076,0:24:30.049
deal here about this
0:24:30.049,0:24:31.039
constantly
0:24:31.039,0:24:33.279
but uh... there is a
0:24:33.279,0:24:35.056
they'd have a little more
0:24:35.056,0:24:42.026
now one other variation on this team
0:24:42.026,0:24:44.065
sometimes it comes to pass
0:24:44.065,0:24:46.075
for a few days
0:24:46.075,0:24:49.005
neoplasm of glandular epithelium
0:24:49.005,0:24:51.559
that grows
0:24:51.559,0:24:52.097
in bubbles
0:24:52.097,0:24:56.042
in other words the neoplastic epithelium[br]lines
0:24:56.042,0:24:59.028
the inner aspect of the holes
0:24:59.028,0:25:04.023
which we call status technically a cyst[br]is a whole space filled with fluid
0:25:04.023,0:25:04.063
blinded
0:25:04.063,0:25:06.075
within epithelium
0:25:06.075,0:25:11.839
there are some neoplasms that growth has[br]collections of multiple bottles vs
0:25:11.839,0:25:13.799
line by this
0:25:13.799,0:25:16.005
neoplastic glandular epithelium
0:25:16.005,0:25:18.075
in a good example of this is a
0:25:18.075,0:25:20.064
but i think fairly common
0:25:20.064,0:25:24.072
seven nine neoplasm we've seen over it
0:25:24.072,0:25:28.081
we call these things because they are[br]multiple cysts
0:25:28.081,0:25:31.179
we call these cyst
0:25:31.179,0:25:34.019
one-word system adenoma
0:25:34.019,0:25:37.079
and here's what it would look like
0:25:37.079,0:25:39.064
don't have a scale on there
0:25:39.064,0:25:42.001
normal ovaries about the size of a
0:25:42.001,0:25:43.026
well you know
0:25:43.026,0:25:45.029
small not
0:25:45.029,0:25:48.042
this thing was about the size of a[br]football
0:25:48.042,0:25:50.052
they can they can get big
0:25:50.052,0:25:52.021
uh...
0:25:52.021,0:25:56.659
levy banana thier this it would be[br]suggested by the fact that the surface
0:25:56.659,0:25:59.073
is perfectly smooth and whatever there[br]is
0:25:59.073,0:26:01.039
there's orderly
0:26:01.039,0:26:04.061
anesth one minute that surfaces[br]perfectly smooth
0:26:04.061,0:26:06.679
cut into the thing
0:26:06.679,0:26:10.007
you see assist the character
0:26:10.007,0:26:13.071
these were these were filled with a[br]musician is material
0:26:13.071,0:26:15.083
which we washed away
0:26:15.083,0:26:20.069
of there's a system that's lined by
0:26:20.069,0:26:24.055
benign glandular epithelium there there[br]there are so far
0:26:24.055,0:26:26.034
many little daughter cysts
0:26:26.034,0:26:29.034
so that is an ovarian
0:26:29.034,0:26:33.058
sister adenoma see how we built the[br]names
0:26:33.058,0:26:35.008
without much in mind
0:26:35.008,0:26:38.097
we got a next step and say what about
0:26:38.097,0:26:39.087
malignancy
0:26:39.087,0:26:40.097
counterparts
0:26:40.097,0:26:46.003
now the role here is if you have been at[br]the same feel neoplasm
0:26:46.003,0:26:48.038
of any sort
0:26:48.038,0:26:50.009
and it has malignant
0:26:50.009,0:26:52.047
it is a carcinoma
0:26:52.047,0:26:54.084
so it's the word
0:26:54.084,0:26:57.002
carcinoma appears as any part of the[br]named
0:26:57.002,0:26:58.075
you say to yourself
0:26:58.075,0:27:01.049
jake this is at it's a little
0:27:01.049,0:27:03.013
and there is no limit
0:27:03.013,0:27:05.072
transmit a lot of information with that
0:27:05.072,0:27:07.069
then you add
0:27:07.069,0:27:09.027
compound
0:27:09.027,0:27:10.459
the parts of the
0:27:10.459,0:27:11.929
gets its day
0:27:11.929,0:27:13.056
glandular
0:27:13.056,0:27:16.025
malignancy what do you suppose you call[br]it
0:27:16.025,0:27:17.083
adamo
0:27:17.083,0:27:18.052
carcinoma
0:27:18.052,0:27:21.007
if this is cuevas malignancy
0:27:21.007,0:27:24.499
square myself carcinoma et cetera only
0:27:24.499,0:27:26.269
and then you can't rely on
0:27:26.269,0:27:29.549
you'll see in our reports all sorts of[br]things
0:27:29.549,0:27:31.859
moderately well differentiation did
0:27:31.859,0:27:35.449
moderately well differentiated nuisance[br]secreting
0:27:35.449,0:27:36.092
adenocarcinoma lacz
0:27:36.092,0:27:39.099
put on some frosting on the cake the[br]food
0:27:39.099,0:27:40.098
the basic thing is that tells you
0:27:40.098,0:27:44.039
that is glandular that it is
0:27:44.039,0:27:46.001
malignant
0:27:46.001,0:27:50.005
so i'll show you some carcinomas quickly
0:27:50.005,0:27:53.045
that'll make about half of you cringe
0:27:53.045,0:27:56.018
uh... that's just what the label says
0:27:56.018,0:27:59.084
of the glands of the penises largely[br]replaced
0:27:59.084,0:28:00.075
by this
0:28:00.075,0:28:02.017
uh...
0:28:02.017,0:28:05.093
i'll give you another few words these[br]are all words you learn to live with we
0:28:05.093,0:28:09.058
would refer to a neoplasm has grown out[br]what how much room here
0:28:09.058,0:28:12.039
we talk about it is fun game
0:28:12.039,0:28:13.009
fungus funding
0:28:13.009,0:28:24.092
so this is
0:28:24.092,0:28:29.078
well some some sisterhood military[br]generic answer some sis
0:28:29.078,0:28:33.033
are not nearly fast
0:28:33.033,0:28:37.015
that you get if you obstructed for[br]instance ductile structure
0:28:37.015,0:28:39.065
and something is secreting into it
0:28:39.065,0:28:43.006
it's obstructed here it'll become[br]systemically dilated before missus
0:28:43.006,0:28:45.044
others just happen to be
0:28:45.044,0:28:50.059
the way they are because they're they're[br]neoplasms
0:28:50.059,0:28:54.096
well at any rate getting medicine is so[br]this is a fun gating
0:28:54.096,0:28:56.028
neoplasm
0:28:56.028,0:29:01.052
another word we use is exo finicky excel[br]meaning outward ph wide ta cee growing
0:29:01.052,0:29:02.041
outward
0:29:02.041,0:29:06.027
well this is partly funding but this was[br]infiltrating deeply
0:29:06.027,0:29:09.149
this is a highly malignant neoplasm even[br]though it's
0:29:09.149,0:29:10.076
pretty well differentiated
0:29:10.076,0:29:13.096
and this is presently mona lymph nodes[br]at the time
0:29:13.096,0:29:15.097
now this happened
0:29:15.097,0:29:19.076
they the covering of the glances cuevas
0:29:19.076,0:29:22.033
epithelium this was a swimmers cell
0:29:22.033,0:29:23.085
carcinoma
0:29:23.085,0:29:26.739
this illustrates a something you'll[br]learn
0:29:26.739,0:29:30.024
it is not uncommon says people have a[br]great sense of the miles
0:29:30.024,0:29:34.049
this thing didn't show up the thursday[br]night before he came into the doctor
0:29:34.049,0:29:37.025
this has been there many many months
0:29:37.025,0:29:40.091
and people have all sorts of ways of[br]explaining these things away in the
0:29:40.091,0:29:43.021
nineteen hoping they're not there[br]tomorrow morning
0:29:43.021,0:29:44.249
when a shower
0:29:44.249,0:29:45.039
and so forth
0:29:45.039,0:29:48.047
but that's a highly advanced lesion
0:29:48.047,0:29:51.005
yours for the other half
0:29:51.005,0:29:53.089
now this one
0:29:53.089,0:29:58.097
is also basically my cell carcinoma[br]reveal a b errol covered by squamous
0:29:58.097,0:29:59.099
epithelium
0:29:59.099,0:30:00.067
scenarios
0:30:00.067,0:30:03.012
now that was sensed by the patient
0:30:03.012,0:30:06.052
as a sore store there that didn't heal
0:30:06.052,0:30:08.539
it was in the master was acts of faith
0:30:08.539,0:30:11.026
but this thing penetrated in
0:30:11.026,0:30:13.003
about a centimeter or two
0:30:13.003,0:30:17.039
not hand it was also present in the imo[br]lymph nodes
0:30:17.039,0:30:19.074
on that side
0:30:19.074,0:30:21.066
when the cell carcinoma
0:30:21.066,0:30:24.097
here's one that we don't see much[br]anymore and i hope you never see one
0:30:24.097,0:30:26.033
like this
0:30:26.033,0:30:28.022
and this is a cervix
0:30:28.022,0:30:30.005
to observe ovaries over here
0:30:30.005,0:30:32.006
and vagina
0:30:32.006,0:30:37.042
and what should have been a nice cervix[br]here is completely destroyed
0:30:37.042,0:30:40.004
by this very very advanced
0:30:40.004,0:30:41.779
square was still
0:30:41.779,0:30:43.068
carcinoma
0:30:43.068,0:30:45.869
the face of the cervix that
0:30:45.869,0:30:49.058
juts into the giant is covered by square[br]was that the feelings of many of these
0:30:49.058,0:30:51.095
cancers are swimmers
0:30:51.095,0:30:55.006
number i showed you beyond the cervix[br]the other day that also has glandular
0:30:55.006,0:30:58.082
line so we do see some admin carcinomas[br]there
0:30:58.082,0:30:59.084
these are
0:30:59.084,0:31:02.011
uh... basically provoked by
0:31:02.011,0:31:07.052
a number of strains of the human[br]papillomavirus
0:31:07.052,0:31:09.003
it's it's uh...
0:31:09.003,0:31:10.006
transmissible
0:31:10.006,0:31:12.046
virus and uh... this is
0:31:12.046,0:31:13.429
one of the
0:31:13.429,0:31:14.007
bad outcomes
0:31:14.007,0:31:19.018
now i say that i hope you'll never[br]senior probably never see one quite
0:31:19.018,0:31:21.015
disadvantage of practice in this country
0:31:21.015,0:31:24.098
because of the widespread use of pap[br]smears we discussed that last time you
0:31:24.098,0:31:25.629
can
0:31:25.629,0:31:29.379
even apprehend this sort of thing one is[br]still in the insight tuesday jury even
0:31:29.379,0:31:31.068
earlier with displeasure
0:31:31.068,0:31:34.089
you don't have to wait for this when[br]this woman already had a follow bloody
0:31:34.089,0:31:38.389
discharge because of this
0:31:38.389,0:31:40.086
neoplasm
0:31:40.086,0:31:44.048
well let's go back to him and gi tract
0:31:44.048,0:31:45.045
uni
0:31:45.045,0:31:50.001
upper aerodynamicists tracked into the[br]tongue the line-item all of the back of
0:31:50.001,0:31:51.094
the throat banks and so forth
0:31:51.094,0:31:57.054
we commonly see squeamish cell[br]carcinomas
0:31:57.054,0:31:59.045
and this is a ton
0:31:59.045,0:32:01.099
that's been amputated
0:32:01.099,0:32:03.045
cuts actually
0:32:03.045,0:32:08.015
and you can see this very deeply[br]invasive mass this was a squamous cell
0:32:08.015,0:32:09.029
carcinoma
0:32:09.029,0:32:09.062
rising
0:32:09.062,0:32:11.052
out here
0:32:11.052,0:32:12.087
these or older
0:32:12.087,0:32:14.076
uh...
0:32:14.076,0:32:20.013
for racial cancers are mostly related to[br]smoking and drinking
0:32:20.013,0:32:22.034
and
0:32:22.034,0:32:26.006
histologically this might look identical[br]to living in the cervix but it's got a
0:32:26.006,0:32:28.009
different etiology
0:32:28.009,0:32:32.559
and different different behavior but[br]this was a very deeply invasive
0:32:32.559,0:32:34.076
square missile carcinoma
0:32:34.076,0:32:38.027
here's another one mister heavy smoker
0:32:38.027,0:32:40.015
this is a larynx
0:32:40.015,0:32:41.046
opened in the back
0:32:41.046,0:32:44.058
so the adam's apple store the front my[br]spread open
0:32:44.058,0:32:47.058
there's a deeply ulcerative tumor there
0:32:47.058,0:32:48.087
uh...
0:32:48.087,0:32:53.062
this may have been around for months and[br]months and months and months
0:32:53.062,0:32:54.089
head-first
0:32:54.089,0:32:56.094
classes don't necessarily cause pain
0:32:56.094,0:33:00.035
you know i must say infiltrate nerves[br]are not going to cause much pain
0:33:00.035,0:33:04.071
this guy had inherited of cough in his[br]voice changed as you can imagine the
0:33:04.071,0:33:07.051
vocal cord gradually being destroyed
0:33:07.051,0:33:10.064
you know a heavy smokers are used to[br]being a horse and coughing and so forth
0:33:10.064,0:33:13.085
and again the denial kicks in
0:33:13.085,0:33:16.509
this was a along the collected
0:33:16.509,0:33:19.002
square was still carcinoma
0:33:19.002,0:33:21.000
larynx
0:33:21.000,0:33:24.279
take it down the esophagus nam two miles[br]is up there
0:33:24.279,0:33:28.009
this is the sound is coming down the[br]summit here and you can see we we've
0:33:28.009,0:33:30.007
opened an office is rough in the area
0:33:30.007,0:33:34.045
and the cut surface area to see at the[br]wall a second
0:33:34.045,0:33:37.169
this is a very advanced
0:33:37.169,0:33:38.022
carcinoma
0:33:38.022,0:33:43.000
aligning of the esophagus disclaimers in[br]this was a square must sell
0:33:43.000,0:33:45.052
carcinoma
0:33:45.052,0:33:48.086
desert you can imagine will produce a[br]mechanical problems patients will have
0:33:48.086,0:33:50.008
trouble swallowing
0:33:50.008,0:33:51.066
and there again
0:33:51.066,0:33:53.239
i've seen patients come in
0:33:53.239,0:33:56.084
and strain baby food before they finally[br]say oncall
0:33:56.084,0:33:59.064
and decide that something might be wrong
0:33:59.064,0:34:02.099
and these are very hard to cure because[br]of the fact that they are advancing
0:34:02.099,0:34:07.000
their local my pastor sees it's not just[br]in the past the seas
0:34:07.000,0:34:08.689
we can also see
0:34:08.689,0:34:11.349
adamo carcinomas nearsightedness
0:34:11.349,0:34:17.829
because there are some glandular[br]epithelium there that can also give rise
0:34:17.829,0:34:21.059
now if you look at that i tell you this[br]is a stomach has been opened in
0:34:21.059,0:34:23.096
washington is the esophagus up there is[br]this
0:34:23.096,0:34:25.959
do indian coming off over here
0:34:25.959,0:34:31.049
if you look at that for a while at first[br]you might say well nothing wrong on that
0:34:31.049,0:34:34.989
but you'll notice that the normal full[br]pattern
0:34:34.989,0:34:37.289
desire note here
0:34:37.289,0:34:40.129
it doesn't look so awful that at first[br]blush
0:34:40.129,0:34:45.699
but that is a diffuse lee infiltrated[br]carcinoma
0:34:45.699,0:34:49.409
what kind is suppose it is given up his[br]stomach is a
0:34:49.409,0:34:52.829
glandular lying
0:34:52.829,0:34:54.399
adenocarcinoma
0:34:54.399,0:34:56.959
and uh... these things are
0:34:56.959,0:35:01.269
very subtle and a symptomatic until[br]their advance this was very advances as
0:35:01.269,0:35:03.299
medicine at ican liver already
0:35:03.299,0:35:04.859
at the time it came
0:35:04.859,0:35:07.059
uh...
0:35:07.059,0:35:11.089
so they may have traditionally symptoms[br]at all and interesting wrinkle here is
0:35:11.089,0:35:15.049
uh... the incidence of this kind of[br]tumor is very high in japan
0:35:15.049,0:35:16.479
much higher than here
0:35:16.479,0:35:20.369
and it's largely in environmental thing[br]because the descendants of japanese who
0:35:20.369,0:35:21.016
come here
0:35:21.016,0:35:22.859
or pick up our other
0:35:22.859,0:35:23.095
yankee problems
0:35:23.095,0:35:28.829
but uh... this incident changes but it's[br]such a public health problem
0:35:28.829,0:35:30.099
that they will screen
0:35:30.099,0:35:34.239
for this sort of thing because there's[br]nothing like this could produce symptoms
0:35:34.239,0:35:34.098
early on
0:35:34.098,0:35:38.074
so the only hope of getting it earlier[br]is played by population screening and
0:35:38.074,0:35:40.599
that's that's another matter
0:35:40.599,0:35:42.038
for another time
0:35:42.038,0:35:46.089
here's one that will anticipate uh...[br]this afternoon
0:35:46.089,0:35:48.319
getting down to a large intestine
0:35:48.319,0:35:51.349
this is actually in the first part of a[br]large intestine over here right where
0:35:51.349,0:35:56.289
the small intestine answers for the[br]appendix comes offices so called safe
0:35:56.289,0:35:57.819
this about
0:35:57.819,0:36:00.229
poultry four inches in diameter
0:36:00.229,0:36:01.008
and there's a huge
0:36:01.008,0:36:05.889
fung gaining neoplasm there
0:36:05.889,0:36:09.459
anissa grown glandular lining so it's an[br]adamo
0:36:09.459,0:36:10.789
carcinoma
0:36:10.789,0:36:11.509
now
0:36:11.509,0:36:13.098
in terms of our clinical present asian
0:36:13.098,0:36:17.077
uh... this thing isn't going to his big[br]is that there is a good person that's
0:36:17.077,0:36:19.739
trucked something bad big so that
0:36:19.739,0:36:22.067
the first confiscate passing by
0:36:22.067,0:36:25.599
doesn't cause any pain
0:36:25.599,0:36:27.999
at least at this stage
0:36:27.999,0:36:31.159
one things that happens with these as[br]they believe
0:36:31.159,0:36:35.169
you know the passing traffic will will[br]erode the surface and they'll believe
0:36:35.169,0:36:37.889
they'll lose blood
0:36:37.889,0:36:39.064
this is all borrow
0:36:39.064,0:36:41.989
three feet from the ins_
0:36:41.989,0:36:46.449
colin goes up here cross here down here[br]there's a little blue goes out
0:36:46.449,0:36:49.639
in the fact is five times the blood
0:36:49.639,0:36:54.729
goes from there to meet a nice it's no[br]longer rat its black
0:36:54.729,0:36:58.979
the patient will be passing schools that[br]i mean if he's losing enough blood
0:36:58.979,0:37:00.679
we passing stools
0:37:00.679,0:37:02.033
that perhaps look
0:37:02.033,0:37:04.008
tari that's the efforts that given to[br]them
0:37:04.008,0:37:07.063
something we called mellon up learn[br]ad-aware
0:37:07.063,0:37:12.939
you don't know if mel_ dna_ means[br]blackberry stole
0:37:12.939,0:37:14.739
and patience will comment
0:37:14.739,0:37:17.073
and a couple of ways with this they may[br]say
0:37:17.073,0:37:21.014
if their particular instrument look in[br]the bolded for a flash
0:37:21.014,0:37:23.049
uh... dr
0:37:23.049,0:37:25.309
harry schools was wrong
0:37:25.309,0:37:29.069
more unlikely in this is something you[br]must always remember middle-aged or
0:37:29.069,0:37:31.169
elderly patient comes an incentive
0:37:31.169,0:37:33.409
i'm just proved all the time
0:37:33.409,0:37:37.499
you know describes being he's easily[br]fatigued and weak and so forth you take
0:37:37.499,0:37:39.064
a look and they were kind of payal
0:37:39.064,0:37:41.229
are you doing a glowing
0:37:41.229,0:37:43.509
you find it terribly anemic
0:37:43.509,0:37:44.399
it's from chronic
0:37:44.399,0:37:48.042
i called blood loss like this
0:37:48.042,0:37:54.159
climate chances on the right side in the[br]korea's
0:37:54.159,0:37:55.679
jess's all through the colon
0:37:55.679,0:37:59.199
uh... this is one very closely nis
0:37:59.199,0:38:02.003
wishes in circles the whole by all[br]around
0:38:02.003,0:38:04.189
like a napkin rings
0:38:04.189,0:38:08.559
you know who actually produce narrowing[br]below min obviously is infiltrated the
0:38:08.559,0:38:13.119
muscle of the wall that would produce a[br]change in bal habits
0:38:13.119,0:38:15.829
it will produce frank
0:38:15.829,0:38:20.249
in the schools is close enough to the[br]unicef if it bleeds can come out blood
0:38:20.249,0:38:21.799
that's referred to
0:38:21.799,0:38:23.569
he met okie xia
0:38:23.569,0:38:25.749
ichi ohmae tito
0:38:25.749,0:38:30.739
cdh_ lindsayolives came at a meaning[br]blood his ears a wonderful greek word
0:38:30.739,0:38:33.004
for me to go potty
0:38:33.004,0:38:36.099
over
0:38:36.099,0:38:39.339
the american uses frank blood
0:38:39.339,0:38:41.879
unit in the school which may be that in
0:38:41.879,0:38:45.709
again people deny this is a law that[br]hemorrhoids and thereby preparation h
0:38:45.709,0:38:48.319
and stick it up there for
0:38:48.319,0:38:51.099
however long before they finally come in
0:38:51.099,0:38:55.339
the important thing is is will also[br]point out this afternoon is be the
0:38:55.339,0:39:00.069
survival of the prognosis is stage[br]related
0:39:00.069,0:39:03.829
farzad penetrate through the ball wall[br]is it in the regional lymph nodes and so
0:39:03.829,0:39:04.509
forth
0:39:04.509,0:39:08.299
uh... these are the important factors
0:39:08.299,0:39:09.021
all right
0:39:09.021,0:39:11.149
couple of smokers things
0:39:11.149,0:39:14.729
you can see about fifty packages of
0:39:14.729,0:39:17.139
and that long
0:39:17.139,0:39:20.329
here is a massive obstructing
0:39:20.329,0:39:24.089
bronchus here this is the dilated[br]bronchus
0:39:24.089,0:39:25.006
and full of
0:39:25.006,0:39:28.719
newco kurland exudate
0:39:28.719,0:39:30.066
that's the tumor right there
0:39:30.066,0:39:32.449
and this patient presented
0:39:32.449,0:39:35.409
or we probably had a cough but all[br]smoker's cough
0:39:35.409,0:39:38.299
uh... presented with repeated pneumonia
0:39:38.299,0:39:39.949
kept coming with episodes of pneumonia
0:39:39.949,0:39:42.289
who's always in the same place
0:39:42.289,0:39:45.659
and they finally tumbled to the fact[br]that we always have obstruct must have
0:39:45.659,0:39:47.299
obstructive lesion there
0:39:47.299,0:39:49.489
and there it was
0:39:49.489,0:39:50.088
not leave
0:39:50.088,0:39:55.079
bronchus is line by a glandular type of[br]epithelium so there are adamo carcinomas
0:39:55.079,0:39:58.609
and one
0:39:58.609,0:40:02.879
notoriously there can be metalplaza xia[br]of the broncos that goes on to display
0:40:02.879,0:40:07.679
not only not a place of the displays[br]human cancer and many of these parts qua
0:40:07.679,0:40:09.019
must sell
0:40:09.019,0:40:10.669
carcinomas
0:40:10.669,0:40:13.053
so there is a relatively small one that[br]produced
0:40:13.053,0:40:14.044
repeated bouts
0:40:14.044,0:40:16.039
of pneumonia
0:40:16.039,0:40:19.019
there's a larger one just to show you[br]what they could look like when they
0:40:19.019,0:40:21.079
really get out of hand
0:40:21.079,0:40:22.549
here's an interesting one
0:40:22.549,0:40:27.019
uh... close up here trachea coming down[br]here bronchus hier bronchus here you see
0:40:27.019,0:40:28.042
this little thing
0:40:28.042,0:40:29.007
this was a
0:40:29.007,0:40:31.509
sway with cell carcinoma
0:40:31.509,0:40:33.052
and you say well why didn't they
0:40:33.052,0:40:37.859
uh... simply doing norman actually take[br]off the bronchus here you can live with
0:40:37.859,0:40:40.309
one long
0:40:40.309,0:40:43.109
doing it right here this is an autopsy[br]specimens
0:40:43.109,0:40:44.051
and actually this
0:40:44.051,0:40:47.046
thing that looks small here had gone[br]through
0:40:47.046,0:40:49.089
the back of the bronchus
0:40:49.089,0:40:52.909
this is all neoplasm kind of in case the[br]heartbeat was
0:40:52.909,0:40:56.000
hopeless from from from the get go[br]swimmin cell
0:40:56.000,0:40:58.809
carcinoma
0:40:58.809,0:41:02.093
sestalo market was the benign one of my[br]smooth surfaces
0:41:02.093,0:41:05.279
inside this this will line when i see[br]you
0:41:05.279,0:41:06.819
had a feeling of
0:41:06.819,0:41:12.008
here's the malignant counterpart you can[br]see the steiner's than other ovarian
0:41:12.008,0:41:13.179
neoplasm
0:41:13.179,0:41:17.109
it's mulligan and so we call it sister i[br]don't know
0:41:17.109,0:41:18.059
carcinoma
0:41:18.059,0:41:20.018
masses there than normal
0:41:20.018,0:41:22.009
disassemble carcinoma
0:41:22.009,0:41:26.067
the thing and then would immediately[br]took us to say this isn't just a simple
0:41:26.067,0:41:27.039
system nama
0:41:27.039,0:41:30.071
is a surface is no longer smooth like[br]this everywhere
0:41:30.071,0:41:31.969
this guy
0:41:31.969,0:41:33.949
very furry looking growth
0:41:33.949,0:41:36.829
all over the surface
0:41:36.829,0:41:42.339
and the bubbles inside ourselves
0:41:42.339,0:41:44.349
neoplasm growing from the lining of the[br]trouble
0:41:44.349,0:41:47.074
in other words the many of you can see[br]some bubbles so there are some cystic
0:41:47.074,0:41:48.061
spaces
0:41:48.061,0:41:53.759
but many of the previously cystic spaces[br]are filled with his rapidly growing
0:41:53.759,0:41:54.479
neoplasm
0:41:54.479,0:41:57.021
so this is sister adamo
0:41:57.021,0:41:59.109
carcinoma
0:41:59.109,0:42:04.239
i don't have an illustration of it but[br]you can imagine papillary tumor
0:42:04.239,0:42:07.659
being eight papillary carcinoma greta[br]papilloma
0:42:07.659,0:42:11.559
or papillary carcinoma
0:42:11.559,0:42:14.043
so learn to to handle
0:42:14.043,0:42:16.092
these uh... the moment but sure here
0:42:16.092,0:42:22.249
as i say quite quite played by reflex
0:42:22.249,0:42:23.014
let's switch
0:42:23.014,0:42:37.299
away from apathy leo
0:42:37.299,0:42:39.014
uh...
0:42:39.014,0:42:40.319
this along
0:42:40.319,0:42:45.068
answer to that but al stroke by a long[br]beard and say thanks a lot of experience
0:42:45.068,0:42:48.409
under the microscope you would see not[br]only
0:42:48.409,0:42:51.469
growth of these fingers but you see[br]invasion
0:42:51.469,0:42:53.759
you'd also see more panoply here
0:42:53.759,0:42:56.709
in you know psychologically it's a[br]combination of things but that's a
0:42:56.709,0:42:58.509
that's a very good point
0:42:58.509,0:43:01.063
and sometimes it's and it's a devilish[br]problem i see a lot of
0:43:01.063,0:43:04.099
stuff growing out we've gotta make[br]multiple sections and see if any of its
0:43:04.099,0:43:07.229
invading
0:43:07.229,0:43:09.579
now getting away from
0:43:09.579,0:43:11.199
as helium
0:43:11.199,0:43:13.079
getting too nice a little dish is what[br]we call
0:43:13.079,0:43:18.709
a supporting tissue or missing coble[br]tissues
0:43:18.709,0:43:19.869
fibrous tissue
0:43:19.869,0:43:23.014
smooth muscles column also bone[br]cartilage those of the things we're
0:43:23.014,0:43:25.069
talking about
0:43:25.069,0:43:28.769
but when i got your becomes easy if you[br]know a little and then great
0:43:28.769,0:43:30.064
if you have a
0:43:30.064,0:43:35.999
benign tumor of fatty tissue adipose[br]tissue recall well-lit
0:43:35.999,0:43:37.004
wal-mart
0:43:37.004,0:43:39.004
like mama
0:43:39.004,0:43:42.659
benign neoplasm carl agin this tissue
0:43:42.659,0:43:44.949
kong drama
0:43:44.949,0:43:47.046
the minute plasma fibrous tissue
0:43:47.046,0:43:50.079
five romana etcetera etcetera
0:43:50.079,0:43:52.369
thursday after the latin and greek
0:43:52.369,0:43:57.149
the system here is if it's malignancy
0:43:57.149,0:43:59.939
milkar carcinoma because that's that's[br]really all
0:43:59.939,0:44:04.047
if it's malignant an album as likable as[br]supporting tissue which holidays
0:44:04.047,0:44:06.049
star
0:44:06.049,0:44:07.056
you've all heard these words
0:44:07.056,0:44:11.799
but now you have to be used in precisely
0:44:11.799,0:44:16.014
malignant neoplasm a fatty tissue is a[br]light posts are calm
0:44:16.014,0:44:18.899
in malignant neoplasm of
0:44:18.899,0:44:20.067
carl edge in this issue is that
0:44:20.067,0:44:22.259
conroe sarcoma
0:44:22.259,0:44:25.109
and so forth
0:44:25.109,0:44:28.749
the interesting thing about these is[br]there not organ specific as many organs
0:44:28.749,0:44:31.769
have smooth muscle in the wall many[br]organs have
0:44:31.769,0:44:32.096
cartilage
0:44:32.096,0:44:35.609
many places in the body have owned
0:44:35.609,0:44:39.109
many uh... everything in the body[br]practice fibrous tissue so you can see
0:44:39.109,0:44:40.339
these tumors
0:44:40.339,0:44:43.369
arising in a variety of places
0:44:43.369,0:44:46.149
hears a strange one
0:44:46.149,0:44:49.659
incidental autopsy findings guide that[br]is something completely different had no
0:44:49.659,0:44:53.629
gi problems this is a little piece of[br]coal have opened it up here
0:44:53.629,0:44:55.289
mucous membrane hearing here
0:44:55.289,0:44:59.239
and you look at that you say that a lot[br]of it
0:44:59.239,0:45:01.149
fatty tissue
0:45:01.149,0:45:04.909
buffer size only to turn on a big golf[br]ball onset
0:45:04.909,0:45:06.026
uh...
0:45:06.026,0:45:09.098
histologically that was perfectly well[br]differentiated i couldn't tell it from
0:45:09.098,0:45:14.019
normal facile in the center of that big[br]glob of
0:45:14.019,0:45:17.999
adipose tissue that's a light palm up
0:45:17.999,0:45:20.979
they do a currently
0:45:20.979,0:45:22.094
their coats of the uh...
0:45:22.094,0:45:28.017
of the bal but it's quite rare where do[br]you suppose locals were coming
0:45:28.017,0:45:30.169
well where there's a lot of fatty tissue
0:45:30.169,0:45:33.629
very common subcutaneously there may be[br]some like homelessness room like a
0:45:33.629,0:45:36.038
chilly at least one
0:45:36.038,0:45:39.469
they're they're not at all on common and[br]they're they're perfectly
0:45:39.469,0:45:41.199
but revealing holiness
0:45:41.199,0:45:44.579
they harbor didn't produce any symptoms
0:45:44.579,0:45:46.083
alright nearest here's a uterus
0:45:46.083,0:45:50.999
and each one of these is what you would[br]call a fibroid
0:45:50.999,0:45:54.015
but now i will give you the correct[br]nomenclature
0:45:54.015,0:45:59.044
these tumors are benign air rising from[br]the muscle of the uterus so they are my
0:45:59.044,0:46:00.088
yo mas
0:46:00.088,0:46:02.829
and wyoming muscle
0:46:02.829,0:46:06.369
and because the particular kind of[br]muscle which you learn about his smooth
0:46:06.369,0:46:06.919
muscle
0:46:06.919,0:46:08.059
this is a
0:46:08.059,0:46:09.589
lower these are multiple
0:46:09.589,0:46:14.279
lightly or my omens
0:46:14.279,0:46:15.044
none of my culture
0:46:15.044,0:46:20.129
these can produce a variety of[br]mechanical systems hyper memory a
0:46:20.129,0:46:24.259
the big bowl compelled us as you[br]mentioned and some of the many a
0:46:24.259,0:46:25.779
marriage symptomatic
0:46:25.779,0:46:28.989
even at this size believe it or not
0:46:28.989,0:46:30.749
here is a
0:46:30.749,0:46:33.017
malignancy moment
0:46:33.017,0:46:34.349
uh...
0:46:34.349,0:46:36.013
here's the x_-ray even see
0:46:36.013,0:46:39.046
this is what the bone should look like[br]it's very dense in here is obviously
0:46:39.046,0:46:41.239
more bone being made
0:46:41.239,0:46:44.979
the outer membrane a perry asked him[br]about has been lifted
0:46:44.979,0:46:48.039
by something pushing out in here it is
0:46:48.039,0:46:51.369
here's the bone here is the bone for me[br]to more here
0:46:51.369,0:46:53.041
has broken through the cortex
0:46:53.041,0:46:57.689
news out into the soft tissues so this[br]is a sarcoma
0:46:57.689,0:46:58.709
osteo
0:46:58.709,0:46:59.088
sarcoma
0:46:59.088,0:47:02.009
this is by a large a tumor just
0:47:02.009,0:47:04.009
in passing of
0:47:04.009,0:47:07.049
growing bones teenage kids young adults
0:47:07.049,0:47:11.579
uh... a highly malignant intent in the[br]past size early on
0:47:11.579,0:47:14.529
cut to the longest
0:47:14.529,0:47:19.559
nothing is immune here is a tumor rising[br]in the soft-tissue beside harry fleshy
0:47:19.559,0:47:21.009
looking
0:47:21.009,0:47:26.022
is derived from scalable muscle mild[br]sarcoma but this time it isn't wyo
0:47:26.022,0:47:27.929
it's rad though
0:47:27.929,0:47:32.369
yo-yo learn these details but you should[br]be able look at bay a name like that and
0:47:32.369,0:47:33.029
say hello
0:47:33.029,0:47:41.599
this is a supporting vision neoplasm[br]some sort
0:47:41.599,0:47:42.929
classes are common
0:47:42.929,0:47:46.219
well i'll again it's a long answer to[br]that these days and then when i started
0:47:46.219,0:47:48.859
out all you could lose amputated hope[br]for the best
0:47:48.859,0:47:53.259
now other forms of chemotherapy and[br]partial resection of the bone with it
0:47:53.259,0:47:56.499
with insertion of other bone and so[br]forth a lot of
0:47:56.499,0:47:58.329
nice fancy things they could do now
0:47:58.329,0:48:01.539
so it's nowhere near as does move that[br]used to be a bit upset this is a highly
0:48:01.539,0:48:04.489
aggressive tumor
0:48:04.489,0:48:07.729
friday quickly now
0:48:07.729,0:48:08.749
another
0:48:08.749,0:48:12.939
crying of neoplasm we talk about[br]epithelial tissue we talk about
0:48:12.939,0:48:14.739
supporting on his ankle both issues
0:48:14.739,0:48:16.479
there are
0:48:16.479,0:48:20.509
neoplasms of the lymphoid tissues and[br]the invite him out of poetic i mean
0:48:20.509,0:48:22.109
blood forming
0:48:22.109,0:48:23.013
tissues
0:48:23.013,0:48:26.089
there are uh... neoplasms of these
0:48:26.089,0:48:31.679
and here is where you get into some sort[br]of a key terminology
0:48:31.679,0:48:36.469
neoplasms of the lymphoid tissues are[br]referred to as lymphomas
0:48:36.469,0:48:38.859
and you would say well that sounds[br]benign
0:48:38.859,0:48:40.309
there's not nice
0:48:40.309,0:48:42.319
behind me a plasma lymphocytes
0:48:42.319,0:48:46.409
faso there's no such thing as a good[br]nine lymphoma
0:48:46.409,0:48:48.014
we don't recognize them
0:48:48.014,0:48:50.059
if there are we don't recognize them
0:48:50.059,0:48:53.015
so when you hear the word lymphoma[br]despite
0:48:53.015,0:48:54.041
what it sounds like
0:48:54.041,0:49:00.038
that's a malignant neoplasm of lymphoid[br]tissue
0:49:00.038,0:49:04.609
similarly well i'll get to this but[br]leukemia refers to any any situation
0:49:04.609,0:49:05.229
really
0:49:05.229,0:49:09.979
where the malignant cells in the usually[br]blood forming cells
0:49:09.979,0:49:12.088
on mass in the circulation
0:49:12.088,0:49:16.299
refer to that is leukemia white blood
0:49:16.299,0:49:18.469
the old german was vices looked
0:49:18.469,0:49:21.859
there was described by them farmers
0:49:21.859,0:49:23.359
interesting they may present
0:49:23.359,0:49:27.014
as seemingly localized tumors with some[br]local spread
0:49:27.014,0:49:30.769
but because lymphocytes there there's[br]lymphoid tissue all of the body
0:49:30.769,0:49:34.079
and lymphocytes you'll learn move around[br]the body
0:49:34.079,0:49:37.005
lymphomas frequently present as systemic[br]diseases
0:49:37.005,0:49:39.149
rather than localized
0:49:39.149,0:49:41.569
sometimes localize it very often
0:49:41.569,0:49:42.099
systemic
0:49:42.099,0:49:43.839
this man came in
0:49:43.839,0:49:46.109
this is an old old photograph
0:49:46.109,0:49:49.023
and you see general swelling in his neck[br]here
0:49:49.023,0:49:53.075
you can see here's his classical he's[br]got a super cobra killer mode there
0:49:53.075,0:49:56.489
similar supercritical in though there
0:49:56.489,0:49:58.689
he noticed those but his armpits
0:49:58.689,0:50:03.043
were full of enlarged lymph nodes by[br]chest x_-ray has me this time was
0:50:03.043,0:50:07.269
widened and full of lymph nodes his[br]abdomen was full of enlargement bones he
0:50:07.269,0:50:07.078
presented
0:50:07.078,0:50:10.409
with a systemic disease
0:50:10.409,0:50:11.098
this was a a
0:50:11.098,0:50:14.189
widely disseminated lymphoma
0:50:14.189,0:50:15.022
lymphoma can
0:50:15.022,0:50:18.019
dennis like too many different
0:50:18.019,0:50:19.529
lymphoid tissues in the body
0:50:19.529,0:50:22.008
this is the rapture para commanders a[br]kidney kidney
0:50:22.008,0:50:24.088
knows you behind a really happening
0:50:24.088,0:50:26.067
this is a mass
0:50:26.067,0:50:29.109
of lymph nodes enlarge they should be
0:50:29.109,0:50:32.339
uh... at the most p size and these are[br]very big
0:50:32.339,0:50:36.649
lymph nodes all matted together this was[br]malignant lymphoma
0:50:36.649,0:50:38.439
dimeric preparing him
0:50:38.439,0:50:40.189
spleen
0:50:40.189,0:50:42.119
started
0:50:42.119,0:50:45.559
manuals of malignant lymphocytes if you[br]will
0:50:45.559,0:50:47.008
one former swings
0:50:47.008,0:50:50.759
even the kidneys any organ can be[br]infiltrated
0:50:50.759,0:50:53.349
lymphoma cells
0:50:53.349,0:50:55.209
and sometimes the marrow
0:50:55.209,0:50:57.639
the bone marrow is overrun
0:50:57.639,0:51:01.679
and the malignant lymphocytes spill in[br]great numbers into the bloodstream and
0:51:01.679,0:51:07.189
you have a lymphocytic form of leukemia
0:51:07.189,0:51:09.269
generically leukemia
0:51:09.269,0:51:13.017
re first to be the presence of
0:51:13.017,0:51:16.065
malignant he mad about whether to remove[br]what elements in circulation
0:51:16.065,0:51:20.619
so we see other forms of leukemia where[br]the merrill just a bone marrow itself
0:51:20.619,0:51:21.889
has gone bad
0:51:21.889,0:51:25.409
can you see malignant precursors of
0:51:25.409,0:51:26.599
leukocytes
0:51:26.599,0:51:30.054
possibly red cells and little bit more[br]rarely or even even platelets so
0:51:30.054,0:51:34.078
this morning so you know the marrow[br]tissue is circulating widely circulated
0:51:34.078,0:51:39.689
malignant cells infiltration of organs[br]and so forth
0:51:39.689,0:51:41.859
register wrap it up
0:51:41.859,0:51:46.119
make the point of no tissue and the[br]body's immune from
0:51:46.119,0:51:49.569
neoplasm even see it in the central[br]nervous system
0:51:49.569,0:51:52.809
please see the neoplasms of the[br]coverings of the brain the so-called
0:51:52.809,0:51:54.013
minmin geez
0:51:54.013,0:51:57.709
and typically eminem geo money is benign
0:51:57.709,0:51:59.809
has thrown his activities was
0:51:59.809,0:52:01.659
the uh...
0:52:01.659,0:52:04.529
no my culture is strange again
0:52:04.529,0:52:05.009
glioma
0:52:05.009,0:52:10.000
is actually uh... you neoplasm arising[br]in the brain tissue from the supporting
0:52:10.000,0:52:12.369
cells called glial cells
0:52:12.369,0:52:15.699
now has told a man in juneau alaska nine
0:52:15.699,0:52:18.019
we almost sounds benign
0:52:18.019,0:52:20.089
they're just varying degrees of[br]malignancy
0:52:20.089,0:52:23.079
they're all bad
0:52:23.079,0:52:26.009
and i'll show you why they're bad here's[br]a brain with the glioma
0:52:26.009,0:52:28.969
is a normal side of the brain
0:52:28.969,0:52:32.679
and at first glance into well you know[br]you might see some things out but
0:52:32.679,0:52:33.339
basically
0:52:33.339,0:52:34.709
this is all
0:52:34.709,0:52:35.889
we all month
0:52:35.889,0:52:40.119
and it's very hard to describe where it[br]stops this infiltrates
0:52:40.119,0:52:41.021
diffuse lee
0:52:41.021,0:52:44.499
numerically almost sells way out here in[br]here in here
0:52:44.499,0:52:46.009
is just
0:52:46.009,0:52:50.379
so orderly diffuse that it's very[br]difficult to handle
0:52:50.379,0:52:51.599
the uh...
0:52:51.599,0:52:54.209
well differentiated low-grade
0:52:54.209,0:52:58.599
gliomas last a little longer patient[br]lasts a little longer the high-grade
0:52:58.599,0:53:01.339
generally don't do so well with some
0:53:01.339,0:53:02.939
promising interventions
0:53:02.939,0:53:05.339
this is a sort of thing that senator
0:53:05.339,0:53:07.389
noticed any
0:53:07.389,0:53:10.579
only looked good the other night so
0:53:10.579,0:53:13.007
yahoo and i think that uh... that[br]central nervous system
0:53:13.007,0:53:15.559
then finally
0:53:15.559,0:53:17.079
uh...
0:53:17.079,0:53:20.129
there
0:53:20.129,0:53:21.629
next time to talk with us
0:53:21.629,0:53:24.069
these are these are before like an[br]interesting
0:53:24.069,0:53:27.309
you can afterwards where you got a[br]couple of different kinds of
0:53:27.309,0:53:28.319
differentiation
0:53:28.319,0:53:29.099
for instance we may see
0:53:29.099,0:53:31.199
uh...
0:53:31.199,0:53:34.849
roscommon salivary gland to where where[br]you see glandular elements proliferating
0:53:34.849,0:53:36.709
and cartilage
0:53:36.709,0:53:38.019
of all things
0:53:38.019,0:53:40.519
and those are referred to as mixed[br]tumors
0:53:40.519,0:53:43.599
of salivary gland or more often now we[br]call them
0:53:43.599,0:53:46.179
cleo morrissette and almost
0:53:46.179,0:53:48.359
meaning a mixed form
0:53:48.359,0:53:48.999
adenoma
0:53:48.999,0:53:52.829
they're such things as fight broke up[br]enormous
0:53:52.829,0:53:56.249
perfectly benign fibrous and granular
0:53:56.249,0:53:59.929
mumbling inside there's such things as
0:53:59.929,0:54:02.409
carson or sarcomas
0:54:02.409,0:54:05.789
through passive differentiation
0:54:05.789,0:54:07.999
apathy little glandular
0:54:07.999,0:54:11.039
any appeal in supporting both both[br]malignant
0:54:11.039,0:54:12.043
the odds are right here
0:54:12.043,0:54:14.031
as it is a really
0:54:14.031,0:54:20.014
mixed kind of tumor that arises from[br]totally potential sales
0:54:20.014,0:54:25.001
and in these tumors are the rumors of[br]all of the embryonic journalists
0:54:25.001,0:54:26.065
criticism mara was saying
0:54:26.065,0:54:28.789
as you've predicted arise
0:54:28.789,0:54:31.299
mostly in gold ads
0:54:31.299,0:54:35.929
but uh... also another two should have[br]seen in the media steinem i've seen them
0:54:35.929,0:54:37.779
in uh... the throat
0:54:37.779,0:54:39.449
but mostly gone mad or
0:54:39.449,0:54:41.479
the yeah
0:54:41.479,0:54:45.055
bad news for the guys is most testicular[br]terra com is a malignant
0:54:45.055,0:54:46.729
highly malignant
0:54:46.729,0:54:51.329
good news for the women is a very[br]intercom asar almost invariably benign
0:54:51.329,0:54:55.459
they're not uncommon there in your age[br]group usually an incidental finding but
0:54:55.459,0:55:00.359
they're endlessly fascinating and allen[br]by showing you a couple
0:55:00.359,0:55:02.009
there's a terra com of the ovary
0:55:02.009,0:55:06.279
i've cut the over his size of tennis[br]ball it should have a surface like that
0:55:06.279,0:55:12.859
i kind of open along the whole blonde[br]hair
0:55:12.859,0:55:16.819
looking at his ovary under the[br]microscope it had not only hair
0:55:16.819,0:55:21.309
follicles but it has construction sweat[br]glands today shes clams
0:55:21.309,0:55:23.239
it had cartilage
0:55:23.239,0:55:25.039
bronchial lining
0:55:25.039,0:55:27.799
it had something to look like i just[br]subtract
0:55:27.799,0:55:30.819
and even had some brain tissue
0:55:30.819,0:55:33.909
weenies irwin marvelous mixtures
0:55:33.909,0:55:37.779
amal solicit perfectly benign and when[br]we get one of the operating room
0:55:37.779,0:55:42.959
neighboring it goes we cuddle we see[br]here we say
0:55:42.959,0:55:47.469
for some reason in the ovarian tumors[br]most often it line by skin like
0:55:47.469,0:55:50.099
structures and sometimes called the[br]ramones
0:55:50.099,0:55:53.089
but they do usually got a great mixture[br]of stuff
0:55:53.089,0:55:55.729
here's another one what do you suppose[br]this was
0:55:55.729,0:56:00.019
for these were
0:56:00.019,0:56:03.099
that showed up as calcification mommy
0:56:03.099,0:56:05.489
public phil
0:56:05.489,0:56:06.429
and then
0:56:06.429,0:56:11.569
glass one i'm absolutely quitters might[br]my favorite this came out of recovery
0:56:11.569,0:56:13.789
looks like a chain with
0:56:13.789,0:56:15.033
five o'clock shadow
0:56:15.033,0:56:16.066
the nice
0:56:16.066,0:56:18.989
dental arch there and so forth
0:56:18.989,0:56:20.001
well that's a
0:56:20.001,0:56:22.619
but i've done is basically teased you
0:56:22.619,0:56:24.669
into uh...
0:56:24.669,9:59:59.000
being interested non-college annual deal[br]with the rest of your life now