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zero waa

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resolved

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monday we'd

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uh... laid out for you

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many of the general concepts about meal
places

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and malignant

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and vote today

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uh... were a lot of them for the most
part of his finish up here in a

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direction the neoplasms

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fighting the look of a lack of once
topic

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pictures show

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of a variety of not a man woman and
stuff

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tumors so that you can appreciate the

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polyimide president clinton please

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attorneys are really

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and kind of the uh...

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broad array of things that can happen

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to give you an beginning him along the
lancaster neoplasms lasted goal for

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today

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as the florida

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begin until and i think we we are told

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asked that question

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so it doesn't get lost

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is ok we got all the cells

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benign or malignant

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what differences that make to the host
in other words what is the impact of

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bridge america is taking what is the
impact

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of uh...

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neoplasm anomalous

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this outline

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is a good way to go out at the

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let's take perfectly benign neoplasms
they're not

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invasive

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metastatic

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questionnaires

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raghavan i neoplasm what going to do the
host

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for most of the facts are going to be
local

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if you receive the cartoon that i sure
do

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it's just a next like an expanding
balloon locally in some areas

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then you would predict that

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there are the first thing at a benign
neoplasm lewis's produce some local

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mechanical effects

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now these very from trivial to lethal

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if you had a

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a marble sized

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benign neoplasm one-year love handles
here

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there'd be a couple of you in the world
i would know about it

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maybe two more than that but

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ferrier area where it would be trivial

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uh... i and the other hand it could be
other cosmetic importance you wouldn't

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want to benign neoplasms sizable walnut
than the tip of your nose

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biologically not terribly threatening
but uh...

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bad anyway

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uh...

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i mentioned result

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this is something to keep your eye and
you can buy of a benign neoplasm sounds

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like a black see more

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but think of an expanding the nine-year
plasma confines of the cranial

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there's no room in there

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as it starts growing as consumers

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related press on something vital in the
brain and you could produce if it's not

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interrupted could produce death

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so benign neoplasms can kill generally

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by something going on

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mechanically

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ka

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nine-year plasmids

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as it's expanding locally again you
think just about cartoon

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it's going to press on adjacent
structures

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as it expands in that made the strongly

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adjacent structures just by sitting on
it

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knock off the function of over one
tissue or another selection b

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uh... quite significant and that's all

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based on our

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adjust the expansion of the benign
neoplasm

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now i have mentioned local complications
here

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these are sort of

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secondary things that may occur and they
may be very important

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a benign neoplasm growing under a
surface may expand to the point where

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the surface all straight silver

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then there may be hemorrhage

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could be trivial could really thought
that they could be hemorrhage from such

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an australian area

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or there might be infection

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these are sort of secondary

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uh... complications of of the local
mechanical situation

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uh... or the other thing is the

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uh... benign you pleasant unplug the
plumbing

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so the wall of a doctor pressing on a
vessel or something of that sort it can

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produce obstruction is very significant

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these are all sort of local effects

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there's one x sort of exception to this
and i've listed systemic and the crying

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effects

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their runs something like this

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you had a good remember i told you the
benign neoplasms are

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almost invariably very well
differentiated

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mhm means they resemble a parental
tissue

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you have a benign neoplasms arising from
an end to the crime that is from the

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hormone

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secreting tissue

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it may well be so well differentiated
that it mimics the adult issued by

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secreting

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a particular hormone

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that ordinarily comes from that issue

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the difference though is

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being autonomous

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and out of control of the body

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this tumor will produce gobs of that
hormone

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and then the patient may present

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little really tiny tumor somewhere may
present

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tremendous number of signs and symptoms
due in excess of a particular hormone

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so in that regard even a local benign
neoplasm could produce

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systemic

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and the crime effects

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now

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when we go over to the to the other side
and we say what to malignant neoplasms

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do

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the first answer is very loudly all of
the above

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except now

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instead of just

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serb pressing the adjacent tissue
malignant neoplasm which is cable

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invasion can

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can destroy the reputation by invading n

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and compress it can can violate ducks
and other structures by invading

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many malignant neoplasms grow much more
rapidly this is not rulebook grow more

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rapidly than benign ones

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so it really does

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all of the above with a vengeance

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and also any given much castesystem
there could be dozens or hundreds of the

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past the seized in any given the task
forces can raise

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local health

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wherever it happens to be

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so you can see that ah...

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that all of the above is where the real

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exclamation point

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um...

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and crime

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cancers

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can also secrete excess hormone just
like the nine and the crime

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so any of those things

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that are listed up here you can see

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now there is there a couple of other
things uh...

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unless i want to go understandably said
a conceptual level

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that uh...

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malignant neoplasms may be associated
with some very very significant systemic

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changes

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and uh... one of them that you may be
familiar with from

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for milliliter answer or friends of
friends of friends

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these are the

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buff

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twinkly cancer patients

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will answer phase of disease

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where they lose their appetites

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we begin to lose weight

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the weight comes highly awesome

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and they get weaker and weaker and
weaker and just

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do windows

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and very often

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so we could their beds have some in the
final event in their lives is nemo near

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which overtakes typically will only take
a belfast patient like that

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we refer to their way sort of wasting
syndrome

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as cake x_-ers

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there's the spelling for it

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as a general term but here we're talking
about cancer coq xy and other words are

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talking about a patient becoming a
nation and wasted because of the cancer

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being there

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when i was a kid in pathologies that
teach that this is simply a caloric

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matter we had a rapidly growing tumor
which isn't enough calories competing

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with the host the host lost appetite
along the way

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and that was that

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we just lost weight on behalf of the
jury

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we now know that that's the only a small
part of the story

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how this is a rather complex business
related and i would lead to a cytochrome

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site a kind secretion on the part of the

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as a gross

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but be aware that very often in patients
with cancer you see this as syndrome of

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cake axia

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there are

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also in this is an important general
concept that i want to get lost in the

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specifics but there are other

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symptom complex is that is a syndromes

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in patients with cancer

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that you cannot explain

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uh... by local effects

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mechanical effects

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that you can't that they're not
explainable on the basis of a

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predictable and the crying secretion in
other words it's not that this is a

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cancer that's

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we know is making insulin and therefore
beginning insulin sometimes it's not

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that

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uh...

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we find some very weird

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syndromes affecting a variety of organ
systems

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that are june should be

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presence of the cancer's not
mechanically but the president cancer in

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the body and these are referred to is

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para neil plastic syndromes

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and i want you to to get an idea that
concept not the details of the various

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syndromes

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they're important because first of all
they may be a greater problem to the

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patient

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than the mechanical aspect of the tumor
itself

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and another thing is that the patient
may present

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the manifestations of a particular
perinatal plastic syndrome

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at the time the cancer is still are cold

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behooves you to be able to recognize
that all my goodness this mixture

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symptoms may mean

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getty just a couple of examples along
with the rest of your skimming reading

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don't try to memorize any of this stuff
but one economist

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uh...

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para neoplastic syndromes is hyper cal
senior elevation in blood

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calcium

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you might think if you think he
mechanically think well cancer spreading

214
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to the bone will destroy both liberate
calcium

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00:10:06,018 --> 00:10:07,005
that happens

216
00:10:07,005 --> 00:10:11,004
that's not apparently plastics into
lesson mechanical thanks

217
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but some tumors will secreted
parathyroid like hormone

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in other words are not related to
parathyroid glands of tumor of this

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error that

220
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but it's a create something that has a
paris i read hormone like activity in a

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race is the serum calcium

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that's not at all uncommon

223
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uh...

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other examples of parent neoplastic
syndromes are from

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what we call ext topic

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hormone production where particular
tumor

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is producing a hormone that has no
business coming from there we see for

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instance

229
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lung tumors

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that produce

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cortical trochmann and other ways that a
pituitary hormone that drives the

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adrenal gland

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this may produce all kinds of hell

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because it real is overactive because of
the that topic

235
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hormone production

236
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some tumors

237
00:11:07,026 --> 00:11:08,003
provoke

238
00:11:08,003 --> 00:11:11,027
hyper coagulate ability in other words
make the flood

239
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more likely to plop

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when the study that in december but

241
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suffice it to say i have seen patients
that present with

242
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delay saying collapsed

243
00:11:22,058 --> 00:11:26,033
not spontaneously as unusual ambulatory
patients with a comment

244
00:11:26,033 --> 00:11:28,095
uh... clocks in their leg means

245
00:11:28,095 --> 00:11:33,005
and after all the dust settles it turns
out they've got an internal cancer

246
00:11:33,005 --> 00:11:35,319
pancreatic cancer ovarian cancer

247
00:11:35,319 --> 00:11:37,039
what have you

248
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it's doing too

249
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pro quo ideal in substances associated
with the tumor

250
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now i'll

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drop-dead at this

252
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and i'd suggest that you take a look at
the uh... the appropriate pages in the

253
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book

254
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and just to see the variety apparently
isp neoplastic syndrome stop tryin

255
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memorized just be aware

256
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that general concept

257
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affair neoplastic syndrome

258
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part one more matter

259
00:12:06,064 --> 00:12:07,999
quick pictures show

260
00:12:07,999 --> 00:12:11,009
as a matter of moments sure

261
00:12:11,009 --> 00:12:15,063
neoplasms and i want to emphasize that
this is not a trivial matter it may seem

262
00:12:15,063 --> 00:12:18,054
trivial to you know namely tumor so what

263
00:12:18,054 --> 00:12:19,096
uh...

264
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this is very very important

265
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because

266
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um...

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if we

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name the tumor

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00:12:28,949 --> 00:12:30,083
precisely and accurately

270
00:12:30,083 --> 00:12:32,759
it transmits a lot of

271
00:12:32,759 --> 00:12:36,459
information i was away as you worry more
about on college if someone says it's

272
00:12:36,459 --> 00:12:38,056
such and such kind of tumor this'll

273
00:12:38,056 --> 00:12:42,034
bring up a a little rolodex card have a
whole bunch of information

274
00:12:42,034 --> 00:12:45,009
so it's important to be precise

275
00:12:45,009 --> 00:12:46,066
in the terminology

276
00:12:46,066 --> 00:12:51,269
and you've got to become familiar with
this has got to be just reflex with u

277
00:12:51,269 --> 00:12:53,025
you'll use it throughout your career

278
00:12:53,025 --> 00:12:56,066
in the time to learn is right now
because of the on your exam

279
00:12:56,066 --> 00:12:58,067
this weekend

280
00:12:58,067 --> 00:13:03,001
i'd promised you upstairs is that
important and look what i want to be

281
00:13:03,001 --> 00:13:06,011
able to do is take

282
00:13:06,011 --> 00:13:07,073
the description

283
00:13:07,073 --> 00:13:09,085
of a neoplasm

284
00:13:09,085 --> 00:13:14,279
and only new picture taken description
other and say okay with those elements

285
00:13:14,279 --> 00:13:18,015
this is exactly how i'm going to name it

286
00:13:18,015 --> 00:13:21,004
you've should be able to use after you
leave the room today

287
00:13:21,004 --> 00:13:22,041
but uh...

288
00:13:22,041 --> 00:13:26,049
certainly by this weekend and it's it's
very important to you throughout your

289
00:13:26,049 --> 00:13:28,006
career

290
00:13:28,006 --> 00:13:28,088
resilient

291
00:13:28,088 --> 00:13:33,007
table in your book i think that page two
seventy three of them are wrong

292
00:13:33,007 --> 00:13:37,062
that shows you benign this anomaly the
counterpart of the nine this animal

293
00:13:37,062 --> 00:13:39,000
wouldn't come apart and so forth

294
00:13:39,000 --> 00:13:42,038
i want to memorize that

295
00:13:42,038 --> 00:13:43,879
you know thirty seconds

296
00:13:43,879 --> 00:13:45,043
without doing that chart

297
00:13:45,043 --> 00:13:51,003
and it will give you an idea of how we
go about naming things

298
00:13:51,003 --> 00:13:51,073
basically

299
00:13:51,073 --> 00:13:54,033
it's it's not rocket science

300
00:13:54,033 --> 00:13:57,008
we name tumors on the on the basis of
two things

301
00:13:57,008 --> 00:13:59,009
the tissue are joan

302
00:13:59,009 --> 00:14:01,095
words benign or malignant

303
00:14:01,095 --> 00:14:03,096
in other words uh...

304
00:14:03,096 --> 00:14:07,034
try and looking at the neoplasm and
you'll be able to do this this coming

305
00:14:07,034 --> 00:14:08,086
spring

306
00:14:08,086 --> 00:14:10,054
you'll be able to decide

307
00:14:10,054 --> 00:14:12,085
its historic genesis white

308
00:14:12,085 --> 00:14:16,034
tissue is springs from

309
00:14:16,034 --> 00:14:18,097
an important part of the name

310
00:14:18,097 --> 00:14:22,048
you'll see is in just a moment

311
00:14:22,048 --> 00:14:27,008
depending on whether it's been nine or
malignant we tack on a different suffix

312
00:14:27,008 --> 00:14:29,078
in the kind of make a compound word

313
00:14:29,078 --> 00:14:31,099
transmits an awful lot of information

314
00:14:31,099 --> 00:14:33,094
so learn

315
00:14:33,094 --> 00:14:35,074
to do this

316
00:14:35,074 --> 00:14:38,027
now let's

317
00:14:38,027 --> 00:14:40,000
dive right in

318
00:14:40,000 --> 00:14:44,037
and and talk about first of all efforts
the lil neoplasm

319
00:14:44,037 --> 00:14:46,074
now the end of the net a c liam

320
00:14:46,074 --> 00:14:49,055
you have become very familiar with this
is a sort of tissue

321
00:14:49,055 --> 00:14:52,081
that covers a surface like the epidermis

322
00:14:52,081 --> 00:14:53,054
deadlines

323
00:14:53,054 --> 00:14:56,022
them out for the g<u>i</u> tract

324
00:14:56,022 --> 00:14:58,021
lines cavities

325
00:14:58,021 --> 00:14:59,569
by convention

326
00:14:59,569 --> 00:15:01,056
we considered

327
00:15:01,056 --> 00:15:04,099
liver tissue to be epithelium

328
00:15:04,099 --> 00:15:09,037
kenny tissue of the two meals in
particular to be to be at the funeral

329
00:15:09,037 --> 00:15:15,015
and so forth so we're talking about the
serial neoplasms

330
00:15:15,015 --> 00:15:18,058
the plot seconds a little bit

331
00:15:18,058 --> 00:15:21,074
different kinds of epithelia as you will
learn

332
00:15:21,074 --> 00:15:25,046
their glandular epithelium they're not
glandular epithelium there is something

333
00:15:25,046 --> 00:15:28,094
we call transitional epithelium etcetera

334
00:15:28,094 --> 00:15:30,039
don't worry about it

335
00:15:30,039 --> 00:15:34,024
but concentrate first-time glandular
epithelia

336
00:15:34,024 --> 00:15:37,036
in other words uh... this is these are
from structures

337
00:15:37,036 --> 00:15:38,089
we're talking about tumors

338
00:15:38,089 --> 00:15:44,048
that arise from epithelia lhs structures
that are glandular or to be more ductile

339
00:15:44,048 --> 00:15:47,074
those are those of the call glandular
type

340
00:15:47,074 --> 00:15:49,007
the rooms

341
00:15:49,007 --> 00:15:51,056
and unknown

342
00:15:51,056 --> 00:15:53,073
means gland

343
00:15:53,073 --> 00:15:56,032
and the suffix beaumont

344
00:15:56,032 --> 00:15:58,096
refers to uh... to amass

345
00:15:58,096 --> 00:16:03,088
and by convention if we have a benign

346
00:16:03,088 --> 00:16:04,005
neoplasm

347
00:16:04,005 --> 00:16:06,093
of glandular epithelium

348
00:16:06,093 --> 00:16:12,004
it is an adenoma

349
00:16:12,004 --> 00:16:15,067
that along transmits a lot of
information that says to your listener

350
00:16:15,067 --> 00:16:19,085
if his name something that no one says
well asap cereal

351
00:16:19,085 --> 00:16:22,419
it is in the connective tissue tumors in
the field

352
00:16:22,419 --> 00:16:27,046
and it's glandular and it's benign

353
00:16:27,046 --> 00:16:30,049
choice and adenomas

354
00:16:30,049 --> 00:16:31,047
this is uh...

355
00:16:31,047 --> 00:16:32,057
a cut

356
00:16:32,057 --> 00:16:34,041
through the adrenal gland

357
00:16:34,041 --> 00:16:38,069
managerial glance its deep enough at
above the kidney waiting here

358
00:16:38,069 --> 00:16:40,024
few inches in here

359
00:16:40,024 --> 00:16:42,051
it's about about that big

360
00:16:42,051 --> 00:16:43,027
normally

361
00:16:43,027 --> 00:16:45,089
not done here is cut through the adrenal
gland

362
00:16:45,089 --> 00:16:48,086
this is a cut through the normal plan

363
00:16:48,086 --> 00:16:50,043
the yellow

364
00:16:50,043 --> 00:16:52,075
part of the sandwiches the cortex

365
00:16:52,075 --> 00:16:55,053
that makes various steroid hormones

366
00:16:55,053 --> 00:16:56,097
and this is the mud all over

367
00:16:56,097 --> 00:16:59,005
that makes catecholamines

368
00:16:59,005 --> 00:17:00,076
i've got an effort and so forth

369
00:17:00,076 --> 00:17:02,094
right in that dark spot

370
00:17:02,094 --> 00:17:04,026
here we have

371
00:17:04,026 --> 00:17:06,035
india plaza

372
00:17:06,035 --> 00:17:11,065
first of all is very well circumscribed
just shout louder there

373
00:17:11,065 --> 00:17:14,037
clearance sale of probably benign
doesn't look invasive

374
00:17:14,037 --> 00:17:17,091
i can tell you that under the microscope
this was

375
00:17:17,091 --> 00:17:21,057
perfectly differentiating himself
herself all their arranged a little

376
00:17:21,057 --> 00:17:22,007
differently

377
00:17:22,007 --> 00:17:24,189
they look like the cells here

378
00:17:24,189 --> 00:17:27,839
you came to get a hint of that and that
it's the same a yellow

379
00:17:27,839 --> 00:17:29,031
sort of stuff

380
00:17:29,031 --> 00:17:30,093
comprising then at that

381
00:17:30,093 --> 00:17:33,052
of which this is made

382
00:17:33,052 --> 00:17:37,091
so this is an added no ma

383
00:17:37,091 --> 00:17:42,299
arising from the adrenal cortex so we
call it a bit and give it the whole in

384
00:17:42,299 --> 00:17:45,043
adrenal cortical adenoma

385
00:17:45,043 --> 00:17:46,065
now the question

386
00:17:46,065 --> 00:17:49,089
is well how did that patient coming in
this a doc

387
00:17:49,089 --> 00:17:51,004
i've got a

388
00:17:51,004 --> 00:17:53,799
walnut sized mass in my super arenal

389
00:17:53,799 --> 00:17:56,023
uh... fat pad

390
00:17:56,023 --> 00:17:59,053
then is obviously buried in there and
you know when you feel that

391
00:17:59,053 --> 00:18:00,094
uh...

392
00:18:00,094 --> 00:18:06,034
the way this presented was because it
was making an access of hormone

393
00:18:06,034 --> 00:18:10,051
knows this is a patient belonged to his
or her life

394
00:18:10,051 --> 00:18:14,041
developed a series of symptoms in this
particular case i can tell from looking

395
00:18:14,041 --> 00:18:16,044
at this and other history

396
00:18:16,044 --> 00:18:18,002
this tumor was making

397
00:18:18,002 --> 00:18:20,086
gobs and gobs of a vast room

398
00:18:20,086 --> 00:18:25,005
and the patient came in with i'd will
bore you with a bit of syndrome

399
00:18:25,005 --> 00:18:29,139
relating to blood pressure and changes
in certain cervelo delights and so forth

400
00:18:29,139 --> 00:18:31,029
and the

401
00:18:31,029 --> 00:18:32,094
smart physicians seven

402
00:18:32,094 --> 00:18:36,419
flipping see these things together
something is making too much

403
00:18:36,419 --> 00:18:39,023
oven adrenal cortical hormone

404
00:18:39,023 --> 00:18:41,082
simply a matter of imaging finding out
which side

405
00:18:41,082 --> 00:18:44,043
out icons and you got a cure

406
00:18:44,043 --> 00:18:48,011
because that's perfectly benign very
well differentiated

407
00:18:48,011 --> 00:18:49,036
here's one for you

408
00:18:49,036 --> 00:18:50,097
have to explain us a little bit like

409
00:18:50,097 --> 00:18:53,082
this is a pancreas has been sliced

410
00:18:53,082 --> 00:18:57,098
in the two has a look at matching this
is what the normal pancreas

411
00:18:57,098 --> 00:19:01,059
pancreas pratama looks like it's a lobby
local angular tissue

412
00:19:01,059 --> 00:19:04,027
and has a marble

413
00:19:04,027 --> 00:19:06,006
very well circumscribed marble

414
00:19:06,006 --> 00:19:07,087
in the middle of it

415
00:19:07,087 --> 00:19:09,047
this was benign

416
00:19:09,047 --> 00:19:13,013
can tell that by looking at exactly but
it's it's benign

417
00:19:13,013 --> 00:19:14,046
it arose

418
00:19:14,046 --> 00:19:19,003
from the island salon their hands

419
00:19:19,003 --> 00:19:20,046
with that in mind

420
00:19:20,046 --> 00:19:22,639
how do you suppose is patient presented

421
00:19:22,639 --> 00:19:26,889
again that's a that's a little marble
military christening lately in their

422
00:19:26,889 --> 00:19:31,007
representation presenter y

423
00:19:31,007 --> 00:19:33,051
removed

424
00:19:33,051 --> 00:19:35,043
hypoglycaemia

425
00:19:35,043 --> 00:19:39,017
another words that tumor was producing
insulin without regard

426
00:19:39,017 --> 00:19:41,064
to the needs of the body

427
00:19:41,064 --> 00:19:44,009
lose patience though there are
variations on this end of the basically

428
00:19:44,009 --> 00:19:47,073
if they did not just beaten

429
00:19:47,073 --> 00:19:52,002
insulin levels high and there's the
serum glucose goes down

430
00:19:52,002 --> 00:19:57,037
you get a variety of symptoms all the
way to convulsions and coma

431
00:19:57,037 --> 00:20:00,039
units that's the most dramatic part of
this and

432
00:20:00,039 --> 00:20:01,008
sexual

433
00:20:01,008 --> 00:20:03,809
has effected by removing

434
00:20:03,809 --> 00:20:06,023
sort of thing

435
00:20:06,023 --> 00:20:09,085
all right here's another sort of that no
one want to talk about this in detail

436
00:20:09,085 --> 00:20:12,066
this afternoon so i'm not going to be a
labor it now

437
00:20:12,066 --> 00:20:14,085
but this is a melanoma

438
00:20:14,085 --> 00:20:15,083
arising

439
00:20:15,083 --> 00:20:18,031
from the lining of the colon

440
00:20:18,031 --> 00:20:20,005
which is a glandular lining

441
00:20:20,005 --> 00:20:24,026
so an isbn nine so well circumscribed

442
00:20:24,026 --> 00:20:25,014
non-invasive thing

443
00:20:25,014 --> 00:20:27,061
so this is a calm on iq

444
00:20:27,061 --> 00:20:30,088
adenoma

445
00:20:30,088 --> 00:20:34,001
sort of growing on the stand here this
is normal

446
00:20:34,001 --> 00:20:36,009
collage mucosa sort of pulled out

447
00:20:36,009 --> 00:20:40,037
uh... won't be another name for that
england and idea

448
00:20:40,037 --> 00:20:42,039
right pollock

449
00:20:42,039 --> 00:20:44,062
but i warn you

450
00:20:44,062 --> 00:20:49,042
you got to be taken precise because the
term pollack is just a topographical

451
00:20:49,042 --> 00:20:50,054
term

452
00:20:50,054 --> 00:20:54,055
anything that hangs like a dingell barry
off of

453
00:20:54,055 --> 00:20:57,009
him you coastal services apollo

454
00:20:57,009 --> 00:21:01,009
now some polyps are in fact neoplasms
like this one

455
00:21:01,009 --> 00:21:05,043
but summer simply inflammatory masses
some of you who have nasal allergies may

456
00:21:05,043 --> 00:21:09,036
have been told that you have nasal
polyps

457
00:21:09,036 --> 00:21:12,077
is things that says sorta look like that
up there

458
00:21:12,077 --> 00:21:17,057
but they're not neoplasms urges bags
into gmail fluid in the few inflammatory

459
00:21:17,057 --> 00:21:18,039
cells

460
00:21:18,039 --> 00:21:20,001
so anything else

461
00:21:20,001 --> 00:21:23,009
off on the surface you call a polyp
alone while you know that's a pollack

462
00:21:23,009 --> 00:21:25,043
with their other kinds of politics and
the colon

463
00:21:25,043 --> 00:21:27,004
they're not all at a moment's

464
00:21:27,004 --> 00:21:31,003
so if you want to be precise you could
say this is an ad anomalous pollock

465
00:21:31,003 --> 00:21:34,309
or simply

466
00:21:34,309 --> 00:21:36,038
some of them ron stems like that

467
00:21:36,038 --> 00:21:39,097
we call that eight people insulated

468
00:21:39,097 --> 00:21:42,001
adenoma

469
00:21:42,001 --> 00:21:43,007
some of them are

470
00:21:43,007 --> 00:21:46,063
sort of attached to the surface without
much of his family are a couple of

471
00:21:46,063 --> 00:21:47,032
little

472
00:21:47,032 --> 00:21:50,036
an anomalous just doesn't budding right
off

473
00:21:50,036 --> 00:21:52,076
the surface

474
00:21:52,076 --> 00:21:56,079
these things are generally a symptomatic

475
00:21:56,079 --> 00:21:59,081
it would take a helluva lot

476
00:21:59,081 --> 00:22:02,001
adenoma to produce any symptoms

477
00:22:02,001 --> 00:22:05,025
usually associate with a little a cold
leading

478
00:22:05,025 --> 00:22:07,007
but basically they're they're hidden
there

479
00:22:07,007 --> 00:22:10,042
the significance is

480
00:22:10,042 --> 00:22:12,009
some of these

481
00:22:12,009 --> 00:22:13,023
dilemmas time

482
00:22:13,023 --> 00:22:17,179
turn of the cancer and that's the news
that the other theme of our

483
00:22:17,179 --> 00:22:21,083
presentation this afternoon so i won't
belabor it at this point

484
00:22:21,083 --> 00:22:23,179
try and what about it

485
00:22:23,179 --> 00:22:25,429
and you can go back on that chart i gave
you

486
00:22:25,429 --> 00:22:29,036
the next step down on my cell on the
left side of the nine

487
00:22:29,036 --> 00:22:31,000
man glandular epithelia

488
00:22:31,000 --> 00:22:32,071
this is a cartoon

489
00:22:32,071 --> 00:22:34,053
of a benign neoplasm

490
00:22:34,053 --> 00:22:39,098
of the lining of the bladder happens to
be what we call transitional epithelium

491
00:22:39,098 --> 00:22:43,009
very often these sorts of things grow
out

492
00:22:43,009 --> 00:22:44,093
and i think they

493
00:22:44,093 --> 00:22:50,009
this does a good job as a series of
finger like projections

494
00:22:50,009 --> 00:22:52,019
pointing at you

495
00:22:52,019 --> 00:22:56,007
in each one of these is that it is a bit
of stromal covered by a layer of

496
00:22:56,007 --> 00:22:59,022
neoplastic transitional epithelium

497
00:22:59,022 --> 00:23:03,059
and we refer to his finger like
projections is painfully

498
00:23:03,059 --> 00:23:05,082
so this becomes a

499
00:23:05,082 --> 00:23:07,087
papilloma

500
00:23:07,087 --> 00:23:11,389
this is a transition hands because it's
a transitional epithelium

501
00:23:11,389 --> 00:23:13,005
the transitional cell

502
00:23:13,005 --> 00:23:16,001
papilloma

503
00:23:16,001 --> 00:23:20,033
lala just mentioned passing that these
can be a symptomatic or these peculiar

504
00:23:20,033 --> 00:23:26,041
break off a little bit and then you get
some blood in the year in you materia

505
00:23:26,041 --> 00:23:29,058
i'll show you a real like real life

506
00:23:29,058 --> 00:23:30,031
papilloma

507
00:23:30,031 --> 00:23:31,046
uh...

508
00:23:31,046 --> 00:23:36,006
these these little thing that these
things presenters so little tiny bulbs

509
00:23:36,006 --> 00:23:42,001
very often in the oral mucosa or the the
back of the throat the oral pharynx

510
00:23:42,001 --> 00:23:46,088
this was one of those about the size of
peace

511
00:23:46,088 --> 00:23:51,099
this is the normal swimmers epithelium
lining the aural pharynx

512
00:23:51,099 --> 00:23:56,072
and what this says is a series of these
finger like projections

513
00:23:56,072 --> 00:23:58,019
growing

514
00:23:58,019 --> 00:24:01,061
out of this epithelium we don't see the
precise point attachment in each one of

515
00:24:01,061 --> 00:24:05,016
these is a little finger cutting
cross-section

516
00:24:05,016 --> 00:24:07,639
covered by this swing this epithelium

517
00:24:07,639 --> 00:24:08,076
perfectly benign

518
00:24:08,076 --> 00:24:12,025
so this would be called a swimmers
itself

519
00:24:12,025 --> 00:24:14,009
papilloma

520
00:24:14,009 --> 00:24:15,051
these are

521
00:24:15,051 --> 00:24:19,069
well the variety of variation in this
team i'm not on the skin surface is a is

522
00:24:19,069 --> 00:24:21,077
a common wart

523
00:24:21,077 --> 00:24:24,036
and they're all sorts of variations in
this

524
00:24:24,036 --> 00:24:28,076
generally caused by one or another
string of the human papilloma virus h<u>p</u>

525
00:24:28,076 --> 00:24:30,049
deal here about this

526
00:24:30,049 --> 00:24:31,039
constantly

527
00:24:31,039 --> 00:24:33,279
but uh... there is a

528
00:24:33,279 --> 00:24:35,056
they'd have a little more

529
00:24:35,056 --> 00:24:42,026
now one other variation on this team

530
00:24:42,026 --> 00:24:44,065
sometimes it comes to pass

531
00:24:44,065 --> 00:24:46,075
for a few days

532
00:24:46,075 --> 00:24:49,005
neoplasm of glandular epithelium

533
00:24:49,005 --> 00:24:51,559
that grows

534
00:24:51,559 --> 00:24:52,097
in bubbles

535
00:24:52,097 --> 00:24:56,042
in other words the neoplastic epithelium
lines

536
00:24:56,042 --> 00:24:59,028
the inner aspect of the holes

537
00:24:59,028 --> 00:25:04,023
which we call status technically a cyst
is a whole space filled with fluid

538
00:25:04,023 --> 00:25:04,063
blinded

539
00:25:04,063 --> 00:25:06,075
within epithelium

540
00:25:06,075 --> 00:25:11,839
there are some neoplasms that growth has
collections of multiple bottles vs

541
00:25:11,839 --> 00:25:13,799
line by this

542
00:25:13,799 --> 00:25:16,005
neoplastic glandular epithelium

543
00:25:16,005 --> 00:25:18,075
in a good example of this is a

544
00:25:18,075 --> 00:25:20,064
but i think fairly common

545
00:25:20,064 --> 00:25:24,072
seven nine neoplasm we've seen over it

546
00:25:24,072 --> 00:25:28,081
we call these things because they are
multiple cysts

547
00:25:28,081 --> 00:25:31,179
we call these cyst

548
00:25:31,179 --> 00:25:34,019
one-word system adenoma

549
00:25:34,019 --> 00:25:37,079
and here's what it would look like

550
00:25:37,079 --> 00:25:39,064
don't have a scale on there

551
00:25:39,064 --> 00:25:42,001
normal ovaries about the size of a

552
00:25:42,001 --> 00:25:43,026
well you know

553
00:25:43,026 --> 00:25:45,029
small not

554
00:25:45,029 --> 00:25:48,042
this thing was about the size of a
football

555
00:25:48,042 --> 00:25:50,052
they can they can get big

556
00:25:50,052 --> 00:25:52,021
uh...

557
00:25:52,021 --> 00:25:56,659
levy banana thier this it would be
suggested by the fact that the surface

558
00:25:56,659 --> 00:25:59,073
is perfectly smooth and whatever there
is

559
00:25:59,073 --> 00:26:01,039
there's orderly

560
00:26:01,039 --> 00:26:04,061
anesth one minute that surfaces
perfectly smooth

561
00:26:04,061 --> 00:26:06,679
cut into the thing

562
00:26:06,679 --> 00:26:10,007
you see assist the character

563
00:26:10,007 --> 00:26:13,071
these were these were filled with a
musician is material

564
00:26:13,071 --> 00:26:15,083
which we washed away

565
00:26:15,083 --> 00:26:20,069
of there's a system that's lined by

566
00:26:20,069 --> 00:26:24,055
benign glandular epithelium there there
there are so far

567
00:26:24,055 --> 00:26:26,034
many little daughter cysts

568
00:26:26,034 --> 00:26:29,034
so that is an ovarian

569
00:26:29,034 --> 00:26:33,058
sister adenoma see how we built the
names

570
00:26:33,058 --> 00:26:35,008
without much in mind

571
00:26:35,008 --> 00:26:38,097
we got a next step and say what about

572
00:26:38,097 --> 00:26:39,087
malignancy

573
00:26:39,087 --> 00:26:40,097
counterparts

574
00:26:40,097 --> 00:26:46,003
now the role here is if you have been at
the same feel neoplasm

575
00:26:46,003 --> 00:26:48,038
of any sort

576
00:26:48,038 --> 00:26:50,009
and it has malignant

577
00:26:50,009 --> 00:26:52,047
it is a carcinoma

578
00:26:52,047 --> 00:26:54,084
so it's the word

579
00:26:54,084 --> 00:26:57,002
carcinoma appears as any part of the
named

580
00:26:57,002 --> 00:26:58,075
you say to yourself

581
00:26:58,075 --> 00:27:01,049
jake this is at it's a little

582
00:27:01,049 --> 00:27:03,013
and there is no limit

583
00:27:03,013 --> 00:27:05,072
transmit a lot of information with that

584
00:27:05,072 --> 00:27:07,069
then you add

585
00:27:07,069 --> 00:27:09,027
compound

586
00:27:09,027 --> 00:27:10,459
the parts of the

587
00:27:10,459 --> 00:27:11,929
gets its day

588
00:27:11,929 --> 00:27:13,056
glandular

589
00:27:13,056 --> 00:27:16,025
malignancy what do you suppose you call
it

590
00:27:16,025 --> 00:27:17,083
adamo

591
00:27:17,083 --> 00:27:18,052
carcinoma

592
00:27:18,052 --> 00:27:21,007
if this is cuevas malignancy

593
00:27:21,007 --> 00:27:24,499
square myself carcinoma et cetera only

594
00:27:24,499 --> 00:27:26,269
and then you can't rely on

595
00:27:26,269 --> 00:27:29,549
you'll see in our reports all sorts of
things

596
00:27:29,549 --> 00:27:31,859
moderately well differentiation did

597
00:27:31,859 --> 00:27:35,449
moderately well differentiated nuisance
secreting

598
00:27:35,449 --> 00:27:36,092
adenocarcinoma lacz

599
00:27:36,092 --> 00:27:39,099
put on some frosting on the cake the
food

600
00:27:39,099 --> 00:27:40,098
the basic thing is that tells you

601
00:27:40,098 --> 00:27:44,039
that is glandular that it is

602
00:27:44,039 --> 00:27:46,001
malignant

603
00:27:46,001 --> 00:27:50,005
so i'll show you some carcinomas quickly

604
00:27:50,005 --> 00:27:53,045
that'll make about half of you cringe

605
00:27:53,045 --> 00:27:56,018
uh... that's just what the label says

606
00:27:56,018 --> 00:27:59,084
of the glands of the penises largely
replaced

607
00:27:59,084 --> 00:28:00,075
by this

608
00:28:00,075 --> 00:28:02,017
uh...

609
00:28:02,017 --> 00:28:05,093
i'll give you another few words these
are all words you learn to live with we

610
00:28:05,093 --> 00:28:09,058
would refer to a neoplasm has grown out
what how much room here

611
00:28:09,058 --> 00:28:12,039
we talk about it is fun game

612
00:28:12,039 --> 00:28:13,009
fungus funding

613
00:28:13,009 --> 00:28:24,092
so this is

614
00:28:24,092 --> 00:28:29,078
well some some sisterhood military
generic answer some sis

615
00:28:29,078 --> 00:28:33,033
are not nearly fast

616
00:28:33,033 --> 00:28:37,015
that you get if you obstructed for
instance ductile structure

617
00:28:37,015 --> 00:28:39,065
and something is secreting into it

618
00:28:39,065 --> 00:28:43,006
it's obstructed here it'll become
systemically dilated before missus

619
00:28:43,006 --> 00:28:45,044
others just happen to be

620
00:28:45,044 --> 00:28:50,059
the way they are because they're they're
neoplasms

621
00:28:50,059 --> 00:28:54,096
well at any rate getting medicine is so
this is a fun gating

622
00:28:54,096 --> 00:28:56,028
neoplasm

623
00:28:56,028 --> 00:29:01,052
another word we use is exo finicky excel
meaning outward ph wide ta cee growing

624
00:29:01,052 --> 00:29:02,041
outward

625
00:29:02,041 --> 00:29:06,027
well this is partly funding but this was
infiltrating deeply

626
00:29:06,027 --> 00:29:09,149
this is a highly malignant neoplasm even
though it's

627
00:29:09,149 --> 00:29:10,076
pretty well differentiated

628
00:29:10,076 --> 00:29:13,096
and this is presently mona lymph nodes
at the time

629
00:29:13,096 --> 00:29:15,097
now this happened

630
00:29:15,097 --> 00:29:19,076
they the covering of the glances cuevas

631
00:29:19,076 --> 00:29:22,033
epithelium this was a swimmers cell

632
00:29:22,033 --> 00:29:23,085
carcinoma

633
00:29:23,085 --> 00:29:26,739
this illustrates a something you'll
learn

634
00:29:26,739 --> 00:29:30,024
it is not uncommon says people have a
great sense of the miles

635
00:29:30,024 --> 00:29:34,049
this thing didn't show up the thursday
night before he came into the doctor

636
00:29:34,049 --> 00:29:37,025
this has been there many many months

637
00:29:37,025 --> 00:29:40,091
and people have all sorts of ways of
explaining these things away in the

638
00:29:40,091 --> 00:29:43,021
nineteen hoping they're not there
tomorrow morning

639
00:29:43,021 --> 00:29:44,249
when a shower

640
00:29:44,249 --> 00:29:45,039
and so forth

641
00:29:45,039 --> 00:29:48,047
but that's a highly advanced lesion

642
00:29:48,047 --> 00:29:51,005
yours for the other half

643
00:29:51,005 --> 00:29:53,089
now this one

644
00:29:53,089 --> 00:29:58,097
is also basically my cell carcinoma
reveal a b errol covered by squamous

645
00:29:58,097 --> 00:29:59,099
epithelium

646
00:29:59,099 --> 00:30:00,067
scenarios

647
00:30:00,067 --> 00:30:03,012
now that was sensed by the patient

648
00:30:03,012 --> 00:30:06,052
as a sore store there that didn't heal

649
00:30:06,052 --> 00:30:08,539
it was in the master was acts of faith

650
00:30:08,539 --> 00:30:11,026
but this thing penetrated in

651
00:30:11,026 --> 00:30:13,003
about a centimeter or two

652
00:30:13,003 --> 00:30:17,039
not hand it was also present in the imo
lymph nodes

653
00:30:17,039 --> 00:30:19,074
on that side

654
00:30:19,074 --> 00:30:21,066
when the cell carcinoma

655
00:30:21,066 --> 00:30:24,097
here's one that we don't see much
anymore and i hope you never see one

656
00:30:24,097 --> 00:30:26,033
like this

657
00:30:26,033 --> 00:30:28,022
and this is a cervix

658
00:30:28,022 --> 00:30:30,005
to observe ovaries over here

659
00:30:30,005 --> 00:30:32,006
and vagina

660
00:30:32,006 --> 00:30:37,042
and what should have been a nice cervix
here is completely destroyed

661
00:30:37,042 --> 00:30:40,004
by this very very advanced

662
00:30:40,004 --> 00:30:41,779
square was still

663
00:30:41,779 --> 00:30:43,068
carcinoma

664
00:30:43,068 --> 00:30:45,869
the face of the cervix that

665
00:30:45,869 --> 00:30:49,058
juts into the giant is covered by square
was that the feelings of many of these

666
00:30:49,058 --> 00:30:51,095
cancers are swimmers

667
00:30:51,095 --> 00:30:55,006
number i showed you beyond the cervix
the other day that also has glandular

668
00:30:55,006 --> 00:30:58,082
line so we do see some admin carcinomas
there

669
00:30:58,082 --> 00:30:59,084
these are

670
00:30:59,084 --> 00:31:02,011
uh... basically provoked by

671
00:31:02,011 --> 00:31:07,052
a number of strains of the human
papillomavirus

672
00:31:07,052 --> 00:31:09,003
it's it's uh...

673
00:31:09,003 --> 00:31:10,006
transmissible

674
00:31:10,006 --> 00:31:12,046
virus and uh... this is

675
00:31:12,046 --> 00:31:13,429
one of the

676
00:31:13,429 --> 00:31:14,007
bad outcomes

677
00:31:14,007 --> 00:31:19,018
now i say that i hope you'll never
senior probably never see one quite

678
00:31:19,018 --> 00:31:21,015
disadvantage of practice in this country

679
00:31:21,015 --> 00:31:24,098
because of the widespread use of pap
smears we discussed that last time you

680
00:31:24,098 --> 00:31:25,629
can

681
00:31:25,629 --> 00:31:29,379
even apprehend this sort of thing one is
still in the insight tuesday jury even

682
00:31:29,379 --> 00:31:31,068
earlier with displeasure

683
00:31:31,068 --> 00:31:34,089
you don't have to wait for this when
this woman already had a follow bloody

684
00:31:34,089 --> 00:31:38,389
discharge because of this

685
00:31:38,389 --> 00:31:40,086
neoplasm

686
00:31:40,086 --> 00:31:44,048
well let's go back to him and g<u>i</u> tract

687
00:31:44,048 --> 00:31:45,045
uni

688
00:31:45,045 --> 00:31:50,001
upper aerodynamicists tracked into the
tongue the line-item all of the back of

689
00:31:50,001 --> 00:31:51,094
the throat banks and so forth

690
00:31:51,094 --> 00:31:57,054
we commonly see squeamish cell
carcinomas

691
00:31:57,054 --> 00:31:59,045
and this is a ton

692
00:31:59,045 --> 00:32:01,099
that's been amputated

693
00:32:01,099 --> 00:32:03,045
cuts actually

694
00:32:03,045 --> 00:32:08,015
and you can see this very deeply
invasive mass this was a squamous cell

695
00:32:08,015 --> 00:32:09,029
carcinoma

696
00:32:09,029 --> 00:32:09,062
rising

697
00:32:09,062 --> 00:32:11,052
out here

698
00:32:11,052 --> 00:32:12,087
these or older

699
00:32:12,087 --> 00:32:14,076
uh...

700
00:32:14,076 --> 00:32:20,013
for racial cancers are mostly related to
smoking and drinking

701
00:32:20,013 --> 00:32:22,034
and

702
00:32:22,034 --> 00:32:26,006
histologically this might look identical
to living in the cervix but it's got a

703
00:32:26,006 --> 00:32:28,009
different etiology

704
00:32:28,009 --> 00:32:32,559
and different different behavior but
this was a very deeply invasive

705
00:32:32,559 --> 00:32:34,076
square missile carcinoma

706
00:32:34,076 --> 00:32:38,027
here's another one mister heavy smoker

707
00:32:38,027 --> 00:32:40,015
this is a larynx

708
00:32:40,015 --> 00:32:41,046
opened in the back

709
00:32:41,046 --> 00:32:44,058
so the adam's apple store the front my
spread open

710
00:32:44,058 --> 00:32:47,058
there's a deeply ulcerative tumor there

711
00:32:47,058 --> 00:32:48,087
uh...

712
00:32:48,087 --> 00:32:53,062
this may have been around for months and
months and months and months

713
00:32:53,062 --> 00:32:54,089
head-first

714
00:32:54,089 --> 00:32:56,094
classes don't necessarily cause pain

715
00:32:56,094 --> 00:33:00,035
you know i must say infiltrate nerves
are not going to cause much pain

716
00:33:00,035 --> 00:33:04,071
this guy had inherited of cough in his
voice changed as you can imagine the

717
00:33:04,071 --> 00:33:07,051
vocal cord gradually being destroyed

718
00:33:07,051 --> 00:33:10,064
you know a heavy smokers are used to
being a horse and coughing and so forth

719
00:33:10,064 --> 00:33:13,085
and again the denial kicks in

720
00:33:13,085 --> 00:33:16,509
this was a along the collected

721
00:33:16,509 --> 00:33:19,002
square was still carcinoma

722
00:33:19,002 --> 00:33:21,000
larynx

723
00:33:21,000 --> 00:33:24,279
take it down the esophagus nam two miles
is up there

724
00:33:24,279 --> 00:33:28,009
this is the sound is coming down the
summit here and you can see we we've

725
00:33:28,009 --> 00:33:30,007
opened an office is rough in the area

726
00:33:30,007 --> 00:33:34,045
and the cut surface area to see at the
wall a second

727
00:33:34,045 --> 00:33:37,169
this is a very advanced

728
00:33:37,169 --> 00:33:38,022
carcinoma

729
00:33:38,022 --> 00:33:43,000
aligning of the esophagus disclaimers in
this was a square must sell

730
00:33:43,000 --> 00:33:45,052
carcinoma

731
00:33:45,052 --> 00:33:48,086
desert you can imagine will produce a
mechanical problems patients will have

732
00:33:48,086 --> 00:33:50,008
trouble swallowing

733
00:33:50,008 --> 00:33:51,066
and there again

734
00:33:51,066 --> 00:33:53,239
i've seen patients come in

735
00:33:53,239 --> 00:33:56,084
and strain baby food before they finally
say oncall

736
00:33:56,084 --> 00:33:59,064
and decide that something might be wrong

737
00:33:59,064 --> 00:34:02,099
and these are very hard to cure because
of the fact that they are advancing

738
00:34:02,099 --> 00:34:07,000
their local my pastor sees it's not just
in the past the seas

739
00:34:07,000 --> 00:34:08,689
we can also see

740
00:34:08,689 --> 00:34:11,349
adamo carcinomas nearsightedness

741
00:34:11,349 --> 00:34:17,829
because there are some glandular
epithelium there that can also give rise

742
00:34:17,829 --> 00:34:21,059
now if you look at that i tell you this
is a stomach has been opened in

743
00:34:21,059 --> 00:34:23,096
washington is the esophagus up there is
this

744
00:34:23,096 --> 00:34:25,959
do indian coming off over here

745
00:34:25,959 --> 00:34:31,049
if you look at that for a while at first
you might say well nothing wrong on that

746
00:34:31,049 --> 00:34:34,989
but you'll notice that the normal full
pattern

747
00:34:34,989 --> 00:34:37,289
desire note here

748
00:34:37,289 --> 00:34:40,129
it doesn't look so awful that at first
blush

749
00:34:40,129 --> 00:34:45,699
but that is a diffuse lee infiltrated
carcinoma

750
00:34:45,699 --> 00:34:49,409
what kind is suppose it is given up his
stomach is a

751
00:34:49,409 --> 00:34:52,829
glandular lying

752
00:34:52,829 --> 00:34:54,399
adenocarcinoma

753
00:34:54,399 --> 00:34:56,959
and uh... these things are

754
00:34:56,959 --> 00:35:01,269
very subtle and a symptomatic until
their advance this was very advances as

755
00:35:01,269 --> 00:35:03,299
medicine at ican liver already

756
00:35:03,299 --> 00:35:04,859
at the time it came

757
00:35:04,859 --> 00:35:07,059
uh...

758
00:35:07,059 --> 00:35:11,089
so they may have traditionally symptoms
at all and interesting wrinkle here is

759
00:35:11,089 --> 00:35:15,049
uh... the incidence of this kind of
tumor is very high in japan

760
00:35:15,049 --> 00:35:16,479
much higher than here

761
00:35:16,479 --> 00:35:20,369
and it's largely in environmental thing
because the descendants of japanese who

762
00:35:20,369 --> 00:35:21,016
come here

763
00:35:21,016 --> 00:35:22,859
or pick up our other

764
00:35:22,859 --> 00:35:23,095
yankee problems

765
00:35:23,095 --> 00:35:28,829
but uh... this incident changes but it's
such a public health problem

766
00:35:28,829 --> 00:35:30,099
that they will screen

767
00:35:30,099 --> 00:35:34,239
for this sort of thing because there's
nothing like this could produce symptoms

768
00:35:34,239 --> 00:35:34,098
early on

769
00:35:34,098 --> 00:35:38,074
so the only hope of getting it earlier
is played by population screening and

770
00:35:38,074 --> 00:35:40,599
that's that's another matter

771
00:35:40,599 --> 00:35:42,038
for another time

772
00:35:42,038 --> 00:35:46,089
here's one that will anticipate uh...
this afternoon

773
00:35:46,089 --> 00:35:48,319
getting down to a large intestine

774
00:35:48,319 --> 00:35:51,349
this is actually in the first part of a
large intestine over here right where

775
00:35:51,349 --> 00:35:56,289
the small intestine answers for the
appendix comes offices so called safe

776
00:35:56,289 --> 00:35:57,819
this about

777
00:35:57,819 --> 00:36:00,229
poultry four inches in diameter

778
00:36:00,229 --> 00:36:01,008
and there's a huge

779
00:36:01,008 --> 00:36:05,889
fung gaining neoplasm there

780
00:36:05,889 --> 00:36:09,459
anissa grown glandular lining so it's an
adamo

781
00:36:09,459 --> 00:36:10,789
carcinoma

782
00:36:10,789 --> 00:36:11,509
now

783
00:36:11,509 --> 00:36:13,098
in terms of our clinical present asian

784
00:36:13,098 --> 00:36:17,077
uh... this thing isn't going to his big
is that there is a good person that's

785
00:36:17,077 --> 00:36:19,739
trucked something bad big so that

786
00:36:19,739 --> 00:36:22,067
the first confiscate passing by

787
00:36:22,067 --> 00:36:25,599
doesn't cause any pain

788
00:36:25,599 --> 00:36:27,999
at least at this stage

789
00:36:27,999 --> 00:36:31,159
one things that happens with these as
they believe

790
00:36:31,159 --> 00:36:35,169
you know the passing traffic will will
erode the surface and they'll believe

791
00:36:35,169 --> 00:36:37,889
they'll lose blood

792
00:36:37,889 --> 00:36:39,064
this is all borrow

793
00:36:39,064 --> 00:36:41,989
three feet from the i<u>n</u>s_

794
00:36:41,989 --> 00:36:46,449
colin goes up here cross here down here
there's a little blue goes out

795
00:36:46,449 --> 00:36:49,639
in the fact is five times the blood

796
00:36:49,639 --> 00:36:54,729
goes from there to meet a nice it's no
longer rat its black

797
00:36:54,729 --> 00:36:58,979
the patient will be passing schools that
i mean if he's losing enough blood

798
00:36:58,979 --> 00:37:00,679
we passing stools

799
00:37:00,679 --> 00:37:02,033
that perhaps look

800
00:37:02,033 --> 00:37:04,008
tari that's the efforts that given to
them

801
00:37:04,008 --> 00:37:07,063
something we called mellon up learn
ad-aware

802
00:37:07,063 --> 00:37:12,939
you don't know if m<u>e</u>l_ d<u>n</u>a_ means
blackberry stole

803
00:37:12,939 --> 00:37:14,739
and patience will comment

804
00:37:14,739 --> 00:37:17,073
and a couple of ways with this they may
say

805
00:37:17,073 --> 00:37:21,014
if their particular instrument look in
the bolded for a flash

806
00:37:21,014 --> 00:37:23,049
uh... dr

807
00:37:23,049 --> 00:37:25,309
harry schools was wrong

808
00:37:25,309 --> 00:37:29,069
more unlikely in this is something you
must always remember middle-aged or

809
00:37:29,069 --> 00:37:31,169
elderly patient comes an incentive

810
00:37:31,169 --> 00:37:33,409
i'm just proved all the time

811
00:37:33,409 --> 00:37:37,499
you know describes being he's easily
fatigued and weak and so forth you take

812
00:37:37,499 --> 00:37:39,064
a look and they were kind of payal

813
00:37:39,064 --> 00:37:41,229
are you doing a glowing

814
00:37:41,229 --> 00:37:43,509
you find it terribly anemic

815
00:37:43,509 --> 00:37:44,399
it's from chronic

816
00:37:44,399 --> 00:37:48,042
i called blood loss like this

817
00:37:48,042 --> 00:37:54,159
climate chances on the right side in the
korea's

818
00:37:54,159 --> 00:37:55,679
jess's all through the colon

819
00:37:55,679 --> 00:37:59,199
uh... this is one very closely nis

820
00:37:59,199 --> 00:38:02,003
wishes in circles the whole by all
around

821
00:38:02,003 --> 00:38:04,189
like a napkin rings

822
00:38:04,189 --> 00:38:08,559
you know who actually produce narrowing
below min obviously is infiltrated the

823
00:38:08,559 --> 00:38:13,119
muscle of the wall that would produce a
change in bal habits

824
00:38:13,119 --> 00:38:15,829
it will produce frank

825
00:38:15,829 --> 00:38:20,249
in the schools is close enough to the
unicef if it bleeds can come out blood

826
00:38:20,249 --> 00:38:21,799
that's referred to

827
00:38:21,799 --> 00:38:23,569
he met okie xia

828
00:38:23,569 --> 00:38:25,749
ichi ohmae tito

829
00:38:25,749 --> 00:38:30,739
c<u>d</u>h_ lindsayolives came at a meaning
blood his ears a wonderful greek word

830
00:38:30,739 --> 00:38:33,004
for me to go potty

831
00:38:33,004 --> 00:38:36,099
over

832
00:38:36,099 --> 00:38:39,339
the american uses frank blood

833
00:38:39,339 --> 00:38:41,879
unit in the school which may be that in

834
00:38:41,879 --> 00:38:45,709
again people deny this is a law that
hemorrhoids and thereby preparation h

835
00:38:45,709 --> 00:38:48,319
and stick it up there for

836
00:38:48,319 --> 00:38:51,099
however long before they finally come in

837
00:38:51,099 --> 00:38:55,339
the important thing is is will also
point out this afternoon is be the

838
00:38:55,339 --> 00:39:00,069
survival of the prognosis is stage
related

839
00:39:00,069 --> 00:39:03,829
farzad penetrate through the ball wall
is it in the regional lymph nodes and so

840
00:39:03,829 --> 00:39:04,509
forth

841
00:39:04,509 --> 00:39:08,299
uh... these are the important factors

842
00:39:08,299 --> 00:39:09,021
all right

843
00:39:09,021 --> 00:39:11,149
couple of smokers things

844
00:39:11,149 --> 00:39:14,729
you can see about fifty packages of

845
00:39:14,729 --> 00:39:17,139
and that long

846
00:39:17,139 --> 00:39:20,329
here is a massive obstructing

847
00:39:20,329 --> 00:39:24,089
bronchus here this is the dilated
bronchus

848
00:39:24,089 --> 00:39:25,006
and full of

849
00:39:25,006 --> 00:39:28,719
newco kurland exudate

850
00:39:28,719 --> 00:39:30,066
that's the tumor right there

851
00:39:30,066 --> 00:39:32,449
and this patient presented

852
00:39:32,449 --> 00:39:35,409
or we probably had a cough but all
smoker's cough

853
00:39:35,409 --> 00:39:38,299
uh... presented with repeated pneumonia

854
00:39:38,299 --> 00:39:39,949
kept coming with episodes of pneumonia

855
00:39:39,949 --> 00:39:42,289
who's always in the same place

856
00:39:42,289 --> 00:39:45,659
and they finally tumbled to the fact
that we always have obstruct must have

857
00:39:45,659 --> 00:39:47,299
obstructive lesion there

858
00:39:47,299 --> 00:39:49,489
and there it was

859
00:39:49,489 --> 00:39:50,088
not leave

860
00:39:50,088 --> 00:39:55,079
bronchus is line by a glandular type of
epithelium so there are adamo carcinomas

861
00:39:55,079 --> 00:39:58,609
and one

862
00:39:58,609 --> 00:40:02,879
notoriously there can be metalplaza xia
of the broncos that goes on to display

863
00:40:02,879 --> 00:40:07,679
not only not a place of the displays
human cancer and many of these parts qua

864
00:40:07,679 --> 00:40:09,019
must sell

865
00:40:09,019 --> 00:40:10,669
carcinomas

866
00:40:10,669 --> 00:40:13,053
so there is a relatively small one that
produced

867
00:40:13,053 --> 00:40:14,044
repeated bouts

868
00:40:14,044 --> 00:40:16,039
of pneumonia

869
00:40:16,039 --> 00:40:19,019
there's a larger one just to show you
what they could look like when they

870
00:40:19,019 --> 00:40:21,079
really get out of hand

871
00:40:21,079 --> 00:40:22,549
here's an interesting one

872
00:40:22,549 --> 00:40:27,019
uh... close up here trachea coming down
here bronchus hier bronchus here you see

873
00:40:27,019 --> 00:40:28,042
this little thing

874
00:40:28,042 --> 00:40:29,007
this was a

875
00:40:29,007 --> 00:40:31,509
sway with cell carcinoma

876
00:40:31,509 --> 00:40:33,052
and you say well why didn't they

877
00:40:33,052 --> 00:40:37,859
uh... simply doing norman actually take
off the bronchus here you can live with

878
00:40:37,859 --> 00:40:40,309
one long

879
00:40:40,309 --> 00:40:43,109
doing it right here this is an autopsy
specimens

880
00:40:43,109 --> 00:40:44,051
and actually this

881
00:40:44,051 --> 00:40:47,046
thing that looks small here had gone
through

882
00:40:47,046 --> 00:40:49,089
the back of the bronchus

883
00:40:49,089 --> 00:40:52,909
this is all neoplasm kind of in case the
heartbeat was

884
00:40:52,909 --> 00:40:56,000
hopeless from from from the get go
swimmin cell

885
00:40:56,000 --> 00:40:58,809
carcinoma

886
00:40:58,809 --> 00:41:02,093
sestalo market was the benign one of my
smooth surfaces

887
00:41:02,093 --> 00:41:05,279
inside this this will line when i see
you

888
00:41:05,279 --> 00:41:06,819
had a feeling of

889
00:41:06,819 --> 00:41:12,008
here's the malignant counterpart you can
see the steiner's than other ovarian

890
00:41:12,008 --> 00:41:13,179
neoplasm

891
00:41:13,179 --> 00:41:17,109
it's mulligan and so we call it sister i
don't know

892
00:41:17,109 --> 00:41:18,059
carcinoma

893
00:41:18,059 --> 00:41:20,018
masses there than normal

894
00:41:20,018 --> 00:41:22,009
disassemble carcinoma

895
00:41:22,009 --> 00:41:26,067
the thing and then would immediately
took us to say this isn't just a simple

896
00:41:26,067 --> 00:41:27,039
system nama

897
00:41:27,039 --> 00:41:30,071
is a surface is no longer smooth like
this everywhere

898
00:41:30,071 --> 00:41:31,969
this guy

899
00:41:31,969 --> 00:41:33,949
very furry looking growth

900
00:41:33,949 --> 00:41:36,829
all over the surface

901
00:41:36,829 --> 00:41:42,339
and the bubbles inside ourselves

902
00:41:42,339 --> 00:41:44,349
neoplasm growing from the lining of the
trouble

903
00:41:44,349 --> 00:41:47,074
in other words the many of you can see
some bubbles so there are some cystic

904
00:41:47,074 --> 00:41:48,061
spaces

905
00:41:48,061 --> 00:41:53,759
but many of the previously cystic spaces
are filled with his rapidly growing

906
00:41:53,759 --> 00:41:54,479
neoplasm

907
00:41:54,479 --> 00:41:57,021
so this is sister adamo

908
00:41:57,021 --> 00:41:59,109
carcinoma

909
00:41:59,109 --> 00:42:04,239
i don't have an illustration of it but
you can imagine papillary tumor

910
00:42:04,239 --> 00:42:07,659
being eight papillary carcinoma greta
papilloma

911
00:42:07,659 --> 00:42:11,559
or papillary carcinoma

912
00:42:11,559 --> 00:42:14,043
so learn to to handle

913
00:42:14,043 --> 00:42:16,092
these uh... the moment but sure here

914
00:42:16,092 --> 00:42:22,249
as i say quite quite played by reflex

915
00:42:22,249 --> 00:42:23,014
let's switch

916
00:42:23,014 --> 00:42:37,299
away from apathy leo

917
00:42:37,299 --> 00:42:39,014
uh...

918
00:42:39,014 --> 00:42:40,319
this along

919
00:42:40,319 --> 00:42:45,068
answer to that but al stroke by a long
beard and say thanks a lot of experience

920
00:42:45,068 --> 00:42:48,409
under the microscope you would see not
only

921
00:42:48,409 --> 00:42:51,469
growth of these fingers but you see
invasion

922
00:42:51,469 --> 00:42:53,759
you'd also see more panoply here

923
00:42:53,759 --> 00:42:56,709
in you know psychologically it's a
combination of things but that's a

924
00:42:56,709 --> 00:42:58,509
that's a very good point

925
00:42:58,509 --> 00:43:01,063
and sometimes it's and it's a devilish
problem i see a lot of

926
00:43:01,063 --> 00:43:04,099
stuff growing out we've gotta make
multiple sections and see if any of its

927
00:43:04,099 --> 00:43:07,229
invading

928
00:43:07,229 --> 00:43:09,579
now getting away from

929
00:43:09,579 --> 00:43:11,199
as helium

930
00:43:11,199 --> 00:43:13,079
getting too nice a little dish is what
we call

931
00:43:13,079 --> 00:43:18,709
a supporting tissue or missing coble
tissues

932
00:43:18,709 --> 00:43:19,869
fibrous tissue

933
00:43:19,869 --> 00:43:23,014
smooth muscles column also bone
cartilage those of the things we're

934
00:43:23,014 --> 00:43:25,069
talking about

935
00:43:25,069 --> 00:43:28,769
but when i got your becomes easy if you
know a little and then great

936
00:43:28,769 --> 00:43:30,064
if you have a

937
00:43:30,064 --> 00:43:35,999
benign tumor of fatty tissue adipose
tissue recall well-lit

938
00:43:35,999 --> 00:43:37,004
wal-mart

939
00:43:37,004 --> 00:43:39,004
like mama

940
00:43:39,004 --> 00:43:42,659
benign neoplasm carl agin this tissue

941
00:43:42,659 --> 00:43:44,949
kong drama

942
00:43:44,949 --> 00:43:47,046
the minute plasma fibrous tissue

943
00:43:47,046 --> 00:43:50,079
five romana etcetera etcetera

944
00:43:50,079 --> 00:43:52,369
thursday after the latin and greek

945
00:43:52,369 --> 00:43:57,149
the system here is if it's malignancy

946
00:43:57,149 --> 00:43:59,939
milkar carcinoma because that's that's
really all

947
00:43:59,939 --> 00:44:04,047
if it's malignant an album as likable as
supporting tissue which holidays

948
00:44:04,047 --> 00:44:06,049
star

949
00:44:06,049 --> 00:44:07,056
you've all heard these words

950
00:44:07,056 --> 00:44:11,799
but now you have to be used in precisely

951
00:44:11,799 --> 00:44:16,014
malignant neoplasm a fatty tissue is a
light posts are calm

952
00:44:16,014 --> 00:44:18,899
in malignant neoplasm of

953
00:44:18,899 --> 00:44:20,067
carl edge in this issue is that

954
00:44:20,067 --> 00:44:22,259
conroe sarcoma

955
00:44:22,259 --> 00:44:25,109
and so forth

956
00:44:25,109 --> 00:44:28,749
the interesting thing about these is
there not organ specific as many organs

957
00:44:28,749 --> 00:44:31,769
have smooth muscle in the wall many
organs have

958
00:44:31,769 --> 00:44:32,096
cartilage

959
00:44:32,096 --> 00:44:35,609
many places in the body have owned

960
00:44:35,609 --> 00:44:39,109
many uh... everything in the body
practice fibrous tissue so you can see

961
00:44:39,109 --> 00:44:40,339
these tumors

962
00:44:40,339 --> 00:44:43,369
arising in a variety of places

963
00:44:43,369 --> 00:44:46,149
hears a strange one

964
00:44:46,149 --> 00:44:49,659
incidental autopsy findings guide that
is something completely different had no

965
00:44:49,659 --> 00:44:53,629
g<u>i</u> problems this is a little piece of
coal have opened it up here

966
00:44:53,629 --> 00:44:55,289
mucous membrane hearing here

967
00:44:55,289 --> 00:44:59,239
and you look at that you say that a lot
of it

968
00:44:59,239 --> 00:45:01,149
fatty tissue

969
00:45:01,149 --> 00:45:04,909
buffer size only to turn on a big golf
ball onset

970
00:45:04,909 --> 00:45:06,026
uh...

971
00:45:06,026 --> 00:45:09,098
histologically that was perfectly well
differentiated i couldn't tell it from

972
00:45:09,098 --> 00:45:14,019
normal facile in the center of that big
glob of

973
00:45:14,019 --> 00:45:17,999
adipose tissue that's a light palm up

974
00:45:17,999 --> 00:45:20,979
they do a currently

975
00:45:20,979 --> 00:45:22,094
their coats of the uh...

976
00:45:22,094 --> 00:45:28,017
of the bal but it's quite rare where do
you suppose locals were coming

977
00:45:28,017 --> 00:45:30,169
well where there's a lot of fatty tissue

978
00:45:30,169 --> 00:45:33,629
very common subcutaneously there may be
some like homelessness room like a

979
00:45:33,629 --> 00:45:36,038
chilly at least one

980
00:45:36,038 --> 00:45:39,469
they're they're not at all on common and
they're they're perfectly

981
00:45:39,469 --> 00:45:41,199
but revealing holiness

982
00:45:41,199 --> 00:45:44,579
they harbor didn't produce any symptoms

983
00:45:44,579 --> 00:45:46,083
alright nearest here's a uterus

984
00:45:46,083 --> 00:45:50,999
and each one of these is what you would
call a fibroid

985
00:45:50,999 --> 00:45:54,015
but now i will give you the correct
nomenclature

986
00:45:54,015 --> 00:45:59,044
these tumors are benign air rising from
the muscle of the uterus so they are my

987
00:45:59,044 --> 00:46:00,088
yo mas

988
00:46:00,088 --> 00:46:02,829
and wyoming muscle

989
00:46:02,829 --> 00:46:06,369
and because the particular kind of
muscle which you learn about his smooth

990
00:46:06,369 --> 00:46:06,919
muscle

991
00:46:06,919 --> 00:46:08,059
this is a

992
00:46:08,059 --> 00:46:09,589
lower these are multiple

993
00:46:09,589 --> 00:46:14,279
lightly or my omens

994
00:46:14,279 --> 00:46:15,044
none of my culture

995
00:46:15,044 --> 00:46:20,129
these can produce a variety of
mechanical systems hyper memory a

996
00:46:20,129 --> 00:46:24,259
the big bowl compelled us as you
mentioned and some of the many a

997
00:46:24,259 --> 00:46:25,779
marriage symptomatic

998
00:46:25,779 --> 00:46:28,989
even at this size believe it or not

999
00:46:28,989 --> 00:46:30,749
here is a

1000
00:46:30,749 --> 00:46:33,017
malignancy moment

1001
00:46:33,017 --> 00:46:34,349
uh...

1002
00:46:34,349 --> 00:46:36,013
here's the x_-ray even see

1003
00:46:36,013 --> 00:46:39,046
this is what the bone should look like
it's very dense in here is obviously

1004
00:46:39,046 --> 00:46:41,239
more bone being made

1005
00:46:41,239 --> 00:46:44,979
the outer membrane a perry asked him
about has been lifted

1006
00:46:44,979 --> 00:46:48,039
by something pushing out in here it is

1007
00:46:48,039 --> 00:46:51,369
here's the bone here is the bone for me
to more here

1008
00:46:51,369 --> 00:46:53,041
has broken through the cortex

1009
00:46:53,041 --> 00:46:57,689
news out into the soft tissues so this
is a sarcoma

1010
00:46:57,689 --> 00:46:58,709
osteo

1011
00:46:58,709 --> 00:46:59,088
sarcoma

1012
00:46:59,088 --> 00:47:02,009
this is by a large a tumor just

1013
00:47:02,009 --> 00:47:04,009
in passing of

1014
00:47:04,009 --> 00:47:07,049
growing bones teenage kids young adults

1015
00:47:07,049 --> 00:47:11,579
uh... a highly malignant intent in the
past size early on

1016
00:47:11,579 --> 00:47:14,529
cut to the longest

1017
00:47:14,529 --> 00:47:19,559
nothing is immune here is a tumor rising
in the soft-tissue beside harry fleshy

1018
00:47:19,559 --> 00:47:21,009
looking

1019
00:47:21,009 --> 00:47:26,022
is derived from scalable muscle mild
sarcoma but this time it isn't wyo

1020
00:47:26,022 --> 00:47:27,929
it's rad though

1021
00:47:27,929 --> 00:47:32,369
yo-yo learn these details but you should
be able look at bay a name like that and

1022
00:47:32,369 --> 00:47:33,029
say hello

1023
00:47:33,029 --> 00:47:41,599
this is a supporting vision neoplasm
some sort

1024
00:47:41,599 --> 00:47:42,929
classes are common

1025
00:47:42,929 --> 00:47:46,219
well i'll again it's a long answer to
that these days and then when i started

1026
00:47:46,219 --> 00:47:48,859
out all you could lose amputated hope
for the best

1027
00:47:48,859 --> 00:47:53,259
now other forms of chemotherapy and
partial resection of the bone with it

1028
00:47:53,259 --> 00:47:56,499
with insertion of other bone and so
forth a lot of

1029
00:47:56,499 --> 00:47:58,329
nice fancy things they could do now

1030
00:47:58,329 --> 00:48:01,539
so it's nowhere near as does move that
used to be a bit upset this is a highly

1031
00:48:01,539 --> 00:48:04,489
aggressive tumor

1032
00:48:04,489 --> 00:48:07,729
friday quickly now

1033
00:48:07,729 --> 00:48:08,749
another

1034
00:48:08,749 --> 00:48:12,939
crying of neoplasm we talk about
epithelial tissue we talk about

1035
00:48:12,939 --> 00:48:14,739
supporting on his ankle both issues

1036
00:48:14,739 --> 00:48:16,479
there are

1037
00:48:16,479 --> 00:48:20,509
neoplasms of the lymphoid tissues and
the invite him out of poetic i mean

1038
00:48:20,509 --> 00:48:22,109
blood forming

1039
00:48:22,109 --> 00:48:23,013
tissues

1040
00:48:23,013 --> 00:48:26,089
there are uh... neoplasms of these

1041
00:48:26,089 --> 00:48:31,679
and here is where you get into some sort
of a key terminology

1042
00:48:31,679 --> 00:48:36,469
neoplasms of the lymphoid tissues are
referred to as lymphomas

1043
00:48:36,469 --> 00:48:38,859
and you would say well that sounds
benign

1044
00:48:38,859 --> 00:48:40,309
there's not nice

1045
00:48:40,309 --> 00:48:42,319
behind me a plasma lymphocytes

1046
00:48:42,319 --> 00:48:46,409
faso there's no such thing as a good
nine lymphoma

1047
00:48:46,409 --> 00:48:48,014
we don't recognize them

1048
00:48:48,014 --> 00:48:50,059
if there are we don't recognize them

1049
00:48:50,059 --> 00:48:53,015
so when you hear the word lymphoma
despite

1050
00:48:53,015 --> 00:48:54,041
what it sounds like

1051
00:48:54,041 --> 00:49:00,038
that's a malignant neoplasm of lymphoid
tissue

1052
00:49:00,038 --> 00:49:04,609
similarly well i'll get to this but
leukemia refers to any any situation

1053
00:49:04,609 --> 00:49:05,229
really

1054
00:49:05,229 --> 00:49:09,979
where the malignant cells in the usually
blood forming cells

1055
00:49:09,979 --> 00:49:12,088
on mass in the circulation

1056
00:49:12,088 --> 00:49:16,299
refer to that is leukemia white blood

1057
00:49:16,299 --> 00:49:18,469
the old german was vices looked

1058
00:49:18,469 --> 00:49:21,859
there was described by them farmers

1059
00:49:21,859 --> 00:49:23,359
interesting they may present

1060
00:49:23,359 --> 00:49:27,014
as seemingly localized tumors with some
local spread

1061
00:49:27,014 --> 00:49:30,769
but because lymphocytes there there's
lymphoid tissue all of the body

1062
00:49:30,769 --> 00:49:34,079
and lymphocytes you'll learn move around
the body

1063
00:49:34,079 --> 00:49:37,005
lymphomas frequently present as systemic
diseases

1064
00:49:37,005 --> 00:49:39,149
rather than localized

1065
00:49:39,149 --> 00:49:41,569
sometimes localize it very often

1066
00:49:41,569 --> 00:49:42,099
systemic

1067
00:49:42,099 --> 00:49:43,839
this man came in

1068
00:49:43,839 --> 00:49:46,109
this is an old old photograph

1069
00:49:46,109 --> 00:49:49,023
and you see general swelling in his neck
here

1070
00:49:49,023 --> 00:49:53,075
you can see here's his classical he's
got a super cobra killer mode there

1071
00:49:53,075 --> 00:49:56,489
similar supercritical in though there

1072
00:49:56,489 --> 00:49:58,689
he noticed those but his armpits

1073
00:49:58,689 --> 00:50:03,043
were full of enlarged lymph nodes by
chest x_-ray has me this time was

1074
00:50:03,043 --> 00:50:07,269
widened and full of lymph nodes his
abdomen was full of enlargement bones he

1075
00:50:07,269 --> 00:50:07,078
presented

1076
00:50:07,078 --> 00:50:10,409
with a systemic disease

1077
00:50:10,409 --> 00:50:11,098
this was a a

1078
00:50:11,098 --> 00:50:14,189
widely disseminated lymphoma

1079
00:50:14,189 --> 00:50:15,022
lymphoma can

1080
00:50:15,022 --> 00:50:18,019
dennis like too many different

1081
00:50:18,019 --> 00:50:19,529
lymphoid tissues in the body

1082
00:50:19,529 --> 00:50:22,008
this is the rapture para commanders a
kidney kidney

1083
00:50:22,008 --> 00:50:24,088
knows you behind a really happening

1084
00:50:24,088 --> 00:50:26,067
this is a mass

1085
00:50:26,067 --> 00:50:29,109
of lymph nodes enlarge they should be

1086
00:50:29,109 --> 00:50:32,339
uh... at the most p size and these are
very big

1087
00:50:32,339 --> 00:50:36,649
lymph nodes all matted together this was
malignant lymphoma

1088
00:50:36,649 --> 00:50:38,439
dimeric preparing him

1089
00:50:38,439 --> 00:50:40,189
spleen

1090
00:50:40,189 --> 00:50:42,119
started

1091
00:50:42,119 --> 00:50:45,559
manuals of malignant lymphocytes if you
will

1092
00:50:45,559 --> 00:50:47,008
one former swings

1093
00:50:47,008 --> 00:50:50,759
even the kidneys any organ can be
infiltrated

1094
00:50:50,759 --> 00:50:53,349
lymphoma cells

1095
00:50:53,349 --> 00:50:55,209
and sometimes the marrow

1096
00:50:55,209 --> 00:50:57,639
the bone marrow is overrun

1097
00:50:57,639 --> 00:51:01,679
and the malignant lymphocytes spill in
great numbers into the bloodstream and

1098
00:51:01,679 --> 00:51:07,189
you have a lymphocytic form of leukemia

1099
00:51:07,189 --> 00:51:09,269
generically leukemia

1100
00:51:09,269 --> 00:51:13,017
re first to be the presence of

1101
00:51:13,017 --> 00:51:16,065
malignant he mad about whether to remove
what elements in circulation

1102
00:51:16,065 --> 00:51:20,619
so we see other forms of leukemia where
the merrill just a bone marrow itself

1103
00:51:20,619 --> 00:51:21,889
has gone bad

1104
00:51:21,889 --> 00:51:25,409
can you see malignant precursors of

1105
00:51:25,409 --> 00:51:26,599
leukocytes

1106
00:51:26,599 --> 00:51:30,054
possibly red cells and little bit more
rarely or even even platelets so

1107
00:51:30,054 --> 00:51:34,078
this morning so you know the marrow
tissue is circulating widely circulated

1108
00:51:34,078 --> 00:51:39,689
malignant cells infiltration of organs
and so forth

1109
00:51:39,689 --> 00:51:41,859
register wrap it up

1110
00:51:41,859 --> 00:51:46,119
make the point of no tissue and the
body's immune from

1111
00:51:46,119 --> 00:51:49,569
neoplasm even see it in the central
nervous system

1112
00:51:49,569 --> 00:51:52,809
please see the neoplasms of the
coverings of the brain the so-called

1113
00:51:52,809 --> 00:51:54,013
minmin geez

1114
00:51:54,013 --> 00:51:57,709
and typically eminem geo money is benign

1115
00:51:57,709 --> 00:51:59,809
has thrown his activities was

1116
00:51:59,809 --> 00:52:01,659
the uh...

1117
00:52:01,659 --> 00:52:04,529
no my culture is strange again

1118
00:52:04,529 --> 00:52:05,009
glioma

1119
00:52:05,009 --> 00:52:10,000
is actually uh... you neoplasm arising
in the brain tissue from the supporting

1120
00:52:10,000 --> 00:52:12,369
cells called glial cells

1121
00:52:12,369 --> 00:52:15,699
now has told a man in juneau alaska nine

1122
00:52:15,699 --> 00:52:18,019
we almost sounds benign

1123
00:52:18,019 --> 00:52:20,089
they're just varying degrees of
malignancy

1124
00:52:20,089 --> 00:52:23,079
they're all bad

1125
00:52:23,079 --> 00:52:26,009
and i'll show you why they're bad here's
a brain with the glioma

1126
00:52:26,009 --> 00:52:28,969
is a normal side of the brain

1127
00:52:28,969 --> 00:52:32,679
and at first glance into well you know
you might see some things out but

1128
00:52:32,679 --> 00:52:33,339
basically

1129
00:52:33,339 --> 00:52:34,709
this is all

1130
00:52:34,709 --> 00:52:35,889
we all month

1131
00:52:35,889 --> 00:52:40,119
and it's very hard to describe where it
stops this infiltrates

1132
00:52:40,119 --> 00:52:41,021
diffuse lee

1133
00:52:41,021 --> 00:52:44,499
numerically almost sells way out here in
here in here

1134
00:52:44,499 --> 00:52:46,009
is just

1135
00:52:46,009 --> 00:52:50,379
so orderly diffuse that it's very
difficult to handle

1136
00:52:50,379 --> 00:52:51,599
the uh...

1137
00:52:51,599 --> 00:52:54,209
well differentiated low-grade

1138
00:52:54,209 --> 00:52:58,599
gliomas last a little longer patient
lasts a little longer the high-grade

1139
00:52:58,599 --> 00:53:01,339
generally don't do so well with some

1140
00:53:01,339 --> 00:53:02,939
promising interventions

1141
00:53:02,939 --> 00:53:05,339
this is a sort of thing that senator

1142
00:53:05,339 --> 00:53:07,389
noticed any

1143
00:53:07,389 --> 00:53:10,579
only looked good the other night so

1144
00:53:10,579 --> 00:53:13,007
yahoo and i think that uh... that
central nervous system

1145
00:53:13,007 --> 00:53:15,559
then finally

1146
00:53:15,559 --> 00:53:17,079
uh...

1147
00:53:17,079 --> 00:53:20,129
there

1148
00:53:20,129 --> 00:53:21,629
next time to talk with us

1149
00:53:21,629 --> 00:53:24,069
these are these are before like an
interesting

1150
00:53:24,069 --> 00:53:27,309
you can afterwards where you got a
couple of different kinds of

1151
00:53:27,309 --> 00:53:28,319
differentiation

1152
00:53:28,319 --> 00:53:29,099
for instance we may see

1153
00:53:29,099 --> 00:53:31,199
uh...

1154
00:53:31,199 --> 00:53:34,849
roscommon salivary gland to where where
you see glandular elements proliferating

1155
00:53:34,849 --> 00:53:36,709
and cartilage

1156
00:53:36,709 --> 00:53:38,019
of all things

1157
00:53:38,019 --> 00:53:40,519
and those are referred to as mixed
tumors

1158
00:53:40,519 --> 00:53:43,599
of salivary gland or more often now we
call them

1159
00:53:43,599 --> 00:53:46,179
cleo morrissette and almost

1160
00:53:46,179 --> 00:53:48,359
meaning a mixed form

1161
00:53:48,359 --> 00:53:48,999
adenoma

1162
00:53:48,999 --> 00:53:52,829
they're such things as fight broke up
enormous

1163
00:53:52,829 --> 00:53:56,249
perfectly benign fibrous and granular

1164
00:53:56,249 --> 00:53:59,929
mumbling inside there's such things as

1165
00:53:59,929 --> 00:54:02,409
carson or sarcomas

1166
00:54:02,409 --> 00:54:05,789
through passive differentiation

1167
00:54:05,789 --> 00:54:07,999
apathy little glandular

1168
00:54:07,999 --> 00:54:11,039
any appeal in supporting both both
malignant

1169
00:54:11,039 --> 00:54:12,043
the odds are right here

1170
00:54:12,043 --> 00:54:14,031
as it is a really

1171
00:54:14,031 --> 00:54:20,014
mixed kind of tumor that arises from
totally potential sales

1172
00:54:20,014 --> 00:54:25,001
and in these tumors are the rumors of
all of the embryonic journalists

1173
00:54:25,001 --> 00:54:26,065
criticism mara was saying

1174
00:54:26,065 --> 00:54:28,789
as you've predicted arise

1175
00:54:28,789 --> 00:54:31,299
mostly in gold ads

1176
00:54:31,299 --> 00:54:35,929
but uh... also another two should have
seen in the media steinem i've seen them

1177
00:54:35,929 --> 00:54:37,779
in uh... the throat

1178
00:54:37,779 --> 00:54:39,449
but mostly gone mad or

1179
00:54:39,449 --> 00:54:41,479
the yeah

1180
00:54:41,479 --> 00:54:45,055
bad news for the guys is most testicular
terra com is a malignant

1181
00:54:45,055 --> 00:54:46,729
highly malignant

1182
00:54:46,729 --> 00:54:51,329
good news for the women is a very
intercom asar almost invariably benign

1183
00:54:51,329 --> 00:54:55,459
they're not uncommon there in your age
group usually an incidental finding but

1184
00:54:55,459 --> 00:55:00,359
they're endlessly fascinating and allen
by showing you a couple

1185
00:55:00,359 --> 00:55:02,009
there's a terra com of the ovary

1186
00:55:02,009 --> 00:55:06,279
i've cut the over his size of tennis
ball it should have a surface like that

1187
00:55:06,279 --> 00:55:12,859
i kind of open along the whole blonde
hair

1188
00:55:12,859 --> 00:55:16,819
looking at his ovary under the
microscope it had not only hair

1189
00:55:16,819 --> 00:55:21,309
follicles but it has construction sweat
glands today shes clams

1190
00:55:21,309 --> 00:55:23,239
it had cartilage

1191
00:55:23,239 --> 00:55:25,039
bronchial lining

1192
00:55:25,039 --> 00:55:27,799
it had something to look like i just
subtract

1193
00:55:27,799 --> 00:55:30,819
and even had some brain tissue

1194
00:55:30,819 --> 00:55:33,909
weenies irwin marvelous mixtures

1195
00:55:33,909 --> 00:55:37,779
amal solicit perfectly benign and when
we get one of the operating room

1196
00:55:37,779 --> 00:55:42,959
neighboring it goes we cuddle we see
here we say

1197
00:55:42,959 --> 00:55:47,469
for some reason in the ovarian tumors
most often it line by skin like

1198
00:55:47,469 --> 00:55:50,099
structures and sometimes called the
ramones

1199
00:55:50,099 --> 00:55:53,089
but they do usually got a great mixture
of stuff

1200
00:55:53,089 --> 00:55:55,729
here's another one what do you suppose
this was

1201
00:55:55,729 --> 00:56:00,019
for these were

1202
00:56:00,019 --> 00:56:03,099
that showed up as calcification mommy

1203
00:56:03,099 --> 00:56:05,489
public phil

1204
00:56:05,489 --> 00:56:06,429
and then

1205
00:56:06,429 --> 00:56:11,569
glass one i'm absolutely quitters might
my favorite this came out of recovery

1206
00:56:11,569 --> 00:56:13,789
looks like a chain with

1207
00:56:13,789 --> 00:56:15,033
five o'clock shadow

1208
00:56:15,033 --> 00:56:16,066
the nice

1209
00:56:16,066 --> 00:56:18,989
dental arch there and so forth

1210
00:56:18,989 --> 00:56:20,001
well that's a

1211
00:56:20,001 --> 00:56:22,619
but i've done is basically teased you

1212
00:56:22,619 --> 00:56:24,669
into uh...

1213
00:56:24,669 --> 99:59:59,999
being interested non-college annual deal
with the rest of your life now