zero waa
resolved
monday we'd
uh... laid out for you
many of the general concepts about meal places
and malignant
and vote today
uh... were a lot of them for the most part of his finish up here in a
direction the neoplasms
fighting the look of a lack of once topic
pictures show
of a variety of not a man woman and stuff
tumors so that you can appreciate the
polyimide president clinton please
attorneys are really
and kind of the uh...
broad array of things that can happen
to give you an beginning him along the lancaster neoplasms lasted goal for
today
as the florida
begin until and i think we we are told
asked that question
so it doesn't get lost
is ok we got all the cells
benign or malignant
what differences that make to the host in other words what is the impact of
bridge america is taking what is the impact
of uh...
neoplasm anomalous
this outline
is a good way to go out at the
let's take perfectly benign neoplasms they're not
invasive
metastatic
questionnaires
raghavan i neoplasm what going to do the host
for most of the facts are going to be local
if you receive the cartoon that i sure do
it's just a next like an expanding balloon locally in some areas
then you would predict that
there are the first thing at a benign neoplasm lewis's produce some local
mechanical effects
now these very from trivial to lethal
if you had a
a marble sized
benign neoplasm one-year love handles here
there'd be a couple of you in the world i would know about it
maybe two more than that but
ferrier area where it would be trivial
uh... i and the other hand it could be other cosmetic importance you wouldn't
want to benign neoplasms sizable walnut than the tip of your nose
biologically not terribly threatening but uh...
bad anyway
uh...
i mentioned result
this is something to keep your eye and you can buy of a benign neoplasm sounds
like a black see more
but think of an expanding the nine-year plasma confines of the cranial
there's no room in there
as it starts growing as consumers
related press on something vital in the brain and you could produce if it's not
interrupted could produce death
so benign neoplasms can kill generally
by something going on
mechanically
ka
nine-year plasmids
as it's expanding locally again you think just about cartoon
it's going to press on adjacent structures
as it expands in that made the strongly
adjacent structures just by sitting on it
knock off the function of over one tissue or another selection b
uh... quite significant and that's all
based on our
adjust the expansion of the benign neoplasm
now i have mentioned local complications here
these are sort of
secondary things that may occur and they may be very important
a benign neoplasm growing under a surface may expand to the point where
the surface all straight silver
then there may be hemorrhage
could be trivial could really thought that they could be hemorrhage from such
an australian area
or there might be infection
these are sort of secondary
uh... complications of of the local mechanical situation
uh... or the other thing is the
uh... benign you pleasant unplug the plumbing
so the wall of a doctor pressing on a vessel or something of that sort it can
produce obstruction is very significant
these are all sort of local effects
there's one x sort of exception to this and i've listed systemic and the crying
effects
their runs something like this
you had a good remember i told you the benign neoplasms are
almost invariably very well differentiated
mhm means they resemble a parental tissue
you have a benign neoplasms arising from an end to the crime that is from the
hormone
secreting tissue
it may well be so well differentiated that it mimics the adult issued by
secreting
a particular hormone
that ordinarily comes from that issue
the difference though is
being autonomous
and out of control of the body
this tumor will produce gobs of that hormone
and then the patient may present
little really tiny tumor somewhere may present
tremendous number of signs and symptoms due in excess of a particular hormone
so in that regard even a local benign neoplasm could produce
systemic
and the crime effects
now
when we go over to the to the other side and we say what to malignant neoplasms
do
the first answer is very loudly all of the above
except now
instead of just
serb pressing the adjacent tissue malignant neoplasm which is cable
invasion can
can destroy the reputation by invading n
and compress it can can violate ducks and other structures by invading
many malignant neoplasms grow much more rapidly this is not rulebook grow more
rapidly than benign ones
so it really does
all of the above with a vengeance
and also any given much castesystem there could be dozens or hundreds of the
past the seized in any given the task forces can raise
local health
wherever it happens to be
so you can see that ah...
that all of the above is where the real
exclamation point
um...
and crime
cancers
can also secrete excess hormone just like the nine and the crime
so any of those things
that are listed up here you can see
now there is there a couple of other things uh...
unless i want to go understandably said a conceptual level
that uh...
malignant neoplasms may be associated with some very very significant systemic
changes
and uh... one of them that you may be familiar with from
for milliliter answer or friends of friends of friends
these are the
buff
twinkly cancer patients
will answer phase of disease
where they lose their appetites
we begin to lose weight
the weight comes highly awesome
and they get weaker and weaker and weaker and just
do windows
and very often
so we could their beds have some in the final event in their lives is nemo near
which overtakes typically will only take a belfast patient like that
we refer to their way sort of wasting syndrome
as cake x_-ers
there's the spelling for it
as a general term but here we're talking about cancer coq xy and other words are
talking about a patient becoming a nation and wasted because of the cancer
being there
when i was a kid in pathologies that teach that this is simply a caloric
matter we had a rapidly growing tumor which isn't enough calories competing
with the host the host lost appetite along the way
and that was that
we just lost weight on behalf of the jury
we now know that that's the only a small part of the story
how this is a rather complex business related and i would lead to a cytochrome
site a kind secretion on the part of the
as a gross
but be aware that very often in patients with cancer you see this as syndrome of
cake axia
there are
also in this is an important general concept that i want to get lost in the
specifics but there are other
symptom complex is that is a syndromes
in patients with cancer
that you cannot explain
uh... by local effects
mechanical effects
that you can't that they're not explainable on the basis of a
predictable and the crying secretion in other words it's not that this is a
cancer that's
we know is making insulin and therefore beginning insulin sometimes it's not
that
uh...
we find some very weird
syndromes affecting a variety of organ systems
that are june should be
presence of the cancer's not mechanically but the president cancer in
the body and these are referred to is
para neil plastic syndromes
and i want you to to get an idea that concept not the details of the various
syndromes
they're important because first of all they may be a greater problem to the
patient
than the mechanical aspect of the tumor itself
and another thing is that the patient may present
the manifestations of a particular perinatal plastic syndrome
at the time the cancer is still are cold
behooves you to be able to recognize that all my goodness this mixture
symptoms may mean
getty just a couple of examples along with the rest of your skimming reading
don't try to memorize any of this stuff but one economist
uh...
para neoplastic syndromes is hyper cal senior elevation in blood
calcium
you might think if you think he mechanically think well cancer spreading
to the bone will destroy both liberate calcium
that happens
that's not apparently plastics into lesson mechanical thanks
but some tumors will secreted parathyroid like hormone
in other words are not related to parathyroid glands of tumor of this
error that
but it's a create something that has a paris i read hormone like activity in a
race is the serum calcium
that's not at all uncommon
uh...
other examples of parent neoplastic syndromes are from
what we call ext topic
hormone production where particular tumor
is producing a hormone that has no business coming from there we see for
instance
lung tumors
that produce
cortical trochmann and other ways that a pituitary hormone that drives the
adrenal gland
this may produce all kinds of hell
because it real is overactive because of the that topic
hormone production
some tumors
provoke
hyper coagulate ability in other words make the flood
more likely to plop
when the study that in december but
suffice it to say i have seen patients that present with
delay saying collapsed
not spontaneously as unusual ambulatory patients with a comment
uh... clocks in their leg means
and after all the dust settles it turns out they've got an internal cancer
pancreatic cancer ovarian cancer
what have you
it's doing too
pro quo ideal in substances associated with the tumor
now i'll
drop-dead at this
and i'd suggest that you take a look at the uh... the appropriate pages in the
book
and just to see the variety apparently isp neoplastic syndrome stop tryin
memorized just be aware
that general concept
affair neoplastic syndrome
part one more matter
quick pictures show
as a matter of moments sure
neoplasms and i want to emphasize that this is not a trivial matter it may seem
trivial to you know namely tumor so what
uh...
this is very very important
because
um...
if we
name the tumor
precisely and accurately
it transmits a lot of
information i was away as you worry more about on college if someone says it's
such and such kind of tumor this'll
bring up a a little rolodex card have a whole bunch of information
so it's important to be precise
in the terminology
and you've got to become familiar with this has got to be just reflex with u
you'll use it throughout your career
in the time to learn is right now because of the on your exam
this weekend
i'd promised you upstairs is that important and look what i want to be
able to do is take
the description
of a neoplasm
and only new picture taken description other and say okay with those elements
this is exactly how i'm going to name it
you've should be able to use after you leave the room today
but uh...
certainly by this weekend and it's it's very important to you throughout your
career
resilient
table in your book i think that page two seventy three of them are wrong
that shows you benign this anomaly the counterpart of the nine this animal
wouldn't come apart and so forth
i want to memorize that
you know thirty seconds
without doing that chart
and it will give you an idea of how we go about naming things
basically
it's it's not rocket science
we name tumors on the on the basis of two things
the tissue are joan
words benign or malignant
in other words uh...
try and looking at the neoplasm and you'll be able to do this this coming
spring
you'll be able to decide
its historic genesis white
tissue is springs from
an important part of the name
you'll see is in just a moment
depending on whether it's been nine or malignant we tack on a different suffix
in the kind of make a compound word
transmits an awful lot of information
so learn
to do this
now let's
dive right in
and and talk about first of all efforts the lil neoplasm
now the end of the net a c liam
you have become very familiar with this is a sort of tissue
that covers a surface like the epidermis
deadlines
them out for the gi tract
lines cavities
by convention
we considered
liver tissue to be epithelium
kenny tissue of the two meals in particular to be to be at the funeral
and so forth so we're talking about the serial neoplasms
the plot seconds a little bit
different kinds of epithelia as you will learn
their glandular epithelium they're not glandular epithelium there is something
we call transitional epithelium etcetera
don't worry about it
but concentrate first-time glandular epithelia
in other words uh... this is these are from structures
we're talking about tumors
that arise from epithelia lhs structures that are glandular or to be more ductile
those are those of the call glandular type
the rooms
and unknown
means gland
and the suffix beaumont
refers to uh... to amass
and by convention if we have a benign
neoplasm
of glandular epithelium
it is an adenoma
that along transmits a lot of information that says to your listener
if his name something that no one says well asap cereal
it is in the connective tissue tumors in the field
and it's glandular and it's benign
choice and adenomas
this is uh...
a cut
through the adrenal gland
managerial glance its deep enough at above the kidney waiting here
few inches in here
it's about about that big
normally
not done here is cut through the adrenal gland
this is a cut through the normal plan
the yellow
part of the sandwiches the cortex
that makes various steroid hormones
and this is the mud all over
that makes catecholamines
i've got an effort and so forth
right in that dark spot
here we have
india plaza
first of all is very well circumscribed just shout louder there
clearance sale of probably benign doesn't look invasive
i can tell you that under the microscope this was
perfectly differentiating himself herself all their arranged a little
differently
they look like the cells here
you came to get a hint of that and that it's the same a yellow
sort of stuff
comprising then at that
of which this is made
so this is an added no ma
arising from the adrenal cortex so we call it a bit and give it the whole in
adrenal cortical adenoma
now the question
is well how did that patient coming in this a doc
i've got a
walnut sized mass in my super arenal
uh... fat pad
then is obviously buried in there and you know when you feel that
uh...
the way this presented was because it was making an access of hormone
knows this is a patient belonged to his or her life
developed a series of symptoms in this particular case i can tell from looking
at this and other history
this tumor was making
gobs and gobs of a vast room
and the patient came in with i'd will bore you with a bit of syndrome
relating to blood pressure and changes in certain cervelo delights and so forth
and the
smart physicians seven
flipping see these things together something is making too much
oven adrenal cortical hormone
simply a matter of imaging finding out which side
out icons and you got a cure
because that's perfectly benign very well differentiated
here's one for you
have to explain us a little bit like
this is a pancreas has been sliced
in the two has a look at matching this is what the normal pancreas
pancreas pratama looks like it's a lobby local angular tissue
and has a marble
very well circumscribed marble
in the middle of it
this was benign
can tell that by looking at exactly but it's it's benign
it arose
from the island salon their hands
with that in mind
how do you suppose is patient presented
again that's a that's a little marble military christening lately in their
representation presenter y
removed
hypoglycaemia
another words that tumor was producing insulin without regard
to the needs of the body
lose patience though there are variations on this end of the basically
if they did not just beaten
insulin levels high and there's the serum glucose goes down
you get a variety of symptoms all the way to convulsions and coma
units that's the most dramatic part of this and
sexual
has effected by removing
sort of thing
all right here's another sort of that no one want to talk about this in detail
this afternoon so i'm not going to be a labor it now
but this is a melanoma
arising
from the lining of the colon
which is a glandular lining
so an isbn nine so well circumscribed
non-invasive thing
so this is a calm on iq
adenoma
sort of growing on the stand here this is normal
collage mucosa sort of pulled out
uh... won't be another name for that england and idea
right pollock
but i warn you
you got to be taken precise because the term pollack is just a topographical
term
anything that hangs like a dingell barry off of
him you coastal services apollo
now some polyps are in fact neoplasms like this one
but summer simply inflammatory masses some of you who have nasal allergies may
have been told that you have nasal polyps
is things that says sorta look like that up there
but they're not neoplasms urges bags into gmail fluid in the few inflammatory
cells
so anything else
off on the surface you call a polyp alone while you know that's a pollack
with their other kinds of politics and the colon
they're not all at a moment's
so if you want to be precise you could say this is an ad anomalous pollock
or simply
some of them ron stems like that
we call that eight people insulated
adenoma
some of them are
sort of attached to the surface without much of his family are a couple of
little
an anomalous just doesn't budding right off
the surface
these things are generally a symptomatic
it would take a helluva lot
adenoma to produce any symptoms
usually associate with a little a cold leading
but basically they're they're hidden there
the significance is
some of these
dilemmas time
turn of the cancer and that's the news that the other theme of our
presentation this afternoon so i won't belabor it at this point
try and what about it
and you can go back on that chart i gave you
the next step down on my cell on the left side of the nine
man glandular epithelia
this is a cartoon
of a benign neoplasm
of the lining of the bladder happens to be what we call transitional epithelium
very often these sorts of things grow out
and i think they
this does a good job as a series of finger like projections
pointing at you
in each one of these is that it is a bit of stromal covered by a layer of
neoplastic transitional epithelium
and we refer to his finger like projections is painfully
so this becomes a
papilloma
this is a transition hands because it's a transitional epithelium
the transitional cell
papilloma
lala just mentioned passing that these can be a symptomatic or these peculiar
break off a little bit and then you get some blood in the year in you materia
i'll show you a real like real life
papilloma
uh...
these these little thing that these things presenters so little tiny bulbs
very often in the oral mucosa or the the back of the throat the oral pharynx
this was one of those about the size of peace
this is the normal swimmers epithelium lining the aural pharynx
and what this says is a series of these finger like projections
growing
out of this epithelium we don't see the precise point attachment in each one of
these is a little finger cutting cross-section
covered by this swing this epithelium
perfectly benign
so this would be called a swimmers itself
papilloma
these are
well the variety of variation in this team i'm not on the skin surface is a is
a common wart
and they're all sorts of variations in this
generally caused by one or another string of the human papilloma virus hp
deal here about this
constantly
but uh... there is a
they'd have a little more
now one other variation on this team
sometimes it comes to pass
for a few days
neoplasm of glandular epithelium
that grows
in bubbles
in other words the neoplastic epithelium lines
the inner aspect of the holes
which we call status technically a cyst is a whole space filled with fluid
blinded
within epithelium
there are some neoplasms that growth has collections of multiple bottles vs
line by this
neoplastic glandular epithelium
in a good example of this is a
but i think fairly common
seven nine neoplasm we've seen over it
we call these things because they are multiple cysts
we call these cyst
one-word system adenoma
and here's what it would look like
don't have a scale on there
normal ovaries about the size of a
well you know
small not
this thing was about the size of a football
they can they can get big
uh...
levy banana thier this it would be suggested by the fact that the surface
is perfectly smooth and whatever there is
there's orderly
anesth one minute that surfaces perfectly smooth
cut into the thing
you see assist the character
these were these were filled with a musician is material
which we washed away
of there's a system that's lined by
benign glandular epithelium there there there are so far
many little daughter cysts
so that is an ovarian
sister adenoma see how we built the names
without much in mind
we got a next step and say what about
malignancy
counterparts
now the role here is if you have been at the same feel neoplasm
of any sort
and it has malignant
it is a carcinoma
so it's the word
carcinoma appears as any part of the named
you say to yourself
jake this is at it's a little
and there is no limit
transmit a lot of information with that
then you add
compound
the parts of the
gets its day
glandular
malignancy what do you suppose you call it
adamo
carcinoma
if this is cuevas malignancy
square myself carcinoma et cetera only
and then you can't rely on
you'll see in our reports all sorts of things
moderately well differentiation did
moderately well differentiated nuisance secreting
adenocarcinoma lacz
put on some frosting on the cake the food
the basic thing is that tells you
that is glandular that it is
malignant
so i'll show you some carcinomas quickly
that'll make about half of you cringe
uh... that's just what the label says
of the glands of the penises largely replaced
by this
uh...
i'll give you another few words these are all words you learn to live with we
would refer to a neoplasm has grown out what how much room here
we talk about it is fun game
fungus funding
so this is
well some some sisterhood military generic answer some sis
are not nearly fast
that you get if you obstructed for instance ductile structure
and something is secreting into it
it's obstructed here it'll become systemically dilated before missus
others just happen to be
the way they are because they're they're neoplasms
well at any rate getting medicine is so this is a fun gating
neoplasm
another word we use is exo finicky excel meaning outward ph wide ta cee growing
outward
well this is partly funding but this was infiltrating deeply
this is a highly malignant neoplasm even though it's
pretty well differentiated
and this is presently mona lymph nodes at the time
now this happened
they the covering of the glances cuevas
epithelium this was a swimmers cell
carcinoma
this illustrates a something you'll learn
it is not uncommon says people have a great sense of the miles
this thing didn't show up the thursday night before he came into the doctor
this has been there many many months
and people have all sorts of ways of explaining these things away in the
nineteen hoping they're not there tomorrow morning
when a shower
and so forth
but that's a highly advanced lesion
yours for the other half
now this one
is also basically my cell carcinoma reveal a b errol covered by squamous
epithelium
scenarios
now that was sensed by the patient
as a sore store there that didn't heal
it was in the master was acts of faith
but this thing penetrated in
about a centimeter or two
not hand it was also present in the imo lymph nodes
on that side
when the cell carcinoma
here's one that we don't see much anymore and i hope you never see one
like this
and this is a cervix
to observe ovaries over here
and vagina
and what should have been a nice cervix here is completely destroyed
by this very very advanced
square was still
carcinoma
the face of the cervix that
juts into the giant is covered by square was that the feelings of many of these
cancers are swimmers
number i showed you beyond the cervix the other day that also has glandular
line so we do see some admin carcinomas there
these are
uh... basically provoked by
a number of strains of the human papillomavirus
it's it's uh...
transmissible
virus and uh... this is
one of the
bad outcomes
now i say that i hope you'll never senior probably never see one quite
disadvantage of practice in this country
because of the widespread use of pap smears we discussed that last time you
can
even apprehend this sort of thing one is still in the insight tuesday jury even
earlier with displeasure
you don't have to wait for this when this woman already had a follow bloody
discharge because of this
neoplasm
well let's go back to him and gi tract
uni
upper aerodynamicists tracked into the tongue the line-item all of the back of
the throat banks and so forth
we commonly see squeamish cell carcinomas
and this is a ton
that's been amputated
cuts actually
and you can see this very deeply invasive mass this was a squamous cell
carcinoma
rising
out here
these or older
uh...
for racial cancers are mostly related to smoking and drinking
and
histologically this might look identical to living in the cervix but it's got a
different etiology
and different different behavior but this was a very deeply invasive
square missile carcinoma
here's another one mister heavy smoker
this is a larynx
opened in the back
so the adam's apple store the front my spread open
there's a deeply ulcerative tumor there
uh...
this may have been around for months and months and months and months
head-first
classes don't necessarily cause pain
you know i must say infiltrate nerves are not going to cause much pain
this guy had inherited of cough in his voice changed as you can imagine the
vocal cord gradually being destroyed
you know a heavy smokers are used to being a horse and coughing and so forth
and again the denial kicks in
this was a along the collected
square was still carcinoma
larynx
take it down the esophagus nam two miles is up there
this is the sound is coming down the summit here and you can see we we've
opened an office is rough in the area
and the cut surface area to see at the wall a second
this is a very advanced
carcinoma
aligning of the esophagus disclaimers in this was a square must sell
carcinoma
desert you can imagine will produce a mechanical problems patients will have
trouble swallowing
and there again
i've seen patients come in
and strain baby food before they finally say oncall
and decide that something might be wrong
and these are very hard to cure because of the fact that they are advancing
their local my pastor sees it's not just in the past the seas
we can also see
adamo carcinomas nearsightedness
because there are some glandular epithelium there that can also give rise
now if you look at that i tell you this is a stomach has been opened in
washington is the esophagus up there is this
do indian coming off over here
if you look at that for a while at first you might say well nothing wrong on that
but you'll notice that the normal full pattern
desire note here
it doesn't look so awful that at first blush
but that is a diffuse lee infiltrated carcinoma
what kind is suppose it is given up his stomach is a
glandular lying
adenocarcinoma
and uh... these things are
very subtle and a symptomatic until their advance this was very advances as
medicine at ican liver already
at the time it came
uh...
so they may have traditionally symptoms at all and interesting wrinkle here is
uh... the incidence of this kind of tumor is very high in japan
much higher than here
and it's largely in environmental thing because the descendants of japanese who
come here
or pick up our other
yankee problems
but uh... this incident changes but it's such a public health problem
that they will screen
for this sort of thing because there's nothing like this could produce symptoms
early on
so the only hope of getting it earlier is played by population screening and
that's that's another matter
for another time
here's one that will anticipate uh... this afternoon
getting down to a large intestine
this is actually in the first part of a large intestine over here right where
the small intestine answers for the appendix comes offices so called safe
this about
poultry four inches in diameter
and there's a huge
fung gaining neoplasm there
anissa grown glandular lining so it's an adamo
carcinoma
now
in terms of our clinical present asian
uh... this thing isn't going to his big is that there is a good person that's
trucked something bad big so that
the first confiscate passing by
doesn't cause any pain
at least at this stage
one things that happens with these as they believe
you know the passing traffic will will erode the surface and they'll believe
they'll lose blood
this is all borrow
three feet from the ins_
colin goes up here cross here down here there's a little blue goes out
in the fact is five times the blood
goes from there to meet a nice it's no longer rat its black
the patient will be passing schools that i mean if he's losing enough blood
we passing stools
that perhaps look
tari that's the efforts that given to them
something we called mellon up learn ad-aware
you don't know if mel_ dna_ means blackberry stole
and patience will comment
and a couple of ways with this they may say
if their particular instrument look in the bolded for a flash
uh... dr
harry schools was wrong
more unlikely in this is something you must always remember middle-aged or
elderly patient comes an incentive
i'm just proved all the time
you know describes being he's easily fatigued and weak and so forth you take
a look and they were kind of payal
are you doing a glowing
you find it terribly anemic
it's from chronic
i called blood loss like this
climate chances on the right side in the korea's
jess's all through the colon
uh... this is one very closely nis
wishes in circles the whole by all around
like a napkin rings
you know who actually produce narrowing below min obviously is infiltrated the
muscle of the wall that would produce a change in bal habits
it will produce frank
in the schools is close enough to the unicef if it bleeds can come out blood
that's referred to
he met okie xia
ichi ohmae tito
cdh_ lindsayolives came at a meaning blood his ears a wonderful greek word
for me to go potty
over
the american uses frank blood
unit in the school which may be that in
again people deny this is a law that hemorrhoids and thereby preparation h
and stick it up there for
however long before they finally come in
the important thing is is will also point out this afternoon is be the
survival of the prognosis is stage related
farzad penetrate through the ball wall is it in the regional lymph nodes and so
forth
uh... these are the important factors
all right
couple of smokers things
you can see about fifty packages of
and that long
here is a massive obstructing
bronchus here this is the dilated bronchus
and full of
newco kurland exudate
that's the tumor right there
and this patient presented
or we probably had a cough but all smoker's cough
uh... presented with repeated pneumonia
kept coming with episodes of pneumonia
who's always in the same place
and they finally tumbled to the fact that we always have obstruct must have
obstructive lesion there
and there it was
not leave
bronchus is line by a glandular type of epithelium so there are adamo carcinomas
and one
notoriously there can be metalplaza xia of the broncos that goes on to display
not only not a place of the displays human cancer and many of these parts qua
must sell
carcinomas
so there is a relatively small one that produced
repeated bouts
of pneumonia
there's a larger one just to show you what they could look like when they
really get out of hand
here's an interesting one
uh... close up here trachea coming down here bronchus hier bronchus here you see
this little thing
this was a
sway with cell carcinoma
and you say well why didn't they
uh... simply doing norman actually take off the bronchus here you can live with
one long
doing it right here this is an autopsy specimens
and actually this
thing that looks small here had gone through
the back of the bronchus
this is all neoplasm kind of in case the heartbeat was
hopeless from from from the get go swimmin cell
carcinoma
sestalo market was the benign one of my smooth surfaces
inside this this will line when i see you
had a feeling of
here's the malignant counterpart you can see the steiner's than other ovarian
neoplasm
it's mulligan and so we call it sister i don't know
carcinoma
masses there than normal
disassemble carcinoma
the thing and then would immediately took us to say this isn't just a simple
system nama
is a surface is no longer smooth like this everywhere
this guy
very furry looking growth
all over the surface
and the bubbles inside ourselves
neoplasm growing from the lining of the trouble
in other words the many of you can see some bubbles so there are some cystic
spaces
but many of the previously cystic spaces are filled with his rapidly growing
neoplasm
so this is sister adamo
carcinoma
i don't have an illustration of it but you can imagine papillary tumor
being eight papillary carcinoma greta papilloma
or papillary carcinoma
so learn to to handle
these uh... the moment but sure here
as i say quite quite played by reflex
let's switch
away from apathy leo
uh...
this along
answer to that but al stroke by a long beard and say thanks a lot of experience
under the microscope you would see not only
growth of these fingers but you see invasion
you'd also see more panoply here
in you know psychologically it's a combination of things but that's a
that's a very good point
and sometimes it's and it's a devilish problem i see a lot of
stuff growing out we've gotta make multiple sections and see if any of its
invading
now getting away from
as helium
getting too nice a little dish is what we call
a supporting tissue or missing coble tissues
fibrous tissue
smooth muscles column also bone cartilage those of the things we're
talking about
but when i got your becomes easy if you know a little and then great
if you have a
benign tumor of fatty tissue adipose tissue recall well-lit
wal-mart
like mama
benign neoplasm carl agin this tissue
kong drama
the minute plasma fibrous tissue
five romana etcetera etcetera
thursday after the latin and greek
the system here is if it's malignancy
milkar carcinoma because that's that's really all
if it's malignant an album as likable as supporting tissue which holidays
star
you've all heard these words
but now you have to be used in precisely
malignant neoplasm a fatty tissue is a light posts are calm
in malignant neoplasm of
carl edge in this issue is that
conroe sarcoma
and so forth
the interesting thing about these is there not organ specific as many organs
have smooth muscle in the wall many organs have
cartilage
many places in the body have owned
many uh... everything in the body practice fibrous tissue so you can see
these tumors
arising in a variety of places
hears a strange one
incidental autopsy findings guide that is something completely different had no
gi problems this is a little piece of coal have opened it up here
mucous membrane hearing here
and you look at that you say that a lot of it
fatty tissue
buffer size only to turn on a big golf ball onset
uh...
histologically that was perfectly well differentiated i couldn't tell it from
normal facile in the center of that big glob of
adipose tissue that's a light palm up
they do a currently
their coats of the uh...
of the bal but it's quite rare where do you suppose locals were coming
well where there's a lot of fatty tissue
very common subcutaneously there may be some like homelessness room like a
chilly at least one
they're they're not at all on common and they're they're perfectly
but revealing holiness
they harbor didn't produce any symptoms
alright nearest here's a uterus
and each one of these is what you would call a fibroid
but now i will give you the correct nomenclature
these tumors are benign air rising from the muscle of the uterus so they are my
yo mas
and wyoming muscle
and because the particular kind of muscle which you learn about his smooth
muscle
this is a
lower these are multiple
lightly or my omens
none of my culture
these can produce a variety of mechanical systems hyper memory a
the big bowl compelled us as you mentioned and some of the many a
marriage symptomatic
even at this size believe it or not
here is a
malignancy moment
uh...
here's the x_-ray even see
this is what the bone should look like it's very dense in here is obviously
more bone being made
the outer membrane a perry asked him about has been lifted
by something pushing out in here it is
here's the bone here is the bone for me to more here
has broken through the cortex
news out into the soft tissues so this is a sarcoma
osteo
sarcoma
this is by a large a tumor just
in passing of
growing bones teenage kids young adults
uh... a highly malignant intent in the past size early on
cut to the longest
nothing is immune here is a tumor rising in the soft-tissue beside harry fleshy
looking
is derived from scalable muscle mild sarcoma but this time it isn't wyo
it's rad though
yo-yo learn these details but you should be able look at bay a name like that and
say hello
this is a supporting vision neoplasm some sort
classes are common
well i'll again it's a long answer to that these days and then when i started
out all you could lose amputated hope for the best
now other forms of chemotherapy and partial resection of the bone with it
with insertion of other bone and so forth a lot of
nice fancy things they could do now
so it's nowhere near as does move that used to be a bit upset this is a highly
aggressive tumor
friday quickly now
another
crying of neoplasm we talk about epithelial tissue we talk about
supporting on his ankle both issues
there are
neoplasms of the lymphoid tissues and the invite him out of poetic i mean
blood forming
tissues
there are uh... neoplasms of these
and here is where you get into some sort of a key terminology
neoplasms of the lymphoid tissues are referred to as lymphomas
and you would say well that sounds benign
there's not nice
behind me a plasma lymphocytes
faso there's no such thing as a good nine lymphoma
we don't recognize them
if there are we don't recognize them
so when you hear the word lymphoma despite
what it sounds like
that's a malignant neoplasm of lymphoid tissue
similarly well i'll get to this but leukemia refers to any any situation
really
where the malignant cells in the usually blood forming cells
on mass in the circulation
refer to that is leukemia white blood
the old german was vices looked
there was described by them farmers
interesting they may present
as seemingly localized tumors with some local spread
but because lymphocytes there there's lymphoid tissue all of the body
and lymphocytes you'll learn move around the body
lymphomas frequently present as systemic diseases
rather than localized
sometimes localize it very often
systemic
this man came in
this is an old old photograph
and you see general swelling in his neck here
you can see here's his classical he's got a super cobra killer mode there
similar supercritical in though there
he noticed those but his armpits
were full of enlarged lymph nodes by chest x_-ray has me this time was
widened and full of lymph nodes his abdomen was full of enlargement bones he
presented
with a systemic disease
this was a a
widely disseminated lymphoma
lymphoma can
dennis like too many different
lymphoid tissues in the body
this is the rapture para commanders a kidney kidney
knows you behind a really happening
this is a mass
of lymph nodes enlarge they should be
uh... at the most p size and these are very big
lymph nodes all matted together this was malignant lymphoma
dimeric preparing him
spleen
started
manuals of malignant lymphocytes if you will
one former swings
even the kidneys any organ can be infiltrated
lymphoma cells
and sometimes the marrow
the bone marrow is overrun
and the malignant lymphocytes spill in great numbers into the bloodstream and
you have a lymphocytic form of leukemia
generically leukemia
re first to be the presence of
malignant he mad about whether to remove what elements in circulation
so we see other forms of leukemia where the merrill just a bone marrow itself
has gone bad
can you see malignant precursors of
leukocytes
possibly red cells and little bit more rarely or even even platelets so
this morning so you know the marrow tissue is circulating widely circulated
malignant cells infiltration of organs and so forth
register wrap it up
make the point of no tissue and the body's immune from
neoplasm even see it in the central nervous system
please see the neoplasms of the coverings of the brain the so-called
minmin geez
and typically eminem geo money is benign
has thrown his activities was
the uh...
no my culture is strange again
glioma
is actually uh... you neoplasm arising in the brain tissue from the supporting
cells called glial cells
now has told a man in juneau alaska nine
we almost sounds benign
they're just varying degrees of malignancy
they're all bad
and i'll show you why they're bad here's a brain with the glioma
is a normal side of the brain
and at first glance into well you know you might see some things out but
basically
this is all
we all month
and it's very hard to describe where it stops this infiltrates
diffuse lee
numerically almost sells way out here in here in here
is just
so orderly diffuse that it's very difficult to handle
the uh...
well differentiated low-grade
gliomas last a little longer patient lasts a little longer the high-grade
generally don't do so well with some
promising interventions
this is a sort of thing that senator
noticed any
only looked good the other night so
yahoo and i think that uh... that central nervous system
then finally
uh...
there
next time to talk with us
these are these are before like an interesting
you can afterwards where you got a couple of different kinds of
differentiation
for instance we may see
uh...
roscommon salivary gland to where where you see glandular elements proliferating
and cartilage
of all things
and those are referred to as mixed tumors
of salivary gland or more often now we call them
cleo morrissette and almost
meaning a mixed form
adenoma
they're such things as fight broke up enormous
perfectly benign fibrous and granular
mumbling inside there's such things as
carson or sarcomas
through passive differentiation
apathy little glandular
any appeal in supporting both both malignant
the odds are right here
as it is a really
mixed kind of tumor that arises from totally potential sales
and in these tumors are the rumors of all of the embryonic journalists
criticism mara was saying
as you've predicted arise
mostly in gold ads
but uh... also another two should have seen in the media steinem i've seen them
in uh... the throat
but mostly gone mad or
the yeah
bad news for the guys is most testicular terra com is a malignant
highly malignant
good news for the women is a very intercom asar almost invariably benign
they're not uncommon there in your age group usually an incidental finding but
they're endlessly fascinating and allen by showing you a couple
there's a terra com of the ovary
i've cut the over his size of tennis ball it should have a surface like that
i kind of open along the whole blonde hair
looking at his ovary under the microscope it had not only hair
follicles but it has construction sweat glands today shes clams
it had cartilage
bronchial lining
it had something to look like i just subtract
and even had some brain tissue
weenies irwin marvelous mixtures
amal solicit perfectly benign and when we get one of the operating room
neighboring it goes we cuddle we see here we say
for some reason in the ovarian tumors most often it line by skin like
structures and sometimes called the ramones
but they do usually got a great mixture of stuff
here's another one what do you suppose this was
for these were
that showed up as calcification mommy
public phil
and then
glass one i'm absolutely quitters might my favorite this came out of recovery
looks like a chain with
five o'clock shadow
the nice
dental arch there and so forth
well that's a
but i've done is basically teased you
into uh...
being interested non-college annual deal with the rest of your life now