WEBVTT

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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

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to the bone will destroy both liberate
calcium

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that happens

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that's not apparently plastics into
lesson mechanical thanks

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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

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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

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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

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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

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hormone production

00:11:04.075 --> 00:11:07.026
some tumors

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provoke

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hyper coagulate ability in other words
make the flood

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more likely to plop

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when the study that in december but

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suffice it to say i have seen patients
that present with

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delay saying collapsed

00:11:22.058 --> 00:11:26.033
not spontaneously as unusual ambulatory
patients with a comment

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uh... clocks in their leg means

00:11:28.095 --> 00:11:33.005
and after all the dust settles it turns
out they've got an internal cancer

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pancreatic cancer ovarian cancer

00:11:35.319 --> 00:11:37.039
what have you

00:11:37.039 --> 00:11:40.023
it's doing too

00:11:40.023 --> 00:11:44.055
pro quo ideal in substances associated
with the tumor

00:11:44.055 --> 00:11:46.016
now i'll

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drop-dead at this

00:11:48.043 --> 00:11:52.021
and i'd suggest that you take a look at
the uh... the appropriate pages in the

00:11:52.021 --> 00:11:52.068
book

00:11:52.068 --> 00:11:57.002
and just to see the variety apparently
isp neoplastic syndrome stop tryin

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memorized just be aware

00:11:58.709 --> 00:12:00.063
that general concept

00:12:00.063 --> 00:12:03.048
affair neoplastic syndrome

00:12:03.048 --> 00:12:06.064
part one more matter

00:12:06.064 --> 00:12:07.999
quick pictures show

00:12:07.999 --> 00:12:11.009
as a matter of moments sure

00:12:11.009 --> 00:12:15.063
neoplasms and i want to emphasize that
this is not a trivial matter it may seem

00:12:15.063 --> 00:12:18.054
trivial to you know namely tumor so what

00:12:18.054 --> 00:12:19.096
uh...

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this is very very important

00:12:22.052 --> 00:12:23.017
because

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um...

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if we

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name the tumor

00:12:28.949 --> 00:12:30.083
precisely and accurately

00:12:30.083 --> 00:12:32.759
it transmits a lot of

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information i was away as you worry more
about on college if someone says it's

00:12:36.459 --> 00:12:38.056
such and such kind of tumor this'll

00:12:38.056 --> 00:12:42.034
bring up a a little rolodex card have a
whole bunch of information

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so it's important to be precise

00:12:45.009 --> 00:12:46.066
in the terminology

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

00:12:51.269 --> 00:12:53.025
you'll use it throughout your career

00:12:53.025 --> 00:12:56.066
in the time to learn is right now
because of the on your exam

00:12:56.066 --> 00:12:58.067
this weekend

00:12:58.067 --> 00:13:03.001
i'd promised you upstairs is that
important and look what i want to be

00:13:03.001 --> 00:13:06.011
able to do is take

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the description

00:13:07.073 --> 00:13:09.085
of a neoplasm

00:13:09.085 --> 00:13:14.279
and only new picture taken description
other and say okay with those elements

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this is exactly how i'm going to name it

00:13:18.015 --> 00:13:21.004
you've should be able to use after you
leave the room today

00:13:21.004 --> 00:13:22.041
but uh...

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certainly by this weekend and it's it's
very important to you throughout your

00:13:26.049 --> 00:13:28.006
career

00:13:28.006 --> 00:13:28.088
resilient

00:13:28.088 --> 00:13:33.007
table in your book i think that page two
seventy three of them are wrong

00:13:33.007 --> 00:13:37.062
that shows you benign this anomaly the
counterpart of the nine this animal

00:13:37.062 --> 00:13:39.000
wouldn't come apart and so forth

00:13:39.000 --> 00:13:42.038
i want to memorize that

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you know thirty seconds

00:13:43.879 --> 00:13:45.043
without doing that chart

00:13:45.043 --> 00:13:51.003
and it will give you an idea of how we
go about naming things

00:13:51.003 --> 00:13:51.073
basically

00:13:51.073 --> 00:13:54.033
it's it's not rocket science

00:13:54.033 --> 00:13:57.008
we name tumors on the on the basis of
two things

00:13:57.008 --> 00:13:59.009
the tissue are joan

00:13:59.009 --> 00:14:01.095
words benign or malignant

00:14:01.095 --> 00:14:03.096
in other words uh...

00:14:03.096 --> 00:14:07.034
try and looking at the neoplasm and
you'll be able to do this this coming

00:14:07.034 --> 00:14:08.086
spring

00:14:08.086 --> 00:14:10.054
you'll be able to decide

00:14:10.054 --> 00:14:12.085
its historic genesis white

00:14:12.085 --> 00:14:16.034
tissue is springs from

00:14:16.034 --> 00:14:18.097
an important part of the name

00:14:18.097 --> 00:14:22.048
you'll see is in just a moment

00:14:22.048 --> 00:14:27.008
depending on whether it's been nine or
malignant we tack on a different suffix

00:14:27.008 --> 00:14:29.078
in the kind of make a compound word

00:14:29.078 --> 00:14:31.099
transmits an awful lot of information

00:14:31.099 --> 00:14:33.094
so learn

00:14:33.094 --> 00:14:35.074
to do this

00:14:35.074 --> 00:14:38.027
now let's

00:14:38.027 --> 00:14:40.000
dive right in

00:14:40.000 --> 00:14:44.037
and and talk about first of all efforts
the lil neoplasm

00:14:44.037 --> 00:14:46.074
now the end of the net a c liam

00:14:46.074 --> 00:14:49.055
you have become very familiar with this
is a sort of tissue

00:14:49.055 --> 00:14:52.081
that covers a surface like the epidermis

00:14:52.081 --> 00:14:53.054
deadlines

00:14:53.054 --> 00:14:56.022
them out for the g<u>i</u> tract

00:14:56.022 --> 00:14:58.021
lines cavities

00:14:58.021 --> 00:14:59.569
by convention

00:14:59.569 --> 00:15:01.056
we considered

00:15:01.056 --> 00:15:04.099
liver tissue to be epithelium

00:15:04.099 --> 00:15:09.037
kenny tissue of the two meals in
particular to be to be at the funeral

00:15:09.037 --> 00:15:15.015
and so forth so we're talking about the
serial neoplasms

00:15:15.015 --> 00:15:18.058
the plot seconds a little bit

00:15:18.058 --> 00:15:21.074
different kinds of epithelia as you will
learn

00:15:21.074 --> 00:15:25.046
their glandular epithelium they're not
glandular epithelium there is something

00:15:25.046 --> 00:15:28.094
we call transitional epithelium etcetera

00:15:28.094 --> 00:15:30.039
don't worry about it

00:15:30.039 --> 00:15:34.024
but concentrate first-time glandular
epithelia

00:15:34.024 --> 00:15:37.036
in other words uh... this is these are
from structures

00:15:37.036 --> 00:15:38.089
we're talking about tumors

00:15:38.089 --> 00:15:44.048
that arise from epithelia lhs structures
that are glandular or to be more ductile

00:15:44.048 --> 00:15:47.074
those are those of the call glandular
type

00:15:47.074 --> 00:15:49.007
the rooms

00:15:49.007 --> 00:15:51.056
and unknown

00:15:51.056 --> 00:15:53.073
means gland

00:15:53.073 --> 00:15:56.032
and the suffix beaumont

00:15:56.032 --> 00:15:58.096
refers to uh... to amass

00:15:58.096 --> 00:16:03.088
and by convention if we have a benign

00:16:03.088 --> 00:16:04.005
neoplasm

00:16:04.005 --> 00:16:06.093
of glandular epithelium

00:16:06.093 --> 00:16:12.004
it is an adenoma

00:16:12.004 --> 00:16:15.067
that along transmits a lot of
information that says to your listener

00:16:15.067 --> 00:16:19.085
if his name something that no one says
well asap cereal

00:16:19.085 --> 00:16:22.419
it is in the connective tissue tumors in
the field

00:16:22.419 --> 00:16:27.046
and it's glandular and it's benign

00:16:27.046 --> 00:16:30.049
choice and adenomas

00:16:30.049 --> 00:16:31.047
this is uh...

00:16:31.047 --> 00:16:32.057
a cut

00:16:32.057 --> 00:16:34.041
through the adrenal gland

00:16:34.041 --> 00:16:38.069
managerial glance its deep enough at
above the kidney waiting here

00:16:38.069 --> 00:16:40.024
few inches in here

00:16:40.024 --> 00:16:42.051
it's about about that big

00:16:42.051 --> 00:16:43.027
normally

00:16:43.027 --> 00:16:45.089
not done here is cut through the adrenal
gland

00:16:45.089 --> 00:16:48.086
this is a cut through the normal plan

00:16:48.086 --> 00:16:50.043
the yellow

00:16:50.043 --> 00:16:52.075
part of the sandwiches the cortex

00:16:52.075 --> 00:16:55.053
that makes various steroid hormones

00:16:55.053 --> 00:16:56.097
and this is the mud all over

00:16:56.097 --> 00:16:59.005
that makes catecholamines

00:16:59.005 --> 00:17:00.076
i've got an effort and so forth

00:17:00.076 --> 00:17:02.094
right in that dark spot

00:17:02.094 --> 00:17:04.026
here we have

00:17:04.026 --> 00:17:06.035
india plaza

00:17:06.035 --> 00:17:11.065
first of all is very well circumscribed
just shout louder there

00:17:11.065 --> 00:17:14.037
clearance sale of probably benign
doesn't look invasive

00:17:14.037 --> 00:17:17.091
i can tell you that under the microscope
this was

00:17:17.091 --> 00:17:21.057
perfectly differentiating himself
herself all their arranged a little

00:17:21.057 --> 00:17:22.007
differently

00:17:22.007 --> 00:17:24.189
they look like the cells here

00:17:24.189 --> 00:17:27.839
you came to get a hint of that and that
it's the same a yellow

00:17:27.839 --> 00:17:29.031
sort of stuff

00:17:29.031 --> 00:17:30.093
comprising then at that

00:17:30.093 --> 00:17:33.052
of which this is made

00:17:33.052 --> 00:17:37.091
so this is an added no ma

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

00:17:42.299 --> 00:17:45.043
adrenal cortical adenoma

00:17:45.043 --> 00:17:46.065
now the question

00:17:46.065 --> 00:17:49.089
is well how did that patient coming in
this a doc

00:17:49.089 --> 00:17:51.004
i've got a

00:17:51.004 --> 00:17:53.799
walnut sized mass in my super arenal

00:17:53.799 --> 00:17:56.023
uh... fat pad

00:17:56.023 --> 00:17:59.053
then is obviously buried in there and
you know when you feel that

00:17:59.053 --> 00:18:00.094
uh...

00:18:00.094 --> 00:18:06.034
the way this presented was because it
was making an access of hormone

00:18:06.034 --> 00:18:10.051
knows this is a patient belonged to his
or her life

00:18:10.051 --> 00:18:14.041
developed a series of symptoms in this
particular case i can tell from looking

00:18:14.041 --> 00:18:16.044
at this and other history

00:18:16.044 --> 00:18:18.002
this tumor was making

00:18:18.002 --> 00:18:20.086
gobs and gobs of a vast room

00:18:20.086 --> 00:18:25.005
and the patient came in with i'd will
bore you with a bit of syndrome

00:18:25.005 --> 00:18:29.139
relating to blood pressure and changes
in certain cervelo delights and so forth

00:18:29.139 --> 00:18:31.029
and the

00:18:31.029 --> 00:18:32.094
smart physicians seven

00:18:32.094 --> 00:18:36.419
flipping see these things together
something is making too much

00:18:36.419 --> 00:18:39.023
oven adrenal cortical hormone

00:18:39.023 --> 00:18:41.082
simply a matter of imaging finding out
which side

00:18:41.082 --> 00:18:44.043
out icons and you got a cure

00:18:44.043 --> 00:18:48.011
because that's perfectly benign very
well differentiated

00:18:48.011 --> 00:18:49.036
here's one for you

00:18:49.036 --> 00:18:50.097
have to explain us a little bit like

00:18:50.097 --> 00:18:53.082
this is a pancreas has been sliced

00:18:53.082 --> 00:18:57.098
in the two has a look at matching this
is what the normal pancreas

00:18:57.098 --> 00:19:01.059
pancreas pratama looks like it's a lobby
local angular tissue

00:19:01.059 --> 00:19:04.027
and has a marble

00:19:04.027 --> 00:19:06.006
very well circumscribed marble

00:19:06.006 --> 00:19:07.087
in the middle of it

00:19:07.087 --> 00:19:09.047
this was benign

00:19:09.047 --> 00:19:13.013
can tell that by looking at exactly but
it's it's benign

00:19:13.013 --> 00:19:14.046
it arose

00:19:14.046 --> 00:19:19.003
from the island salon their hands

00:19:19.003 --> 00:19:20.046
with that in mind

00:19:20.046 --> 00:19:22.639
how do you suppose is patient presented

00:19:22.639 --> 00:19:26.889
again that's a that's a little marble
military christening lately in their

00:19:26.889 --> 00:19:31.007
representation presenter y

00:19:31.007 --> 00:19:33.051
removed

00:19:33.051 --> 00:19:35.043
hypoglycaemia

00:19:35.043 --> 00:19:39.017
another words that tumor was producing
insulin without regard

00:19:39.017 --> 00:19:41.064
to the needs of the body

00:19:41.064 --> 00:19:44.009
lose patience though there are
variations on this end of the basically

00:19:44.009 --> 00:19:47.073
if they did not just beaten

00:19:47.073 --> 00:19:52.002
insulin levels high and there's the
serum glucose goes down

00:19:52.002 --> 00:19:57.037
you get a variety of symptoms all the
way to convulsions and coma

00:19:57.037 --> 00:20:00.039
units that's the most dramatic part of
this and

00:20:00.039 --> 00:20:01.008
sexual

00:20:01.008 --> 00:20:03.809
has effected by removing

00:20:03.809 --> 00:20:06.023
sort of thing

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

00:20:09.085 --> 00:20:12.066
this afternoon so i'm not going to be a
labor it now

00:20:12.066 --> 00:20:14.085
but this is a melanoma

00:20:14.085 --> 00:20:15.083
arising

00:20:15.083 --> 00:20:18.031
from the lining of the colon

00:20:18.031 --> 00:20:20.005
which is a glandular lining

00:20:20.005 --> 00:20:24.026
so an isbn nine so well circumscribed

00:20:24.026 --> 00:20:25.014
non-invasive thing

00:20:25.014 --> 00:20:27.061
so this is a calm on iq

00:20:27.061 --> 00:20:30.088
adenoma

00:20:30.088 --> 00:20:34.001
sort of growing on the stand here this
is normal

00:20:34.001 --> 00:20:36.009
collage mucosa sort of pulled out

00:20:36.009 --> 00:20:40.037
uh... won't be another name for that
england and idea

00:20:40.037 --> 00:20:42.039
right pollock

00:20:42.039 --> 00:20:44.062
but i warn you

00:20:44.062 --> 00:20:49.042
you got to be taken precise because the
term pollack is just a topographical

00:20:49.042 --> 00:20:50.054
term

00:20:50.054 --> 00:20:54.055
anything that hangs like a dingell barry
off of

00:20:54.055 --> 00:20:57.009
him you coastal services apollo

00:20:57.009 --> 00:21:01.009
now some polyps are in fact neoplasms
like this one

00:21:01.009 --> 00:21:05.043
but summer simply inflammatory masses
some of you who have nasal allergies may

00:21:05.043 --> 00:21:09.036
have been told that you have nasal
polyps

00:21:09.036 --> 00:21:12.077
is things that says sorta look like that
up there

00:21:12.077 --> 00:21:17.057
but they're not neoplasms urges bags
into gmail fluid in the few inflammatory

00:21:17.057 --> 00:21:18.039
cells

00:21:18.039 --> 00:21:20.001
so anything else

00:21:20.001 --> 00:21:23.009
off on the surface you call a polyp
alone while you know that's a pollack

00:21:23.009 --> 00:21:25.043
with their other kinds of politics and
the colon

00:21:25.043 --> 00:21:27.004
they're not all at a moment's

00:21:27.004 --> 00:21:31.003
so if you want to be precise you could
say this is an ad anomalous pollock

00:21:31.003 --> 00:21:34.309
or simply

00:21:34.309 --> 00:21:36.038
some of them ron stems like that

00:21:36.038 --> 00:21:39.097
we call that eight people insulated

00:21:39.097 --> 00:21:42.001
adenoma

00:21:42.001 --> 00:21:43.007
some of them are

00:21:43.007 --> 00:21:46.063
sort of attached to the surface without
much of his family are a couple of

00:21:46.063 --> 00:21:47.032
little

00:21:47.032 --> 00:21:50.036
an anomalous just doesn't budding right
off

00:21:50.036 --> 00:21:52.076
the surface

00:21:52.076 --> 00:21:56.079
these things are generally a symptomatic

00:21:56.079 --> 00:21:59.081
it would take a helluva lot

00:21:59.081 --> 00:22:02.001
adenoma to produce any symptoms

00:22:02.001 --> 00:22:05.025
usually associate with a little a cold
leading

00:22:05.025 --> 00:22:07.007
but basically they're they're hidden
there

00:22:07.007 --> 00:22:10.042
the significance is

00:22:10.042 --> 00:22:12.009
some of these

00:22:12.009 --> 00:22:13.023
dilemmas time

00:22:13.023 --> 00:22:17.179
turn of the cancer and that's the news
that the other theme of our

00:22:17.179 --> 00:22:21.083
presentation this afternoon so i won't
belabor it at this point

00:22:21.083 --> 00:22:23.179
try and what about it

00:22:23.179 --> 00:22:25.429
and you can go back on that chart i gave
you

00:22:25.429 --> 00:22:29.036
the next step down on my cell on the
left side of the nine

00:22:29.036 --> 00:22:31.000
man glandular epithelia

00:22:31.000 --> 00:22:32.071
this is a cartoon

00:22:32.071 --> 00:22:34.053
of a benign neoplasm

00:22:34.053 --> 00:22:39.098
of the lining of the bladder happens to
be what we call transitional epithelium

00:22:39.098 --> 00:22:43.009
very often these sorts of things grow
out

00:22:43.009 --> 00:22:44.093
and i think they

00:22:44.093 --> 00:22:50.009
this does a good job as a series of
finger like projections

00:22:50.009 --> 00:22:52.019
pointing at you

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

00:22:56.007 --> 00:22:59.022
neoplastic transitional epithelium

00:22:59.022 --> 00:23:03.059
and we refer to his finger like
projections is painfully

00:23:03.059 --> 00:23:05.082
so this becomes a

00:23:05.082 --> 00:23:07.087
papilloma

00:23:07.087 --> 00:23:11.389
this is a transition hands because it's
a transitional epithelium

00:23:11.389 --> 00:23:13.005
the transitional cell

00:23:13.005 --> 00:23:16.001
papilloma

00:23:16.001 --> 00:23:20.033
lala just mentioned passing that these
can be a symptomatic or these peculiar

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

00:23:26.041 --> 00:23:29.058
i'll show you a real like real life

00:23:29.058 --> 00:23:30.031
papilloma

00:23:30.031 --> 00:23:31.046
uh...

00:23:31.046 --> 00:23:36.006
these these little thing that these
things presenters so little tiny bulbs

00:23:36.006 --> 00:23:42.001
very often in the oral mucosa or the the
back of the throat the oral pharynx

00:23:42.001 --> 00:23:46.088
this was one of those about the size of
peace

00:23:46.088 --> 00:23:51.099
this is the normal swimmers epithelium
lining the aural pharynx

00:23:51.099 --> 00:23:56.072
and what this says is a series of these
finger like projections

00:23:56.072 --> 00:23:58.019
growing

00:23:58.019 --> 00:24:01.061
out of this epithelium we don't see the
precise point attachment in each one of

00:24:01.061 --> 00:24:05.016
these is a little finger cutting
cross-section

00:24:05.016 --> 00:24:07.639
covered by this swing this epithelium

00:24:07.639 --> 00:24:08.076
perfectly benign

00:24:08.076 --> 00:24:12.025
so this would be called a swimmers
itself

00:24:12.025 --> 00:24:14.009
papilloma

00:24:14.009 --> 00:24:15.051
these are

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

00:24:19.069 --> 00:24:21.077
a common wart

00:24:21.077 --> 00:24:24.036
and they're all sorts of variations in
this

00:24:24.036 --> 00:24:28.076
generally caused by one or another
string of the human papilloma virus h<u>p</u>

00:24:28.076 --> 00:24:30.049
deal here about this

00:24:30.049 --> 00:24:31.039
constantly

00:24:31.039 --> 00:24:33.279
but uh... there is a

00:24:33.279 --> 00:24:35.056
they'd have a little more

00:24:35.056 --> 00:24:42.026
now one other variation on this team

00:24:42.026 --> 00:24:44.065
sometimes it comes to pass

00:24:44.065 --> 00:24:46.075
for a few days

00:24:46.075 --> 00:24:49.005
neoplasm of glandular epithelium

00:24:49.005 --> 00:24:51.559
that grows

00:24:51.559 --> 00:24:52.097
in bubbles

00:24:52.097 --> 00:24:56.042
in other words the neoplastic epithelium
lines

00:24:56.042 --> 00:24:59.028
the inner aspect of the holes

00:24:59.028 --> 00:25:04.023
which we call status technically a cyst
is a whole space filled with fluid

00:25:04.023 --> 00:25:04.063
blinded

00:25:04.063 --> 00:25:06.075
within epithelium

00:25:06.075 --> 00:25:11.839
there are some neoplasms that growth has
collections of multiple bottles vs

00:25:11.839 --> 00:25:13.799
line by this

00:25:13.799 --> 00:25:16.005
neoplastic glandular epithelium

00:25:16.005 --> 00:25:18.075
in a good example of this is a

00:25:18.075 --> 00:25:20.064
but i think fairly common

00:25:20.064 --> 00:25:24.072
seven nine neoplasm we've seen over it

00:25:24.072 --> 00:25:28.081
we call these things because they are
multiple cysts

00:25:28.081 --> 00:25:31.179
we call these cyst

00:25:31.179 --> 00:25:34.019
one-word system adenoma

00:25:34.019 --> 00:25:37.079
and here's what it would look like

00:25:37.079 --> 00:25:39.064
don't have a scale on there

00:25:39.064 --> 00:25:42.001
normal ovaries about the size of a

00:25:42.001 --> 00:25:43.026
well you know

00:25:43.026 --> 00:25:45.029
small not

00:25:45.029 --> 00:25:48.042
this thing was about the size of a
football

00:25:48.042 --> 00:25:50.052
they can they can get big

00:25:50.052 --> 00:25:52.021
uh...

00:25:52.021 --> 00:25:56.659
levy banana thier this it would be
suggested by the fact that the surface

00:25:56.659 --> 00:25:59.073
is perfectly smooth and whatever there
is

00:25:59.073 --> 00:26:01.039
there's orderly

00:26:01.039 --> 00:26:04.061
anesth one minute that surfaces
perfectly smooth

00:26:04.061 --> 00:26:06.679
cut into the thing

00:26:06.679 --> 00:26:10.007
you see assist the character

00:26:10.007 --> 00:26:13.071
these were these were filled with a
musician is material

00:26:13.071 --> 00:26:15.083
which we washed away

00:26:15.083 --> 00:26:20.069
of there's a system that's lined by

00:26:20.069 --> 00:26:24.055
benign glandular epithelium there there
there are so far

00:26:24.055 --> 00:26:26.034
many little daughter cysts

00:26:26.034 --> 00:26:29.034
so that is an ovarian

00:26:29.034 --> 00:26:33.058
sister adenoma see how we built the
names

00:26:33.058 --> 00:26:35.008
without much in mind

00:26:35.008 --> 00:26:38.097
we got a next step and say what about

00:26:38.097 --> 00:26:39.087
malignancy

00:26:39.087 --> 00:26:40.097
counterparts

00:26:40.097 --> 00:26:46.003
now the role here is if you have been at
the same feel neoplasm

00:26:46.003 --> 00:26:48.038
of any sort

00:26:48.038 --> 00:26:50.009
and it has malignant

00:26:50.009 --> 00:26:52.047
it is a carcinoma

00:26:52.047 --> 00:26:54.084
so it's the word

00:26:54.084 --> 00:26:57.002
carcinoma appears as any part of the
named

00:26:57.002 --> 00:26:58.075
you say to yourself

00:26:58.075 --> 00:27:01.049
jake this is at it's a little

00:27:01.049 --> 00:27:03.013
and there is no limit

00:27:03.013 --> 00:27:05.072
transmit a lot of information with that

00:27:05.072 --> 00:27:07.069
then you add

00:27:07.069 --> 00:27:09.027
compound

00:27:09.027 --> 00:27:10.459
the parts of the

00:27:10.459 --> 00:27:11.929
gets its day

00:27:11.929 --> 00:27:13.056
glandular

00:27:13.056 --> 00:27:16.025
malignancy what do you suppose you call
it

00:27:16.025 --> 00:27:17.083
adamo

00:27:17.083 --> 00:27:18.052
carcinoma

00:27:18.052 --> 00:27:21.007
if this is cuevas malignancy

00:27:21.007 --> 00:27:24.499
square myself carcinoma et cetera only

00:27:24.499 --> 00:27:26.269
and then you can't rely on

00:27:26.269 --> 00:27:29.549
you'll see in our reports all sorts of
things

00:27:29.549 --> 00:27:31.859
moderately well differentiation did

00:27:31.859 --> 00:27:35.449
moderately well differentiated nuisance
secreting

00:27:35.449 --> 00:27:36.092
adenocarcinoma lacz

00:27:36.092 --> 00:27:39.099
put on some frosting on the cake the
food

00:27:39.099 --> 00:27:40.098
the basic thing is that tells you

00:27:40.098 --> 00:27:44.039
that is glandular that it is

00:27:44.039 --> 00:27:46.001
malignant

00:27:46.001 --> 00:27:50.005
so i'll show you some carcinomas quickly

00:27:50.005 --> 00:27:53.045
that'll make about half of you cringe

00:27:53.045 --> 00:27:56.018
uh... that's just what the label says

00:27:56.018 --> 00:27:59.084
of the glands of the penises largely
replaced

00:27:59.084 --> 00:28:00.075
by this

00:28:00.075 --> 00:28:02.017
uh...

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

00:28:05.093 --> 00:28:09.058
would refer to a neoplasm has grown out
what how much room here

00:28:09.058 --> 00:28:12.039
we talk about it is fun game

00:28:12.039 --> 00:28:13.009
fungus funding

00:28:13.009 --> 00:28:24.092
so this is

00:28:24.092 --> 00:28:29.078
well some some sisterhood military
generic answer some sis

00:28:29.078 --> 00:28:33.033
are not nearly fast

00:28:33.033 --> 00:28:37.015
that you get if you obstructed for
instance ductile structure

00:28:37.015 --> 00:28:39.065
and something is secreting into it

00:28:39.065 --> 00:28:43.006
it's obstructed here it'll become
systemically dilated before missus

00:28:43.006 --> 00:28:45.044
others just happen to be

00:28:45.044 --> 00:28:50.059
the way they are because they're they're
neoplasms

00:28:50.059 --> 00:28:54.096
well at any rate getting medicine is so
this is a fun gating

00:28:54.096 --> 00:28:56.028
neoplasm

00:28:56.028 --> 00:29:01.052
another word we use is exo finicky excel
meaning outward ph wide ta cee growing

00:29:01.052 --> 00:29:02.041
outward

00:29:02.041 --> 00:29:06.027
well this is partly funding but this was
infiltrating deeply

00:29:06.027 --> 00:29:09.149
this is a highly malignant neoplasm even
though it's

00:29:09.149 --> 00:29:10.076
pretty well differentiated

00:29:10.076 --> 00:29:13.096
and this is presently mona lymph nodes
at the time

00:29:13.096 --> 00:29:15.097
now this happened

00:29:15.097 --> 00:29:19.076
they the covering of the glances cuevas

00:29:19.076 --> 00:29:22.033
epithelium this was a swimmers cell

00:29:22.033 --> 00:29:23.085
carcinoma

00:29:23.085 --> 00:29:26.739
this illustrates a something you'll
learn

00:29:26.739 --> 00:29:30.024
it is not uncommon says people have a
great sense of the miles

00:29:30.024 --> 00:29:34.049
this thing didn't show up the thursday
night before he came into the doctor

00:29:34.049 --> 00:29:37.025
this has been there many many months

00:29:37.025 --> 00:29:40.091
and people have all sorts of ways of
explaining these things away in the

00:29:40.091 --> 00:29:43.021
nineteen hoping they're not there
tomorrow morning

00:29:43.021 --> 00:29:44.249
when a shower

00:29:44.249 --> 00:29:45.039
and so forth

00:29:45.039 --> 00:29:48.047
but that's a highly advanced lesion

00:29:48.047 --> 00:29:51.005
yours for the other half

00:29:51.005 --> 00:29:53.089
now this one

00:29:53.089 --> 00:29:58.097
is also basically my cell carcinoma
reveal a b errol covered by squamous

00:29:58.097 --> 00:29:59.099
epithelium

00:29:59.099 --> 00:30:00.067
scenarios

00:30:00.067 --> 00:30:03.012
now that was sensed by the patient

00:30:03.012 --> 00:30:06.052
as a sore store there that didn't heal

00:30:06.052 --> 00:30:08.539
it was in the master was acts of faith

00:30:08.539 --> 00:30:11.026
but this thing penetrated in

00:30:11.026 --> 00:30:13.003
about a centimeter or two

00:30:13.003 --> 00:30:17.039
not hand it was also present in the imo
lymph nodes

00:30:17.039 --> 00:30:19.074
on that side

00:30:19.074 --> 00:30:21.066
when the cell carcinoma

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

00:30:24.097 --> 00:30:26.033
like this

00:30:26.033 --> 00:30:28.022
and this is a cervix

00:30:28.022 --> 00:30:30.005
to observe ovaries over here

00:30:30.005 --> 00:30:32.006
and vagina

00:30:32.006 --> 00:30:37.042
and what should have been a nice cervix
here is completely destroyed

00:30:37.042 --> 00:30:40.004
by this very very advanced

00:30:40.004 --> 00:30:41.779
square was still

00:30:41.779 --> 00:30:43.068
carcinoma

00:30:43.068 --> 00:30:45.869
the face of the cervix that

00:30:45.869 --> 00:30:49.058
juts into the giant is covered by square
was that the feelings of many of these

00:30:49.058 --> 00:30:51.095
cancers are swimmers

00:30:51.095 --> 00:30:55.006
number i showed you beyond the cervix
the other day that also has glandular

00:30:55.006 --> 00:30:58.082
line so we do see some admin carcinomas
there

00:30:58.082 --> 00:30:59.084
these are

00:30:59.084 --> 00:31:02.011
uh... basically provoked by

00:31:02.011 --> 00:31:07.052
a number of strains of the human
papillomavirus

00:31:07.052 --> 00:31:09.003
it's it's uh...

00:31:09.003 --> 00:31:10.006
transmissible

00:31:10.006 --> 00:31:12.046
virus and uh... this is

00:31:12.046 --> 00:31:13.429
one of the

00:31:13.429 --> 00:31:14.007
bad outcomes

00:31:14.007 --> 00:31:19.018
now i say that i hope you'll never
senior probably never see one quite

00:31:19.018 --> 00:31:21.015
disadvantage of practice in this country

00:31:21.015 --> 00:31:24.098
because of the widespread use of pap
smears we discussed that last time you

00:31:24.098 --> 00:31:25.629
can

00:31:25.629 --> 00:31:29.379
even apprehend this sort of thing one is
still in the insight tuesday jury even

00:31:29.379 --> 00:31:31.068
earlier with displeasure

00:31:31.068 --> 00:31:34.089
you don't have to wait for this when
this woman already had a follow bloody

00:31:34.089 --> 00:31:38.389
discharge because of this

00:31:38.389 --> 00:31:40.086
neoplasm

00:31:40.086 --> 00:31:44.048
well let's go back to him and g<u>i</u> tract

00:31:44.048 --> 00:31:45.045
uni

00:31:45.045 --> 00:31:50.001
upper aerodynamicists tracked into the
tongue the line-item all of the back of

00:31:50.001 --> 00:31:51.094
the throat banks and so forth

00:31:51.094 --> 00:31:57.054
we commonly see squeamish cell
carcinomas

00:31:57.054 --> 00:31:59.045
and this is a ton

00:31:59.045 --> 00:32:01.099
that's been amputated

00:32:01.099 --> 00:32:03.045
cuts actually

00:32:03.045 --> 00:32:08.015
and you can see this very deeply
invasive mass this was a squamous cell

00:32:08.015 --> 00:32:09.029
carcinoma

00:32:09.029 --> 00:32:09.062
rising

00:32:09.062 --> 00:32:11.052
out here

00:32:11.052 --> 00:32:12.087
these or older

00:32:12.087 --> 00:32:14.076
uh...

00:32:14.076 --> 00:32:20.013
for racial cancers are mostly related to
smoking and drinking

00:32:20.013 --> 00:32:22.034
and

00:32:22.034 --> 00:32:26.006
histologically this might look identical
to living in the cervix but it's got a

00:32:26.006 --> 00:32:28.009
different etiology

00:32:28.009 --> 00:32:32.559
and different different behavior but
this was a very deeply invasive

00:32:32.559 --> 00:32:34.076
square missile carcinoma

00:32:34.076 --> 00:32:38.027
here's another one mister heavy smoker

00:32:38.027 --> 00:32:40.015
this is a larynx

00:32:40.015 --> 00:32:41.046
opened in the back

00:32:41.046 --> 00:32:44.058
so the adam's apple store the front my
spread open

00:32:44.058 --> 00:32:47.058
there's a deeply ulcerative tumor there

00:32:47.058 --> 00:32:48.087
uh...

00:32:48.087 --> 00:32:53.062
this may have been around for months and
months and months and months

00:32:53.062 --> 00:32:54.089
head-first

00:32:54.089 --> 00:32:56.094
classes don't necessarily cause pain

00:32:56.094 --> 00:33:00.035
you know i must say infiltrate nerves
are not going to cause much pain

00:33:00.035 --> 00:33:04.071
this guy had inherited of cough in his
voice changed as you can imagine the

00:33:04.071 --> 00:33:07.051
vocal cord gradually being destroyed

00:33:07.051 --> 00:33:10.064
you know a heavy smokers are used to
being a horse and coughing and so forth

00:33:10.064 --> 00:33:13.085
and again the denial kicks in

00:33:13.085 --> 00:33:16.509
this was a along the collected

00:33:16.509 --> 00:33:19.002
square was still carcinoma

00:33:19.002 --> 00:33:21.000
larynx

00:33:21.000 --> 00:33:24.279
take it down the esophagus nam two miles
is up there

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

00:33:28.009 --> 00:33:30.007
opened an office is rough in the area

00:33:30.007 --> 00:33:34.045
and the cut surface area to see at the
wall a second

00:33:34.045 --> 00:33:37.169
this is a very advanced

00:33:37.169 --> 00:33:38.022
carcinoma

00:33:38.022 --> 00:33:43.000
aligning of the esophagus disclaimers in
this was a square must sell

00:33:43.000 --> 00:33:45.052
carcinoma

00:33:45.052 --> 00:33:48.086
desert you can imagine will produce a
mechanical problems patients will have

00:33:48.086 --> 00:33:50.008
trouble swallowing

00:33:50.008 --> 00:33:51.066
and there again

00:33:51.066 --> 00:33:53.239
i've seen patients come in

00:33:53.239 --> 00:33:56.084
and strain baby food before they finally
say oncall

00:33:56.084 --> 00:33:59.064
and decide that something might be wrong

00:33:59.064 --> 00:34:02.099
and these are very hard to cure because
of the fact that they are advancing

00:34:02.099 --> 00:34:07.000
their local my pastor sees it's not just
in the past the seas

00:34:07.000 --> 00:34:08.689
we can also see

00:34:08.689 --> 00:34:11.349
adamo carcinomas nearsightedness

00:34:11.349 --> 00:34:17.829
because there are some glandular
epithelium there that can also give rise

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

00:34:21.059 --> 00:34:23.096
washington is the esophagus up there is
this

00:34:23.096 --> 00:34:25.959
do indian coming off over here

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

00:34:31.049 --> 00:34:34.989
but you'll notice that the normal full
pattern

00:34:34.989 --> 00:34:37.289
desire note here

00:34:37.289 --> 00:34:40.129
it doesn't look so awful that at first
blush

00:34:40.129 --> 00:34:45.699
but that is a diffuse lee infiltrated
carcinoma

00:34:45.699 --> 00:34:49.409
what kind is suppose it is given up his
stomach is a

00:34:49.409 --> 00:34:52.829
glandular lying

00:34:52.829 --> 00:34:54.399
adenocarcinoma

00:34:54.399 --> 00:34:56.959
and uh... these things are

00:34:56.959 --> 00:35:01.269
very subtle and a symptomatic until
their advance this was very advances as

00:35:01.269 --> 00:35:03.299
medicine at ican liver already

00:35:03.299 --> 00:35:04.859
at the time it came

00:35:04.859 --> 00:35:07.059
uh...

00:35:07.059 --> 00:35:11.089
so they may have traditionally symptoms
at all and interesting wrinkle here is

00:35:11.089 --> 00:35:15.049
uh... the incidence of this kind of
tumor is very high in japan

00:35:15.049 --> 00:35:16.479
much higher than here

00:35:16.479 --> 00:35:20.369
and it's largely in environmental thing
because the descendants of japanese who

00:35:20.369 --> 00:35:21.016
come here

00:35:21.016 --> 00:35:22.859
or pick up our other

00:35:22.859 --> 00:35:23.095
yankee problems

00:35:23.095 --> 00:35:28.829
but uh... this incident changes but it's
such a public health problem

00:35:28.829 --> 00:35:30.099
that they will screen

00:35:30.099 --> 00:35:34.239
for this sort of thing because there's
nothing like this could produce symptoms

00:35:34.239 --> 00:35:34.098
early on

00:35:34.098 --> 00:35:38.074
so the only hope of getting it earlier
is played by population screening and

00:35:38.074 --> 00:35:40.599
that's that's another matter

00:35:40.599 --> 00:35:42.038
for another time

00:35:42.038 --> 00:35:46.089
here's one that will anticipate uh...
this afternoon

00:35:46.089 --> 00:35:48.319
getting down to a large intestine

00:35:48.319 --> 00:35:51.349
this is actually in the first part of a
large intestine over here right where

00:35:51.349 --> 00:35:56.289
the small intestine answers for the
appendix comes offices so called safe

00:35:56.289 --> 00:35:57.819
this about

00:35:57.819 --> 00:36:00.229
poultry four inches in diameter

00:36:00.229 --> 00:36:01.008
and there's a huge

00:36:01.008 --> 00:36:05.889
fung gaining neoplasm there

00:36:05.889 --> 00:36:09.459
anissa grown glandular lining so it's an
adamo

00:36:09.459 --> 00:36:10.789
carcinoma

00:36:10.789 --> 00:36:11.509
now

00:36:11.509 --> 00:36:13.098
in terms of our clinical present asian

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

00:36:17.077 --> 00:36:19.739
trucked something bad big so that

00:36:19.739 --> 00:36:22.067
the first confiscate passing by

00:36:22.067 --> 00:36:25.599
doesn't cause any pain

00:36:25.599 --> 00:36:27.999
at least at this stage

00:36:27.999 --> 00:36:31.159
one things that happens with these as
they believe

00:36:31.159 --> 00:36:35.169
you know the passing traffic will will
erode the surface and they'll believe

00:36:35.169 --> 00:36:37.889
they'll lose blood

00:36:37.889 --> 00:36:39.064
this is all borrow

00:36:39.064 --> 00:36:41.989
three feet from the i<u>n</u>s_

00:36:41.989 --> 00:36:46.449
colin goes up here cross here down here
there's a little blue goes out

00:36:46.449 --> 00:36:49.639
in the fact is five times the blood

00:36:49.639 --> 00:36:54.729
goes from there to meet a nice it's no
longer rat its black

00:36:54.729 --> 00:36:58.979
the patient will be passing schools that
i mean if he's losing enough blood

00:36:58.979 --> 00:37:00.679
we passing stools

00:37:00.679 --> 00:37:02.033
that perhaps look

00:37:02.033 --> 00:37:04.008
tari that's the efforts that given to
them

00:37:04.008 --> 00:37:07.063
something we called mellon up learn
ad-aware

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

00:37:12.939 --> 00:37:14.739
and patience will comment

00:37:14.739 --> 00:37:17.073
and a couple of ways with this they may
say

00:37:17.073 --> 00:37:21.014
if their particular instrument look in
the bolded for a flash

00:37:21.014 --> 00:37:23.049
uh... dr

00:37:23.049 --> 00:37:25.309
harry schools was wrong

00:37:25.309 --> 00:37:29.069
more unlikely in this is something you
must always remember middle-aged or

00:37:29.069 --> 00:37:31.169
elderly patient comes an incentive

00:37:31.169 --> 00:37:33.409
i'm just proved all the time

00:37:33.409 --> 00:37:37.499
you know describes being he's easily
fatigued and weak and so forth you take

00:37:37.499 --> 00:37:39.064
a look and they were kind of payal

00:37:39.064 --> 00:37:41.229
are you doing a glowing

00:37:41.229 --> 00:37:43.509
you find it terribly anemic

00:37:43.509 --> 00:37:44.399
it's from chronic

00:37:44.399 --> 00:37:48.042
i called blood loss like this

00:37:48.042 --> 00:37:54.159
climate chances on the right side in the
korea's

00:37:54.159 --> 00:37:55.679
jess's all through the colon

00:37:55.679 --> 00:37:59.199
uh... this is one very closely nis

00:37:59.199 --> 00:38:02.003
wishes in circles the whole by all
around

00:38:02.003 --> 00:38:04.189
like a napkin rings

00:38:04.189 --> 00:38:08.559
you know who actually produce narrowing
below min obviously is infiltrated the

00:38:08.559 --> 00:38:13.119
muscle of the wall that would produce a
change in bal habits

00:38:13.119 --> 00:38:15.829
it will produce frank

00:38:15.829 --> 00:38:20.249
in the schools is close enough to the
unicef if it bleeds can come out blood

00:38:20.249 --> 00:38:21.799
that's referred to

00:38:21.799 --> 00:38:23.569
he met okie xia

00:38:23.569 --> 00:38:25.749
ichi ohmae tito

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

00:38:30.739 --> 00:38:33.004
for me to go potty

00:38:33.004 --> 00:38:36.099
over

00:38:36.099 --> 00:38:39.339
the american uses frank blood

00:38:39.339 --> 00:38:41.879
unit in the school which may be that in

00:38:41.879 --> 00:38:45.709
again people deny this is a law that
hemorrhoids and thereby preparation h

00:38:45.709 --> 00:38:48.319
and stick it up there for

00:38:48.319 --> 00:38:51.099
however long before they finally come in

00:38:51.099 --> 00:38:55.339
the important thing is is will also
point out this afternoon is be the

00:38:55.339 --> 00:39:00.069
survival of the prognosis is stage
related

00:39:00.069 --> 00:39:03.829
farzad penetrate through the ball wall
is it in the regional lymph nodes and so

00:39:03.829 --> 00:39:04.509
forth

00:39:04.509 --> 00:39:08.299
uh... these are the important factors

00:39:08.299 --> 00:39:09.021
all right

00:39:09.021 --> 00:39:11.149
couple of smokers things

00:39:11.149 --> 00:39:14.729
you can see about fifty packages of

00:39:14.729 --> 00:39:17.139
and that long

00:39:17.139 --> 00:39:20.329
here is a massive obstructing

00:39:20.329 --> 00:39:24.089
bronchus here this is the dilated
bronchus

00:39:24.089 --> 00:39:25.006
and full of

00:39:25.006 --> 00:39:28.719
newco kurland exudate

00:39:28.719 --> 00:39:30.066
that's the tumor right there

00:39:30.066 --> 00:39:32.449
and this patient presented

00:39:32.449 --> 00:39:35.409
or we probably had a cough but all
smoker's cough

00:39:35.409 --> 00:39:38.299
uh... presented with repeated pneumonia

00:39:38.299 --> 00:39:39.949
kept coming with episodes of pneumonia

00:39:39.949 --> 00:39:42.289
who's always in the same place

00:39:42.289 --> 00:39:45.659
and they finally tumbled to the fact
that we always have obstruct must have

00:39:45.659 --> 00:39:47.299
obstructive lesion there

00:39:47.299 --> 00:39:49.489
and there it was

00:39:49.489 --> 00:39:50.088
not leave

00:39:50.088 --> 00:39:55.079
bronchus is line by a glandular type of
epithelium so there are adamo carcinomas

00:39:55.079 --> 00:39:58.609
and one

00:39:58.609 --> 00:40:02.879
notoriously there can be metalplaza xia
of the broncos that goes on to display

00:40:02.879 --> 00:40:07.679
not only not a place of the displays
human cancer and many of these parts qua

00:40:07.679 --> 00:40:09.019
must sell

00:40:09.019 --> 00:40:10.669
carcinomas

00:40:10.669 --> 00:40:13.053
so there is a relatively small one that
produced

00:40:13.053 --> 00:40:14.044
repeated bouts

00:40:14.044 --> 00:40:16.039
of pneumonia

00:40:16.039 --> 00:40:19.019
there's a larger one just to show you
what they could look like when they

00:40:19.019 --> 00:40:21.079
really get out of hand

00:40:21.079 --> 00:40:22.549
here's an interesting one

00:40:22.549 --> 00:40:27.019
uh... close up here trachea coming down
here bronchus hier bronchus here you see

00:40:27.019 --> 00:40:28.042
this little thing

00:40:28.042 --> 00:40:29.007
this was a

00:40:29.007 --> 00:40:31.509
sway with cell carcinoma

00:40:31.509 --> 00:40:33.052
and you say well why didn't they

00:40:33.052 --> 00:40:37.859
uh... simply doing norman actually take
off the bronchus here you can live with

00:40:37.859 --> 00:40:40.309
one long

00:40:40.309 --> 00:40:43.109
doing it right here this is an autopsy
specimens

00:40:43.109 --> 00:40:44.051
and actually this

00:40:44.051 --> 00:40:47.046
thing that looks small here had gone
through

00:40:47.046 --> 00:40:49.089
the back of the bronchus

00:40:49.089 --> 00:40:52.909
this is all neoplasm kind of in case the
heartbeat was

00:40:52.909 --> 00:40:56.000
hopeless from from from the get go
swimmin cell

00:40:56.000 --> 00:40:58.809
carcinoma

00:40:58.809 --> 00:41:02.093
sestalo market was the benign one of my
smooth surfaces

00:41:02.093 --> 00:41:05.279
inside this this will line when i see
you

00:41:05.279 --> 00:41:06.819
had a feeling of

00:41:06.819 --> 00:41:12.008
here's the malignant counterpart you can
see the steiner's than other ovarian

00:41:12.008 --> 00:41:13.179
neoplasm

00:41:13.179 --> 00:41:17.109
it's mulligan and so we call it sister i
don't know

00:41:17.109 --> 00:41:18.059
carcinoma

00:41:18.059 --> 00:41:20.018
masses there than normal

00:41:20.018 --> 00:41:22.009
disassemble carcinoma

00:41:22.009 --> 00:41:26.067
the thing and then would immediately
took us to say this isn't just a simple

00:41:26.067 --> 00:41:27.039
system nama

00:41:27.039 --> 00:41:30.071
is a surface is no longer smooth like
this everywhere

00:41:30.071 --> 00:41:31.969
this guy

00:41:31.969 --> 00:41:33.949
very furry looking growth

00:41:33.949 --> 00:41:36.829
all over the surface

00:41:36.829 --> 00:41:42.339
and the bubbles inside ourselves

00:41:42.339 --> 00:41:44.349
neoplasm growing from the lining of the
trouble

00:41:44.349 --> 00:41:47.074
in other words the many of you can see
some bubbles so there are some cystic

00:41:47.074 --> 00:41:48.061
spaces

00:41:48.061 --> 00:41:53.759
but many of the previously cystic spaces
are filled with his rapidly growing

00:41:53.759 --> 00:41:54.479
neoplasm

00:41:54.479 --> 00:41:57.021
so this is sister adamo

00:41:57.021 --> 00:41:59.109
carcinoma

00:41:59.109 --> 00:42:04.239
i don't have an illustration of it but
you can imagine papillary tumor

00:42:04.239 --> 00:42:07.659
being eight papillary carcinoma greta
papilloma

00:42:07.659 --> 00:42:11.559
or papillary carcinoma

00:42:11.559 --> 00:42:14.043
so learn to to handle

00:42:14.043 --> 00:42:16.092
these uh... the moment but sure here

00:42:16.092 --> 00:42:22.249
as i say quite quite played by reflex

00:42:22.249 --> 00:42:23.014
let's switch

00:42:23.014 --> 00:42:37.299
away from apathy leo

00:42:37.299 --> 00:42:39.014
uh...

00:42:39.014 --> 00:42:40.319
this along

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

00:42:45.068 --> 00:42:48.409
under the microscope you would see not
only

00:42:48.409 --> 00:42:51.469
growth of these fingers but you see
invasion

00:42:51.469 --> 00:42:53.759
you'd also see more panoply here

00:42:53.759 --> 00:42:56.709
in you know psychologically it's a
combination of things but that's a

00:42:56.709 --> 00:42:58.509
that's a very good point

00:42:58.509 --> 00:43:01.063
and sometimes it's and it's a devilish
problem i see a lot of

00:43:01.063 --> 00:43:04.099
stuff growing out we've gotta make
multiple sections and see if any of its

00:43:04.099 --> 00:43:07.229
invading

00:43:07.229 --> 00:43:09.579
now getting away from

00:43:09.579 --> 00:43:11.199
as helium

00:43:11.199 --> 00:43:13.079
getting too nice a little dish is what
we call

00:43:13.079 --> 00:43:18.709
a supporting tissue or missing coble
tissues

00:43:18.709 --> 00:43:19.869
fibrous tissue

00:43:19.869 --> 00:43:23.014
smooth muscles column also bone
cartilage those of the things we're

00:43:23.014 --> 00:43:25.069
talking about

00:43:25.069 --> 00:43:28.769
but when i got your becomes easy if you
know a little and then great

00:43:28.769 --> 00:43:30.064
if you have a

00:43:30.064 --> 00:43:35.999
benign tumor of fatty tissue adipose
tissue recall well-lit

00:43:35.999 --> 00:43:37.004
wal-mart

00:43:37.004 --> 00:43:39.004
like mama

00:43:39.004 --> 00:43:42.659
benign neoplasm carl agin this tissue

00:43:42.659 --> 00:43:44.949
kong drama

00:43:44.949 --> 00:43:47.046
the minute plasma fibrous tissue

00:43:47.046 --> 00:43:50.079
five romana etcetera etcetera

00:43:50.079 --> 00:43:52.369
thursday after the latin and greek

00:43:52.369 --> 00:43:57.149
the system here is if it's malignancy

00:43:57.149 --> 00:43:59.939
milkar carcinoma because that's that's
really all

00:43:59.939 --> 00:44:04.047
if it's malignant an album as likable as
supporting tissue which holidays

00:44:04.047 --> 00:44:06.049
star

00:44:06.049 --> 00:44:07.056
you've all heard these words

00:44:07.056 --> 00:44:11.799
but now you have to be used in precisely

00:44:11.799 --> 00:44:16.014
malignant neoplasm a fatty tissue is a
light posts are calm

00:44:16.014 --> 00:44:18.899
in malignant neoplasm of

00:44:18.899 --> 00:44:20.067
carl edge in this issue is that

00:44:20.067 --> 00:44:22.259
conroe sarcoma

00:44:22.259 --> 00:44:25.109
and so forth

00:44:25.109 --> 00:44:28.749
the interesting thing about these is
there not organ specific as many organs

00:44:28.749 --> 00:44:31.769
have smooth muscle in the wall many
organs have

00:44:31.769 --> 00:44:32.096
cartilage

00:44:32.096 --> 00:44:35.609
many places in the body have owned

00:44:35.609 --> 00:44:39.109
many uh... everything in the body
practice fibrous tissue so you can see

00:44:39.109 --> 00:44:40.339
these tumors

00:44:40.339 --> 00:44:43.369
arising in a variety of places

00:44:43.369 --> 00:44:46.149
hears a strange one

00:44:46.149 --> 00:44:49.659
incidental autopsy findings guide that
is something completely different had no

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

00:44:53.629 --> 00:44:55.289
mucous membrane hearing here

00:44:55.289 --> 00:44:59.239
and you look at that you say that a lot
of it

00:44:59.239 --> 00:45:01.149
fatty tissue

00:45:01.149 --> 00:45:04.909
buffer size only to turn on a big golf
ball onset

00:45:04.909 --> 00:45:06.026
uh...

00:45:06.026 --> 00:45:09.098
histologically that was perfectly well
differentiated i couldn't tell it from

00:45:09.098 --> 00:45:14.019
normal facile in the center of that big
glob of

00:45:14.019 --> 00:45:17.999
adipose tissue that's a light palm up

00:45:17.999 --> 00:45:20.979
they do a currently

00:45:20.979 --> 00:45:22.094
their coats of the uh...

00:45:22.094 --> 00:45:28.017
of the bal but it's quite rare where do
you suppose locals were coming

00:45:28.017 --> 00:45:30.169
well where there's a lot of fatty tissue

00:45:30.169 --> 00:45:33.629
very common subcutaneously there may be
some like homelessness room like a

00:45:33.629 --> 00:45:36.038
chilly at least one

00:45:36.038 --> 00:45:39.469
they're they're not at all on common and
they're they're perfectly

00:45:39.469 --> 00:45:41.199
but revealing holiness

00:45:41.199 --> 00:45:44.579
they harbor didn't produce any symptoms

00:45:44.579 --> 00:45:46.083
alright nearest here's a uterus

00:45:46.083 --> 00:45:50.999
and each one of these is what you would
call a fibroid

00:45:50.999 --> 00:45:54.015
but now i will give you the correct
nomenclature

00:45:54.015 --> 00:45:59.044
these tumors are benign air rising from
the muscle of the uterus so they are my

00:45:59.044 --> 00:46:00.088
yo mas

00:46:00.088 --> 00:46:02.829
and wyoming muscle

00:46:02.829 --> 00:46:06.369
and because the particular kind of
muscle which you learn about his smooth

00:46:06.369 --> 00:46:06.919
muscle

00:46:06.919 --> 00:46:08.059
this is a

00:46:08.059 --> 00:46:09.589
lower these are multiple

00:46:09.589 --> 00:46:14.279
lightly or my omens

00:46:14.279 --> 00:46:15.044
none of my culture

00:46:15.044 --> 00:46:20.129
these can produce a variety of
mechanical systems hyper memory a

00:46:20.129 --> 00:46:24.259
the big bowl compelled us as you
mentioned and some of the many a

00:46:24.259 --> 00:46:25.779
marriage symptomatic

00:46:25.779 --> 00:46:28.989
even at this size believe it or not

00:46:28.989 --> 00:46:30.749
here is a

00:46:30.749 --> 00:46:33.017
malignancy moment

00:46:33.017 --> 00:46:34.349
uh...

00:46:34.349 --> 00:46:36.013
here's the x_-ray even see

00:46:36.013 --> 00:46:39.046
this is what the bone should look like
it's very dense in here is obviously

00:46:39.046 --> 00:46:41.239
more bone being made

00:46:41.239 --> 00:46:44.979
the outer membrane a perry asked him
about has been lifted

00:46:44.979 --> 00:46:48.039
by something pushing out in here it is

00:46:48.039 --> 00:46:51.369
here's the bone here is the bone for me
to more here

00:46:51.369 --> 00:46:53.041
has broken through the cortex

00:46:53.041 --> 00:46:57.689
news out into the soft tissues so this
is a sarcoma

00:46:57.689 --> 00:46:58.709
osteo

00:46:58.709 --> 00:46:59.088
sarcoma

00:46:59.088 --> 00:47:02.009
this is by a large a tumor just

00:47:02.009 --> 00:47:04.009
in passing of

00:47:04.009 --> 00:47:07.049
growing bones teenage kids young adults

00:47:07.049 --> 00:47:11.579
uh... a highly malignant intent in the
past size early on

00:47:11.579 --> 00:47:14.529
cut to the longest

00:47:14.529 --> 00:47:19.559
nothing is immune here is a tumor rising
in the soft-tissue beside harry fleshy

00:47:19.559 --> 00:47:21.009
looking

00:47:21.009 --> 00:47:26.022
is derived from scalable muscle mild
sarcoma but this time it isn't wyo

00:47:26.022 --> 00:47:27.929
it's rad though

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

00:47:32.369 --> 00:47:33.029
say hello

00:47:33.029 --> 00:47:41.599
this is a supporting vision neoplasm
some sort

00:47:41.599 --> 00:47:42.929
classes are common

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

00:47:46.219 --> 00:47:48.859
out all you could lose amputated hope
for the best

00:47:48.859 --> 00:47:53.259
now other forms of chemotherapy and
partial resection of the bone with it

00:47:53.259 --> 00:47:56.499
with insertion of other bone and so
forth a lot of

00:47:56.499 --> 00:47:58.329
nice fancy things they could do now

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

00:48:01.539 --> 00:48:04.489
aggressive tumor

00:48:04.489 --> 00:48:07.729
friday quickly now

00:48:07.729 --> 00:48:08.749
another

00:48:08.749 --> 00:48:12.939
crying of neoplasm we talk about
epithelial tissue we talk about

00:48:12.939 --> 00:48:14.739
supporting on his ankle both issues

00:48:14.739 --> 00:48:16.479
there are

00:48:16.479 --> 00:48:20.509
neoplasms of the lymphoid tissues and
the invite him out of poetic i mean

00:48:20.509 --> 00:48:22.109
blood forming

00:48:22.109 --> 00:48:23.013
tissues

00:48:23.013 --> 00:48:26.089
there are uh... neoplasms of these

00:48:26.089 --> 00:48:31.679
and here is where you get into some sort
of a key terminology

00:48:31.679 --> 00:48:36.469
neoplasms of the lymphoid tissues are
referred to as lymphomas

00:48:36.469 --> 00:48:38.859
and you would say well that sounds
benign

00:48:38.859 --> 00:48:40.309
there's not nice

00:48:40.309 --> 00:48:42.319
behind me a plasma lymphocytes

00:48:42.319 --> 00:48:46.409
faso there's no such thing as a good
nine lymphoma

00:48:46.409 --> 00:48:48.014
we don't recognize them

00:48:48.014 --> 00:48:50.059
if there are we don't recognize them

00:48:50.059 --> 00:48:53.015
so when you hear the word lymphoma
despite

00:48:53.015 --> 00:48:54.041
what it sounds like

00:48:54.041 --> 00:49:00.038
that's a malignant neoplasm of lymphoid
tissue

00:49:00.038 --> 00:49:04.609
similarly well i'll get to this but
leukemia refers to any any situation

00:49:04.609 --> 00:49:05.229
really

00:49:05.229 --> 00:49:09.979
where the malignant cells in the usually
blood forming cells

00:49:09.979 --> 00:49:12.088
on mass in the circulation

00:49:12.088 --> 00:49:16.299
refer to that is leukemia white blood

00:49:16.299 --> 00:49:18.469
the old german was vices looked

00:49:18.469 --> 00:49:21.859
there was described by them farmers

00:49:21.859 --> 00:49:23.359
interesting they may present

00:49:23.359 --> 00:49:27.014
as seemingly localized tumors with some
local spread

00:49:27.014 --> 00:49:30.769
but because lymphocytes there there's
lymphoid tissue all of the body

00:49:30.769 --> 00:49:34.079
and lymphocytes you'll learn move around
the body

00:49:34.079 --> 00:49:37.005
lymphomas frequently present as systemic
diseases

00:49:37.005 --> 00:49:39.149
rather than localized

00:49:39.149 --> 00:49:41.569
sometimes localize it very often

00:49:41.569 --> 00:49:42.099
systemic

00:49:42.099 --> 00:49:43.839
this man came in

00:49:43.839 --> 00:49:46.109
this is an old old photograph

00:49:46.109 --> 00:49:49.023
and you see general swelling in his neck
here

00:49:49.023 --> 00:49:53.075
you can see here's his classical he's
got a super cobra killer mode there

00:49:53.075 --> 00:49:56.489
similar supercritical in though there

00:49:56.489 --> 00:49:58.689
he noticed those but his armpits

00:49:58.689 --> 00:50:03.043
were full of enlarged lymph nodes by
chest x_-ray has me this time was

00:50:03.043 --> 00:50:07.269
widened and full of lymph nodes his
abdomen was full of enlargement bones he

00:50:07.269 --> 00:50:07.078
presented

00:50:07.078 --> 00:50:10.409
with a systemic disease

00:50:10.409 --> 00:50:11.098
this was a a

00:50:11.098 --> 00:50:14.189
widely disseminated lymphoma

00:50:14.189 --> 00:50:15.022
lymphoma can

00:50:15.022 --> 00:50:18.019
dennis like too many different

00:50:18.019 --> 00:50:19.529
lymphoid tissues in the body

00:50:19.529 --> 00:50:22.008
this is the rapture para commanders a
kidney kidney

00:50:22.008 --> 00:50:24.088
knows you behind a really happening

00:50:24.088 --> 00:50:26.067
this is a mass

00:50:26.067 --> 00:50:29.109
of lymph nodes enlarge they should be

00:50:29.109 --> 00:50:32.339
uh... at the most p size and these are
very big

00:50:32.339 --> 00:50:36.649
lymph nodes all matted together this was
malignant lymphoma

00:50:36.649 --> 00:50:38.439
dimeric preparing him

00:50:38.439 --> 00:50:40.189
spleen

00:50:40.189 --> 00:50:42.119
started

00:50:42.119 --> 00:50:45.559
manuals of malignant lymphocytes if you
will

00:50:45.559 --> 00:50:47.008
one former swings

00:50:47.008 --> 00:50:50.759
even the kidneys any organ can be
infiltrated

00:50:50.759 --> 00:50:53.349
lymphoma cells

00:50:53.349 --> 00:50:55.209
and sometimes the marrow

00:50:55.209 --> 00:50:57.639
the bone marrow is overrun

00:50:57.639 --> 00:51:01.679
and the malignant lymphocytes spill in
great numbers into the bloodstream and

00:51:01.679 --> 00:51:07.189
you have a lymphocytic form of leukemia

00:51:07.189 --> 00:51:09.269
generically leukemia

00:51:09.269 --> 00:51:13.017
re first to be the presence of

00:51:13.017 --> 00:51:16.065
malignant he mad about whether to remove
what elements in circulation

00:51:16.065 --> 00:51:20.619
so we see other forms of leukemia where
the merrill just a bone marrow itself

00:51:20.619 --> 00:51:21.889
has gone bad

00:51:21.889 --> 00:51:25.409
can you see malignant precursors of

00:51:25.409 --> 00:51:26.599
leukocytes

00:51:26.599 --> 00:51:30.054
possibly red cells and little bit more
rarely or even even platelets so

00:51:30.054 --> 00:51:34.078
this morning so you know the marrow
tissue is circulating widely circulated

00:51:34.078 --> 00:51:39.689
malignant cells infiltration of organs
and so forth

00:51:39.689 --> 00:51:41.859
register wrap it up

00:51:41.859 --> 00:51:46.119
make the point of no tissue and the
body's immune from

00:51:46.119 --> 00:51:49.569
neoplasm even see it in the central
nervous system

00:51:49.569 --> 00:51:52.809
please see the neoplasms of the
coverings of the brain the so-called

00:51:52.809 --> 00:51:54.013
minmin geez

00:51:54.013 --> 00:51:57.709
and typically eminem geo money is benign

00:51:57.709 --> 00:51:59.809
has thrown his activities was

00:51:59.809 --> 00:52:01.659
the uh...

00:52:01.659 --> 00:52:04.529
no my culture is strange again

00:52:04.529 --> 00:52:05.009
glioma

00:52:05.009 --> 00:52:10.000
is actually uh... you neoplasm arising
in the brain tissue from the supporting

00:52:10.000 --> 00:52:12.369
cells called glial cells

00:52:12.369 --> 00:52:15.699
now has told a man in juneau alaska nine

00:52:15.699 --> 00:52:18.019
we almost sounds benign

00:52:18.019 --> 00:52:20.089
they're just varying degrees of
malignancy

00:52:20.089 --> 00:52:23.079
they're all bad

00:52:23.079 --> 00:52:26.009
and i'll show you why they're bad here's
a brain with the glioma

00:52:26.009 --> 00:52:28.969
is a normal side of the brain

00:52:28.969 --> 00:52:32.679
and at first glance into well you know
you might see some things out but

00:52:32.679 --> 00:52:33.339
basically

00:52:33.339 --> 00:52:34.709
this is all

00:52:34.709 --> 00:52:35.889
we all month

00:52:35.889 --> 00:52:40.119
and it's very hard to describe where it
stops this infiltrates

00:52:40.119 --> 00:52:41.021
diffuse lee

00:52:41.021 --> 00:52:44.499
numerically almost sells way out here in
here in here

00:52:44.499 --> 00:52:46.009
is just

00:52:46.009 --> 00:52:50.379
so orderly diffuse that it's very
difficult to handle

00:52:50.379 --> 00:52:51.599
the uh...

00:52:51.599 --> 00:52:54.209
well differentiated low-grade

00:52:54.209 --> 00:52:58.599
gliomas last a little longer patient
lasts a little longer the high-grade

00:52:58.599 --> 00:53:01.339
generally don't do so well with some

00:53:01.339 --> 00:53:02.939
promising interventions

00:53:02.939 --> 00:53:05.339
this is a sort of thing that senator

00:53:05.339 --> 00:53:07.389
noticed any

00:53:07.389 --> 00:53:10.579
only looked good the other night so

00:53:10.579 --> 00:53:13.007
yahoo and i think that uh... that
central nervous system

00:53:13.007 --> 00:53:15.559
then finally

00:53:15.559 --> 00:53:17.079
uh...

00:53:17.079 --> 00:53:20.129
there

00:53:20.129 --> 00:53:21.629
next time to talk with us

00:53:21.629 --> 00:53:24.069
these are these are before like an
interesting

00:53:24.069 --> 00:53:27.309
you can afterwards where you got a
couple of different kinds of

00:53:27.309 --> 00:53:28.319
differentiation

00:53:28.319 --> 00:53:29.099
for instance we may see

00:53:29.099 --> 00:53:31.199
uh...

00:53:31.199 --> 00:53:34.849
roscommon salivary gland to where where
you see glandular elements proliferating

00:53:34.849 --> 00:53:36.709
and cartilage

00:53:36.709 --> 00:53:38.019
of all things

00:53:38.019 --> 00:53:40.519
and those are referred to as mixed
tumors

00:53:40.519 --> 00:53:43.599
of salivary gland or more often now we
call them

00:53:43.599 --> 00:53:46.179
cleo morrissette and almost

00:53:46.179 --> 00:53:48.359
meaning a mixed form

00:53:48.359 --> 00:53:48.999
adenoma

00:53:48.999 --> 00:53:52.829
they're such things as fight broke up
enormous

00:53:52.829 --> 00:53:56.249
perfectly benign fibrous and granular

00:53:56.249 --> 00:53:59.929
mumbling inside there's such things as

00:53:59.929 --> 00:54:02.409
carson or sarcomas

00:54:02.409 --> 00:54:05.789
through passive differentiation

00:54:05.789 --> 00:54:07.999
apathy little glandular

00:54:07.999 --> 00:54:11.039
any appeal in supporting both both
malignant

00:54:11.039 --> 00:54:12.043
the odds are right here

00:54:12.043 --> 00:54:14.031
as it is a really

00:54:14.031 --> 00:54:20.014
mixed kind of tumor that arises from
totally potential sales

00:54:20.014 --> 00:54:25.001
and in these tumors are the rumors of
all of the embryonic journalists

00:54:25.001 --> 00:54:26.065
criticism mara was saying

00:54:26.065 --> 00:54:28.789
as you've predicted arise

00:54:28.789 --> 00:54:31.299
mostly in gold ads

00:54:31.299 --> 00:54:35.929
but uh... also another two should have
seen in the media steinem i've seen them

00:54:35.929 --> 00:54:37.779
in uh... the throat

00:54:37.779 --> 00:54:39.449
but mostly gone mad or

00:54:39.449 --> 00:54:41.479
the yeah

00:54:41.479 --> 00:54:45.055
bad news for the guys is most testicular
terra com is a malignant

00:54:45.055 --> 00:54:46.729
highly malignant

00:54:46.729 --> 00:54:51.329
good news for the women is a very
intercom asar almost invariably benign

00:54:51.329 --> 00:54:55.459
they're not uncommon there in your age
group usually an incidental finding but

00:54:55.459 --> 00:55:00.359
they're endlessly fascinating and allen
by showing you a couple

00:55:00.359 --> 00:55:02.009
there's a terra com of the ovary

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

00:55:06.279 --> 00:55:12.859
i kind of open along the whole blonde
hair

00:55:12.859 --> 00:55:16.819
looking at his ovary under the
microscope it had not only hair

00:55:16.819 --> 00:55:21.309
follicles but it has construction sweat
glands today shes clams

00:55:21.309 --> 00:55:23.239
it had cartilage

00:55:23.239 --> 00:55:25.039
bronchial lining

00:55:25.039 --> 00:55:27.799
it had something to look like i just
subtract

00:55:27.799 --> 00:55:30.819
and even had some brain tissue

00:55:30.819 --> 00:55:33.909
weenies irwin marvelous mixtures

00:55:33.909 --> 00:55:37.779
amal solicit perfectly benign and when
we get one of the operating room

00:55:37.779 --> 00:55:42.959
neighboring it goes we cuddle we see
here we say

00:55:42.959 --> 00:55:47.469
for some reason in the ovarian tumors
most often it line by skin like

00:55:47.469 --> 00:55:50.099
structures and sometimes called the
ramones

00:55:50.099 --> 00:55:53.089
but they do usually got a great mixture
of stuff

00:55:53.089 --> 00:55:55.729
here's another one what do you suppose
this was

00:55:55.729 --> 00:56:00.019
for these were

00:56:00.019 --> 00:56:03.099
that showed up as calcification mommy

00:56:03.099 --> 00:56:05.489
public phil

00:56:05.489 --> 00:56:06.429
and then

00:56:06.429 --> 00:56:11.569
glass one i'm absolutely quitters might
my favorite this came out of recovery

00:56:11.569 --> 00:56:13.789
looks like a chain with

00:56:13.789 --> 00:56:15.033
five o'clock shadow

00:56:15.033 --> 00:56:16.066
the nice

00:56:16.066 --> 00:56:18.989
dental arch there and so forth

00:56:18.989 --> 00:56:20.001
well that's a

00:56:20.001 --> 00:56:22.619
but i've done is basically teased you

00:56:22.619 --> 00:56:24.669
into uh...

00:56:24.669 --> 99:59:59.999
being interested non-college annual deal
with the rest of your life now