Neoplasia lII

A lecture on Neoplasia by Dr. Gerald Abrams, M.D. This lecture was taught as a part of the University of Michigan Medical School's M1 - Patients and Populations Sequence.

View the course materials:
http://open.umich.edu/education/med/m1/patientspop-genetics/fall2008/materials

Creative Commons Attribution-Non Commercial-Share Alike 3.0 License
http://creativecommons.org/licenses/by-nc-sa/3.0/

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

so the only hope of getting it earlier
is played by population screening and

early on

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

with a systemic disease

presented

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