FIBROUS ORIGIN: FIBROMA GIANT CELL FIBROMA

1. BENIGN SOFT TISSUE TUMORS • FIBROUS ORIGIN: FIBROMA GIANT CELL FIBROMA POF, COF CGCG, PGCG 2. MYOFIBROBLAST: MYOFIBROMA & MYOFIBROMATOSIS 3. FAT CELLS- LIPOMA, VERRUCIFORM XANTHOMA 4. BLOOD VESSEL- HEMANGIOMS VASCULAR MALFORMATION 5. NERVE ORIGIN – TRAUMATIC NEUROMA - Pallisaded encapsulated neuroma - Neurofibroma

2. MALIG SOFT TISSUE TUMORS • TUMORS OF LYMPHOCYTE ORIGIN - LYMPHOMA • BURKITT’S LYMPHOMA/ NHL • HOGDKIN’S LYMPHOMA 2. TUMORS OF PLASMA CELL ORIGIN • PLASMA CYTOMA • MULTIPLE MYELOMA 3.TUMORS OF BONE - FIBROSARCOMA 4.TUMORS OF BONE • OSTEOSARCOMA 5. INTERMEDIATE MALIGNANCY OF BLOOD VESSELS - HEMANGIO ENDOTHELIOMA • HEMANGIO PERICYTOMA 4 MALIGNANT TUMORS OF BLOOD VESSELS • KAPOSIS SARCOMA • EWING’S SARCOMA

3. MALIGNANT LYMPHOMA • GROUP OF NEOPLASMS OF VARYING DEGREES OF MALIGNANCY DERIVED FROM BASIC CELLS OF LYMPHOID TISSUE • LYMPHOCYTES OR HISTIOCYTES IN ANY OF THEIR DEVELOPMENT STAGES

4. NON-HODGKIN’S LYMPHOMA • HETEROGENOUS GROUP OF LYMPHOPROLIFERATIVE MALIGNANCIES WHICH CAN INVOLVE BOTH LYMPH NODES & LYMPHOID ORGANS AS WELL AS EXTRANODAL ORGANS & TISSUES

5. CLASSIFICATION WORKING FORMULATION CLASSIFICATION • LOW GRADE • INTERMEDIATE • HIGH GRADE

6. RAPPAPORT CLASSIFICATION • NODULAR • DIFFUSE • LYMPHOCYTIC • HISTIOCYTIC

7. REAL [ REVISED EUROPEAN – AMERICAN LYMPHOMA] • B- CELL NEOPLASMS • T- CELL – NK CELL NEOPLASMS • HODGKIN LYMPHOMA

8. BURKITT’S LYMPHOMA • TUMOUR OF CHILDREN OF TROPICAL AFRICA • DENIS PARSONS BURKIT • ENDEMIC & NON ENDEMIC FORM • FASTEST GROWING MALIGNANCY IN HUMANS

9. C/F • MAX OR MAND • SPORADIC FORM – ABDOMINAL ORGANS

10. ETIOLOGY • EBV • MALARIA – IMMUNOSUPRESSION – INADEQUATE T CELL RESPONSE AGAINST B CELLS INFECTED LATENTLY WITH EBV.

11. AFRICAN FORM • SWELLING OF AFFECTED JAW OR OTHER FACIAL BONES • LOOSENING OF TEETH • SWELLING OF LYMPH NODE • NON TENDER & RAPIDLY GROWING IN NECK OR BELOW JAW • ABDOMINAL PRESENTATION – LESS COMMON

12. SPORADIC FORM • ABDOMINAL TUMOURS • SWELLING & PAIN • BOWEL OBSTRUCTION • METABOLIC DERANGEMENT & RENAL FUNCTION IMPAIRMENT

13. MAJOR SIGNS • INVOLVEMENT OF JAWS OR FACIAL BONES • ENLARGED CERVICAL LYMPH NODES • ABDOMINAL MASSES • ASCITIS

15. ‘STARRY SKY APPEARANCE’ • SEEN IN AFRICAN JAW LYMPHOMA • SCATTERED MACROPHAGES WITH CLEAR CYTOPLASM OFTEN PHAGOCYTIC CELLULAR DEBRIS

17. TREATMENT • COMBINATION CHEMOTHERAPY & CNS PROPHYLAXIS

18. HODGKIN’S DISEASE • MAIN TYPES OF MALIGNANT LYMPHOMA • THOMAS HODGKIN • POTENTIALLY CURABLE MALIGNANT LYMPHOMA

19. ETIOLOGY • EBV • ASSOCIATED WITH AIDS • GENETIC PREDISPOSITION

20. C/F • BIMODAL DISTRIBUTION [ 15-34 - >55 YRS] • MALES • COMMON IN WHITES • PAINLESS ENLARGEMENT OF ONE OR MORE CERVICAL L.N • FIRM, RUBBERY IN CONSISTENCY • OVERLYING SKIN NORMAL

21. UNEXPLAINED WT.LOSS • FEVER • NIGHT SWEATS • CHEST • SHORTNESS OF BREADTH • ALCOHOL INDUCED PAIN • PRURITIS • BACK, ABDOMEN, BONE PAIN

22. O.M • SECONDARY INVOLVEMENT OF MAND & ALVEOLAR MUCOSA

23. H/P HISTOPATHOLOGICAL VARIANTS: • NODULAR SCLEROSIS • MIXED CELLULARITY • LYMPHOCYTE DEPLETED • NODULAR LYMPHOCYTE – PREDOMINANT H.D

24. H/P • NODULAR SCLEROSIS : 60 – 80% NODULAR PATTERN FIBROSIS DIVIDING IT INTO NODULES • LACUNAR TYPE REED STERNBERG CELL – “owls eye” Mono lobulated or multi lobulated nucleus, abundant & pale cytoplasm, small nucleolous • ADOLESCENTS & YOUNG ADULTS

26. TREATMENT • RADIATION THERAPY & COMBINATION CHEMOTHERAPY

27. MULTIPLE MYELOMA • MALIGNANCY OF PLASMA CELLS • SUBSET OF B CELLS

28. PATHOGENESIS • MUTATION OF TERMINALLY DIFFERENTIATED B CELLS • ETIOLOGY -RADIATION -CHEMICAL -OCCUPATION

29. C/F • OLDER PEOPLE [ 60-65 YRS] • MEN > WOMEN • DIFFUSE DISEASE OF BONE MARROW • AXIAL SKELETON, VERTEBRAL COLUMN, RIBS, SKULL, PELVIS, FEMUR

30. SOLITARY PLASMA CELL MYELOMA/ PLASMACYTOMA • SOLITARY MASS OF NEOPLASTIC MONOCLONAL PLASMA CELLS IN EITHER BONE MARROW OR SOFT TISSUE SITE • SOFT TISSUE PLASMACYTOMA • PLASMACYTOMA OF SKELETAL SYSTEM

31. O.M • EXTRAMEDULLARY – GINGIVA, PALATE, FLOOR OF THE MOUTH, TONGUE, TONSILS, PNS • SESSILE OR POLYPOID REDDISH MASSES

32. R/F • DESTRUCTIVE INTRAMEDULLARY LESION • LYTIC DESTRUCTION OF BONE

33. LAB VALUES • BENCE JONES PROTEIN IN THE URINE OR SERUM • MONOCLONAL PROTEIN IN SERUM OR URINE • HYPERGLOBULINEMIA, ANEMIA

34. TREATMENT & PROGNOSIS • LOCAL RADIOTHERAPY • COMPLETE RESECTION

35. Malignant tumors of blood vessels • Hemangioendothelioma • Hemangiopericytoma • Angiosarcoma • Kaposi’s sarcoma

36. HEMANGIOENDOTHELIOMA • BEHAVIOUR B/W BENIGN HEMANGIOMA & MALIGNANT ANGIOSARCOMA. • ASSOCIATED WITH DEVELOPMANTAL ANOMALIES • CHROMOSOMAL TRANSLOCATIONS

37. C/F • 2ND – 3RD DECADE OF LIFE • NO GENDER PREDILECTION • SKIN & SUBCUT TISSUE • O.M – Gingiva, Tongue, Lips, Palate central • Localized swelling with occasional pain

38. MALIGNANT HEMANGIOENDOTHELIOMA • Flat or slightly raised • Dark red or bluish • Ulcerated • Tendency to bleed

39. H/F • Biphasic proliferation of venous & capillary vessles • Epitheloidhemangioendothelioma – epitheloid cells • Spindle cell hemangioendothelioma – spindle cells

41. TREATMENT & PROGNOSIS • WIDE SURGICAL EXCISION • METASTASIS ?????

42. HEMANGIOPERICYTOMA • NEOPLASM WHICH IS BENIGN HAVING A DEFINITE MALIGNANT COUNTER-PART • H&N 16-25% • Chromosomal Translocations

43. C/F • Red or bluish mass • Before 2nd or after 7th decade • Soft rubbery, Painless • Well demarcated • Sessile or pedunculated • Surface lobular or telangiectasias • INFANTILE HEMANGIOPERICYTOMA- Multiple, Congenital, Rapid enlargement

44. H/F • GROSS • Grayish white • Consistency- Solid or spongy Friable or granular

45. Tumour of pericytes Numerous vascular channels lined by plump endothelial cells Surronding oval or spindle cells with hyperchromatic nuclei Branching vascular channels – STAG HORN PATTERN

48. OLDER LESIONS Less cellularity Mucoid interstitial appearance Focal cartilage

49. MALIGNANT SOFT TISSUE TUMORS - FIBROBLASTIC ORIGIN