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TUMORS

TUMORS. Dr. Poovarasan S. What student should learn …. Definition Types Spread Various tumors and their clinical presentations Management. Definition. A tumour or 'neoplasm' is a growth of new cells which proliferate without relation to the needs of the body .

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TUMORS

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  1. TUMORS Dr. Poovarasan S

  2. What student should learn … • Definition • Types • Spread • Various tumors and their clinical presentations • Management

  3. Definition • A tumour or 'neoplasm' is a growth of new cells which proliferate without relation to the needs of the body. • Tumour' should be reserved for new growths only and should not be used for any 'swelling' either inflammatory or traumatic.

  4. Types • Benign or innocent • Malignant

  5. Benign • Show no tendency to invade the surrounding tissues. • Presence of a capsule is a characteristic feature of a benign tumour. • Benign tumours proliferate slowly and show little evidence of mitosis.

  6. Malignant • Hallmark of malignant tumours is invasiveness. • The tumour edge is therefore ill-defined in contrast to the well-defined encapsulated margin of benign tumours. • Excluding the locally malignant group, all malignant tumours metastasize.

  7. BenigntumorMalignant tumor

  8. Types of malignant tumors • Carcinoma in situ • Locally malignant • Dormant • Latent

  9. ETIOLOGY OF MALIGNANT TUMORS • Hydrocarbons • Sex hormones • Radiation • Viruses • Co carcinogens- hereditary, irritation, trauma, diet, geography.

  10. Spread of malignant Tumors • 1. Local or direct spread • 2. Invasion by lymphatics • 3. Through blood vessels • 4. Through serous cavities • 5. Natural passages • 6. Inoculation.

  11. Benign tumors

  12. Papilloma • Common benign sessile or pedunculated tumour composed of squamous epithelium. • It is a simple overgrowth of all layers of the skin. • It may arise — either from epidermis or from mucous membrane.

  13. From the epidermis — papilloma of the skin. • From mucous membrane — • (a) Squamous cells.— It may arise in the tongue, cheek, lip, oesophagus etc. • (b) Transitional cells — pelvis of the ureter, bladder etc. • (c) Columnar cells — Colon and rectum (commonest), stomach, small intestine etc. • From the wall of the duct e.g. breast. • From the wall of the cyst e.g. ovary or breast.

  14. Squamous cell papilloma • (i) Congenital papilloma. • ii) Infective papilloma or infective wart (Verruca vulgaris).— • It is a common papilloma —virus infection. • It may be single or multiple and may disappear spontaneously. • seen in children or adolescents. • It particularly affects the fingers, palm and the sole.

  15. (iii) Soft papilloma, which is often seen on the eyelids of elderly people. • (iv) Keratin horns.— This is due to excess keratin formation.

  16. Basal cell papilloma Seborrhoeic or senile wart; Seborrhoeic Keratosis • seen in middle or old age. • occur in numbers on trunk, face, arms and arm pits. • Clinical- raised brownish warts. It is slightly harder and stiffer than normal skin. • slow growing, beginning as a minute patch which gradually increases in area. • Treatment.— excised for cosmetic reason

  17. Adenoma • A benign tumour of glandular tissue . • usually arises from secretory gland. • It consists of a dense mass of acini lined by exuberant epithelium which may be columnar or cuboidal . • Common sites- breast, prostate and endocrine glands

  18. Variants • Fibroadenoma • Cystadenoma

  19. Fibroma • Rare TUMOR • Arises from fibroblasts • Combined with mesodermal tissues e.g.- fibrolipoma, neurofibromas etc

  20. Myoma • Arises from muscles • Rhabdomyoma.— striated muscle and is extremely rare. • May turn malignant - Rhabdomyosarcoma particularly in young children. • Leiomyoma.— commoner than rhabdomyoma. • The usual sites are uterus, stomach, intestine and skin. This tumour may be multiple.

  21. Treatment of all these tumors is excision .

  22. Some common benign tumors • Lipoma • Lymohangioma • Hamartoma • Neuroma • Hemangioma

  23. LIPOMA • One of the commonest and most benign of all tumours. • It is composed of fat cells of adult type. • It can occur anywhere in the body, often called as 'universal tumour’ . • common sites are the subcutaneous tissue of (i) the trunk, (ii) the nape of the neck and (iii) the limbs. • 1. Encapsulated variety - commonest • 2. Diffuse variety - pseudolipoma • 3. Multiple lipomas.

  24. Dercums disease or adiposis dolorosa • Fibrolipoma • Naevolipoma • Neurolipoma

  25. Subcutaneous lipoma • Clinical features • Adults, extremely slow growing • Painless swelling • On examination…. • Site , size, shape, consistency , surface, skin,mobility • Slip sign- classical of lipoma

  26. Anatomical sites • Subcutaneous • Subfascial • Inter muscular • Subserosal • Submucosal • Sub synovial • Intra articular

  27. Complications • Myxomatous degeneration. • Saponification. • Calcification.

  28. Treatment • Excision.

  29. Lymphangioma • Congenitalcondition • Localized cluster of dilated lymph sacs in the skin and subcutaneous tissues which cannot connect into the normal lymph system • Types.—

  30. (a) Superficial variant presents as circumscribed lesion which appears as small blisters and slightly elevated skin patches. • These lesions are called lymphangiomacircumscriptum. .

  31. b) Deep lesions are large, cystic, translucent and may be seen in the neck, mediastinum or axilla. • These are called cystic hygromata

  32. Symptoms • Disfigurement • Swelling • Clinical examination • Size,site,shape,surface,consistency. • Brilliantly transilluminant • Fluctuant

  33. Treatment • Excision.

  34. HAEMANGIOMA • A haemangioma is a developmental malformation of blood vessels and not a typical tumour. • 1. Capillary haemangioma — arising from capillaries. • 2. Venous or cavernous haemangioma — arising from the veins. • 3. Arterial or plexiform haemangioma — arising from arteries.

  35. Capillaryhemangioma • STRAWBERRYANGIOMA - Begins at 1 to 3 weeks of birth. • Gradually increases in size for a few month till it takes atypical strawberry or raspberry like swelling. - Clinically the swelling is compressible. • After the first birthday the angioma gradually regresses in size and involusion may be completed by the age of 7 to 8 years.

  36. PORT-WINESTAIN.— • It is present since birth and does not show any changefor the rest of the life. • It is common on the face, shoulders, neck and buttock. - This is deep purple-red in colour which may become palein later life. • There is no definite swelling but it is a diffuse vascular deformity.

  37. SALMONPATCH • Present since birth. • It usually disappears before the first birthday. • It is mostly seen over the forehead or occiput or anywhere in the midline of the body

  38. Cavernous hemangioma • Multiple dilated venous channels • Spongy swelling • Treatment - Conservative / surgery

  39. Plexiform hemangioma • It is a type of congenitalarteriovenous fistula. • There is pulsatile swelling of arteries and the veins become arterialized i.e. tortuous and thick walled and pulsatile. • Clinically -Bag of pulsating earthworms. • This is often called cirsoid aneurysm. • Commonly seen on the forehead or in the scalp over the temporal region.

  40. Treatment- • Ligation of vessels and excision . • Therapeutic embolisation of the feeding artery.

  41. GLOMUS TUMOR • The glomustumour or the glomangioma is a benign and circumscribed tumour blue or reddish in colour. • Small extremelypainfulTUMOR of skin and subcutaneous tissue. • Site- nail beds of hand and feet .

  42. what is a glomus… • specialized arteriovenous anastomosis surrounded by large pale cells which are called glomus cells. • Between these cells there are numerous medullated and non- medullated nerve fibres. • Such glomus is most abundantly present in the region of the nail-bed at the tips of the fingers and toes and the palmar surface of phalanges.

  43. Clinically.. • Small, soft, severe tenderness, red or brown colour • Treatment – excision ..

  44. HAMARTOMA • Benign (noncancerous) tumorlike malformation made up of an abnormal mixture of cells and tissues found in areas of the body where growth occurs. • Fault or miss fire • Present since birth, grows till adolescence • Benign, non capsulated, multiple • E.g.. Moles, angiomas, neurofibromas.

  45. NEUROFIBROMA • Arises from the connective tissue of the nerve sheath. ( from endoneurium) • This is a developmental disorder and is often considered as Hamartoma and not a typical tumour. • often runs in families.

  46. Types • Localised • Generalised. • Plexiform • Elephantiasis nerofibromatosa • Cutaneous

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