Surgery
Prof. Dr.Abdul Ganny AL-Dabbagh
Tumor, Cyst , Ulcer , Sinus & Fistula
Tumour
is a new growth of tissue , can refer to an inflammatory swelling or a Neoplastic growth ; a Neoplastic tumor is an uncontrolled proliferation of a clone of cells without useful function can be Benign or Malignant
- Benign tumor : grows by expansion , without invasion into the extracellular matrix
- Malignant tumor (Cancer) : grows by invasion into the extracellular matrix ; most solid tumors also invade the basement membrane of the endothelium and metastasize; the unit of cancer is the altered malignant cell which proliferate (clone) , clone can metastasise via different characteristics such via blood vessels ,and lymphatics
Cancer is a disease of the gene which may be inherited or acquired
Causes of cancer
-Inherited : As familial breast cancer ,familial ovarian- breast cancer
- Chemical carcinogenesis : as lung cancer (tobacco ) ,Ca bladder
-UV irradiation : BCC , malignant Melanoma
-Ionizing ration : thyroid cancer , bone marrow cancer
-Viruses : as with Hodgkin’s disease , Kaposi sarcoma ,liver cancers
- Cellular instability : as cancer of old patients & H. pylori Infection Ca stomachPATHOLOGICAL DEFINITIONS
Hypertrophy : is an increase in the size of an organ without an increase in the cell number
Hyperplasia : is an increase in the size of an organ due to an increase in the cell number
Metaplasia : the epithelium from which tumor grows has already changed its characteristics as bladder transitional epithelium changed to sequamous Epi. In bladder cancer ,and the seqaumous epithelium into
columnar epithelium in Ca esophagus Barrett’s esophagus
Dysplasia ; represent earliest changes of neoplastic transformation than can be occurred on at the micostructural level ( by light microscopy ) alteration in intracellular organization, the individual size and shape of nucleus , cellular size and shape and intercellular organization indicates dysplasia , can be classified into mild , moderate or severe dysplasia.
Carcinoma in situ : sever dysplasia may progress to carcinoma in situ , cellular , nuclear and 3 dimensional architecture resemble cancer but without invasion into the extracellular matrix.
Anaplasia : tumors are usually composed of cells which the resemble those tissues from which they arise ,complete loss of differentiation anaplasia usually associated with aggressive cancer
Benign tumours
Usually encapsulated , do not disseminate or recur after complete removal ,Symptoms effects can be harmful ,are due to its size , position and pressure ; certain adenomas secrete hormones which may affect bodily functions , Benign tumors are often multiple
Example of benign tumors ; Lipoma. Adenoma ( secretary gland tumor ) , papiloma , fibroma (fibrous connective tissue tumor) ,keloid ….. etc .
Lipoma
Is a slowly growing tumor of fat cell of adult type ; lipoma may be encapsulated or diffused ; they may occur anywhere in the body where there is fatty tissue found , mostly at the head , neck , abd. wall , back and the theigh
Encapsulated lipoma are among the commonest tumors , characteristic features are the presence of definite edge and lobulation & fluctuant ; deeply situated lipomas may be mistaken for other swellings .
Lipomas are usually painless, multiple lipomas are not uncommon , usually remain small to moderate in size , sometimes contain excessive amount of fibrous tissue ( fibrolipoma) or considerable amount of vascularity may be present often with telangiectasis of overlying skin ( naevolipoma) …
Clinically , Lipoma can be classified according to their situation ;
_ subcutaneous : commonly on shoulders or back
_ subfascial : mostly under palmer or planter fascia
_ subsynovial : fatty padding around the joints especially knee joint
_ Intra-articular
_ intra muscular mainly in the thiegh or around the shoulders
_ parosteal : occasionally occur under periosteium of a bone
_ subserous or retroperitoneal
_ submucus
_ CNS : anywhere in the extradural space , spinal cord, brain usually arise from pia matter
_ Intraglandular : usually Pancreas , breast ,under renal capsule
Treatment
Usually lipoma causing trouble because of its site ,size ,appearance or presence of pain , so surgical removal is indicated
Tumor is relatively avascular although care must be paid to obtain good homeostasis , any finger –like projections (to surround the tissue) should be removed .
Malignant Tumours
Carcinomas may arise from ectodermal , endodermal origin classified as sequamous , basal or glandular (as adenocarcinoma) ; whereas mesodermal origin as sarcoma ( connective tissue cancer of mesoplastic origin ) and as fibrosarcoma , osteosarcoma ; germ cell cancer as teratoma seminoma , thecoma …..etc
Note :
Certain benign tumors are prone to undergo malignant changes and it’s important to distinguish them for both treatment and prognosis , these may show the following changes
Increase in size
Increase in vascularity
Fixity ; due to invasion of surrounding s
-Involvement of adjacent structures
Dissemination : discovery of secondary deposits
المادة المعروضة اعلاه هي مدخل الى المحاضرة المرفوعة بواسطة استاذ(ة) المادة . وقد تبدو لك غير متكاملة . حيث يضع استاذ المادة في بعض الاحيان فقط الجزء الاول من المحاضرة من اجل الاطلاع على ما ستقوم بتحميله لاحقا . في نظام التعليم الالكتروني نوفر هذه الخدمة لكي نبقيك على اطلاع حول محتوى الملف الذي ستقوم بتحميله .