Basosquamous Carcinoma in the Temple

This photo shows  large, crusted tumor on the temple that has clinical features of both squamous cell carcinoma (scaly crust), and basal cell carcinoma (translucency in some areas)........

Read more..........>>

Histopathology of Osteosarcoma

The staging evaluation of Esophageal Cancer

After establishing a diagnosis of esophageal cancer, adequate staging is required, because staging is the most important step in choosing appropriate therapy. More than 50% of patients have unresectable or metastatic disease at the time of presentation. For the others, survival is closely related to the stage of the disease.

The staging evaluation allows patients to be ...................

Read more.............>>

Normal vs. Cancerous Testicle

CT interpretation : pancreas cancer with liver metastasis

Fibroadenoma

Fibroadenomas, which are generally firm, smooth, and round, can be readily moved under the skin and are often described as feeling similar to marbles. Typically the masses measure from 1 to 3 centimeters in size, but occasionally they may grow much larger, in which case they are termed giant fibroadenomas. Fibroadenomas, which arise from the intralobular stroma, are solid and consist of a combination of glandular and fibrous tissues. The tumors are usually painless and present no symptoms, typically being discovered by young women only due to self-examination. In older women, fibroadenomas are often less palpable and may first be discovered during a routine mammogram.

Fibroadenomas showing circumscribed margins, even distribution of epithelial and stromal components and low stromal cellularity.
-Low power scanning of Fibroadenoma :

# Use low power scanning to determine:

•  the basic pattern - pericanalicular or intracanalicular
•  edge of lesion (pushing or infiltrative) - should be pushing
•  balance between stroma and epithelium - should be even
•  to pick out areas of stromal hypercellularity

# The stroma can be cellular particularly in younger patient's lesions - but it's usually uniform

# The occasional stromal mitosis is acceptable in a younger patient's lesion but take advice

# Uneven stromal cellularity in a core biopsy may be a pointer to a Phyllodes Tumour

You can suspect Phyllodes Tumour if:
* Patient older than 40 years
* Lesion larger than 4 cm
* History of recent growth

Kaposi's sarcoma PIC

Kaposi's sarcoma In AIDS patient

Although Kaposi's sarcoma (KS) is a type of cancer it differs from other types of cancer in the way it develops. Unlike most cancers, .................

Read more...............>>

Histopathology Skin--Glomus tumor

What is Nanomedicine?

Nanomaterials Used in Vivo Applications

A handful of nanomaterials are being studied in clinical trials or have already been approved by the FDA for use in humans and many proof-of-concept studies of nanomaterials in cell-culture and small-animal models for medical applications are under way.

Many of these nanomaterials are designed to target tumors in vivo and are intended for use either as drug ...............

Read more............>>

Mesothelioma-Exposure To Asbestos

/>

Gynecomastia versus Carcinoma

WE can summarize presentation of male breast disease either as mass, pain or nipple discharge.
Gynecomastia and invasive ductal cancer are the most common lesions in the male breast, but there are other rarer benign and malignant lesions.
Gynecomastia and carcinoma can usually be differentiated, but biopsy is sometimes necessary to separate them.All lesions eccentric to the nipple need biopsy unless they are characteristically benign, i.e.contain fat or typical lymph node.

On this diagram a list of characteristics of gynecomastia versus carcinoma.Notice that there are many similarities.
Both gynecomastia and carcinoma occur mostly at the age of 60 and can be soft, mobile, subareolar and unilateral.
So that does not help.
$$Carcinoma is usually eccentric, while gynecomastia is never eccentric.
$$Gynecomastia has to have extensions into the surroundig fat.
$$Carcinoma sometimes may have spiculations, that can look the same.
Actually we call it extension into the fat, if we think it is gynecomastia and spiculation, if we think it is a carcinoma.

To differentiate between true gynecomastia and pseudogynecomastia

HERE

Diplopia in a Patient with HIV Infection

A 25-year-old man with human immunodeficiency virus (HIV) infection who was receiving highly active antiretroviral therapy presented with a 1-week history of diplopia and headache. The CD4 count was 218 cells per cubic millimeter, and the viral load was 50,000 copies per milliliter.
The neurologic examination revealed an inability to abduct the right eye with horizontal gaze, a finding that was consistent with an isolated right abducens nerve palsy (rightward gaze, Panel A; leftward gaze, Panel B). The examination of other cranial nerves was normal. The remainder of the motor and sensory examination was within normal limits.
The patient reported having had low back pain and constipation for the previous week. There was no history of bowel or bladder incontinence. A gadolinium-enhanced magnetic resonance image of the brain showed a minimally enhancing mass filling and expanding the right cavernous sinus (Panel C, arrow). Lumbar-spine imaging showed a mass with similar radiographic characteristics involving the ventral epidural compartment.
Biopsy of the spinal lesion revealed diffuse large-B-cell lymphoma. A chemotherapeutic regimen of cyclophosphamide, doxorubicin, vincristine, and prednisolone, along with the monoclonal antibody rituximab (R-CHOP), was started. Progressive leg weakness from spinal involvement developed, and the patient had a poor response to corticosteroids and radiation therapy and died 3 months later.

Characteristic Shape of Erythema Gyratum Repens and underlying malignancy

A 83 years old man was evaluated for a 1 year history of a pruritic, progressively worsening migratory rash, with associated weakness and a 5 kilograms weight loss. He had a history of 30 pack year smoking; he had stopped smoking 45 years earlier.

On examination, he had erythematous skin lesions that Characterised by concentric, raised, serpiginous bands, with desquamation (Panel A). The rash affected mainly the trunk and proximal extremities. A clinical diagnosis of erythema gyratum repens was made.

A C.T. scan revealed a pulmonary mass measuring 59 by 43 mm (Panel B). Bronchoscopy with biopsy revealed squamous-cell carcinoma of the lung.

Erythema gyratum repens is a rare syndrome typically associated with an underlying malignant condition. It occurs most frequently in conjunction with lung cancer and next most frequently with esophageal and breast cancers. It may regress with treatment of the cancer.
Treatment with gemcitabine was initiated for this patient, but he died 3 months after diagnosis, after only one infusion; the rash had not resolved.

Lymphoma; a common cause of Intussusception above 6 years

An 8 year old is seen in the emergency room secondary to abdominal pain. Further evaluation confirms the presence of intussusception. The most likely precipitating cause is

• A) colon polyp
• B) Meckel's diverticulum
• C) lymphoma
• D) parasite infection
• E) foreign body

The answer is ( C ).
Intussusception is the most common cause of intestinal obstruction in the first 2 years of life. It is more common in males than in females. In most cases (85%) the cause is not apparent. Associated conditions that can result in intussusception include polyps, Meckel's diverticulum, Henoch–Schönlein purpura, lymphoma, lipoma, parasites, foreign bodies, and viral enteritis with hypertrophy of Peyer patches.

Intussusception of the small intestine occurs in patients with celiac disease and cystic fibrosis—related to the bulk of stool in the terminal ileum. Henoch–Schönlein purpura may also cause isolated small-bowel intussusception. In children older than 6 years, lymphoma is the most common cause. Intermittent small-bowel intussusception is a rare cause of recurrent abdominal pain.

Mucocutaneous Manifestations of Necrolytic Migratory Erythema

Necrolytic migratory erythema is a rare inflammatory dermatosis.which occurs in 70% of patients with the glucagonoma syndrome.
Its clinical features are polymorphic mucocutaneous manifestations, encompassing multiple annular erythematous scaling and crusting patches with hyperpigmentation. These lesions can affect the entire body with a predilection for the perineum, buttocks, groin, abdomen, and limbs — in other words, areas that are subject to increased pressure and friction. The only two reported oral findings are angular cheilitis and atrophic glossitis.

This Figure shows Mucocutaneous Manifestations of Necrolytic Migratory Erythema.
Bullous, erosive oral mucositis with areas having lichenoid features are visible on the tongue and the upper and lower lips (Panel A) and inside the right cheek (Panel B). The patient's entire body, including the back, is covered with purplish, confluent erythematopapulous scaling and crusting lesions with a keratotic surface (Panel C). Histologic analysis of the skin (Panel D, left) shows hyperparakeratosis and spongiosis, accompanied by the presence of necrotic keratinocytes, and vascular proliferation. Histologic analysis of the oral mucosa (Panel D, right) shows a prominent neutrophilic, eosinophilic, and plasmacellular infiltrate (hematoxylin and eosin).

The patient's nutritional status was normal. Routine hematologic tests revealed mild hyperglycemia, hypoalbuminemia, a glucagon level of 73 pg per milliliter (normal range, 25 to 250), and a zinc level of 134 μg per deciliter (normal range, 60 to 250). Tumor markers showed a CA-125 level of 232 U per milliliter (normal range, 0 to 35) and a β2-microglobulin level of 2924 ng per milliliter (normal range, 600 to 2600). Total-body computed tomography revealed the presence of an ovoid mass measuring 40 mm in diameter in the upper lobe of the right lung, with prominent striae hooking the apical and costal homolateral pleura. No evidence of a pancreatic tumor was detected. Needle biopsy of the lung with ultrasonographic guidance revealed a small-cell lung cancer. A diagnosis of nonglucagonoma-associated necrolytic migratory erythema was made. The patient died 2 months later.

How is Neuroblastoma Clinically Presentating ?

Neuroblastoma is a childhood cancer that is diagnosed at a median age of about 17 months. Tumors can arise anywhere along the sympathetic nervous system, with the majority occurring in the adrenal medulla. Primary tumors in the neck or upper chest can cause Horner's syndrome (ptosis, miosis, and anhidrosis)............

Read more..........>>

Research Shows CT Scans Reduce Lung Cancer Deaths

Breast Cancer Progression and Staging

This 3D medical animation outlines the progression of breast cancer and describes the stage classifications based on the extent of the disease.

Multiple Beau's Lines

A 69-year-old man was referred for the evaluation of changes to his fingernails that developed after the initiation of chemotherapy with docetaxel–cisplatin–fluorouracil for gastric cancer. Physical examination revealed multiple white lines on the fingernails, known as Beau's lines.
The lines corresponded to the start of each chemotherapy cycle, with the distance between the lines proportional to the interval between the cycles.
One white line showed less severe dystrophia than the others (arrow); on reviewing the medical records, it was noted that the corresponding chemotherapy cycle consisted of docetaxel–fluorouracil only, owing to the patient's compromised renal function at the time, whereas all the other cycles consisted of the complete docetaxel–cisplatin–fluorouracil regimen.

Cytotoxic chemotherapeutic agents can induce the temporary arrest of proliferative function of the nail matrix, which may be manifested as multiple Beau's lines in the nail plate. This nail pattern can provide insight into the interval between and intensity of chemotherapy cycles.