Metastasis is the MC malignancy of bone.
Breast cancer is the MC primary site.
Others include:
Prostate ,Lung ,Kidney and thyroid
Nature of metastasis
Osteolytic:
Destructive
Most mets (breast**, lung, kidney etc)
Osteoblastic:
Reactive new bone formation
Carcinoma prostate**, breast Ca.
Identified in 1921 by James Ewing
2nd most common bone tumor in children
Ewing’s Sarcoma Family of tumors:
Ewing’s sarcoma (Bone –87%)
Extraosseous Ewing’s sarcoma (8%)
Peripheral PNET(5%)
Askin’s tumor
Identified in 1921 by James Ewing
2nd most common bone tumor in children
Ewing’s Sarcoma Family of tumors:
Ewing’s sarcoma (Bone –87%)
Extraosseous Ewing’s sarcoma (8%)
Peripheral PNET(5%)
Askin’s tumor
Presentation on bone tumors for undergraduate 2nd year MBBS medical students. The information for this presentation has been taken from texbook of Robbins & Cotran Pathologic Basis of Disease 8th ed.
Anti diabetic medications
Patients who are intolerant of metformin are unlikely to be successful with a third trial of that agent. Empagliflozin, an SGLT2 inhibitor, is considered a second-line choice for patients who are intolerant of metformin. Both sitagliptin, a DPP-4 inhibitor, and liraglutide, a GLP-1 receptor agonist, should be avoided or used with caution in patients with a history of pancreatitis
-Linagliptin is not cleared by the kidney second choice if GFR<35(Stop Metformin)
only liraglutide has been shown to lower the risk of recurrent cardiovascular events and has received FDA approval for this indication
Empagliflozin, an SGLT2 inhibitor, has also been associated with secondary prevention of cardiovascular disease.
Fasting C-peptide levels are markedly elevated in patients with T2DM, but in people with T1DM, C-peptide levels should be low
. TZDs tend to cause fluid retention and should not be used in patients with congestive heart failure
References
ADA
Step up to medicine
Toronto notes
UpToDate
ABFM
Membranous GN
MOST COMMON cause is idiopathic (85%); peak age 30-50; male:female, 2:1
May be secondary to:
Drugs-captopril, penicillamine, gold, mercury, trimethadione, NSAIDS
Infections-malaria (P. malariae), leprosy, schistosomiasis, syphilis, hepatitis B and C, filariasis, hydatid disease and enterococcal endocarditis
Diseases-malignancy (Carcinoma of breast, lung, colon, stomach, and esophagus) melanoma, renal cell CA, SLE, sarcoidosis, diabetes, thyroiditis, sickle cell anemia, Crohn’s disease
Normal Heart
Fist size muscular pump
Pumps 6000 lit of blood daily
Perfuses
tissues with nutrients and
Facilitates
removal of waste products.
Heart diseases
Have severe physiologic consequences
Are leading cause of morbidity and mortality in developed nations
750,000 deaths/ year (In US
Congenital Heart Diseases(CHD)
Are abnormalities of the heart or great vessels that are present at birth.
Majority due to faulty embryogenesis.
Etiology:
Idiopathic (90%)
Genetic associations*
Trisomies, Cri du Chat, Turner syndrome
Viral infections
Congenital rubella*
Drugs and alcohol
Infective Endocarditis(IE)
Is due to bacterial or fungal infection of the heart valves (endocardium).
Characterized by:
Formation of bulky, friable,easily detached and infected vegetations.
Damage to heart Valves and Chorda tendinae
perforation, ulceration, destruction (causes valve dysfunction)
Ischemic Heart Disease
IHD is caused by myocardial ischemia due to
Imbalance between the myocardial oxygen demand and supply from the coronary arteries.
Majority of cases due to
Reduction in coronary artery blood flow caused by
Obstructive atherosclerotic disease.
IHD is also known as Coronary artery disease
Restrictive lung diseases (interstitial lung diseases)
Histological Structure of Alveoli
The wall of the alveoli is formed by a thin sheet of tissue separating two neighbouring alveoli.
This sheet is formed by epithelial cells and intervening connective tissue.
Collagenous , reticular and elastic fibres are present.
Between the connective tissue fibres we find a dense, anastomosing network of pulmonary capillaries. The wall of the capillaries are in direct contact with the epithelial lining of the alveoli.
Neighbouring alveoli may be connected to each other by small alveolar pores (pores of Kohn).
The epithelium of the alveoli is formed by two cell types:
Alveolar type I cells (small alveolar cells or type I pneumocytes) are extremely flattened and form the bulk (95%) of the surface of the alveolar walls.
Alveolar type II cells (large alveolar cells or type II pneumocytes) are irregularly (sometimes cuboidal) shaped.
They form small bulges on the alveolar walls.
Type II alveolar cells contain are large number of granules called cytosomes (or multilamellar bodies), which consist of precursors to pulmonary surfactant (the mixture of phospholipids which keep surface tension in the alveoli low) .
Cilia are absent from the alveolar epithelium and cannot help to remove particulate matter which continuously enters the alveoli with the inspired air. Alveolar macrophages take care of this job. They migrate freely over the alveolar epithelium and ingest particulate matter.
FUNCTIONS OF PULMONARY CELLS
Type I pneumocytes
Permeable to Oxygen and CO2, do not divide
Type II pneumocytes
Reserve cells
secrete pulmonary surfactant
Serve as repair cells
Alveolar macrophages
Phagocytosis
Pores of Kohn (allow passage of Macrophages)
Asthma
A chronic relapsing inflammatory disorder characterized by:
Hyper-reactivity of the respiratory tree to various stimuli leading to
Reversible airway obstruction
Obstruction produced by combination of :
Constriction of bronchial musculature (bronchospasm)
Mucosal inflammation (edema)
Excessive secretion of mucus.
Clinically Manifested by :
Difficulty in breathing (Dyspnea)
Wheeze (a soft whistling sound during expiration)
Difficulty in expiration.
Asthma is:
Episodic and reversible airway disease
Primarily targets the bronchi and terminal bronchioles
MC chronic respiratory disease in children
Two types:
Extrinsic asthma (allergic, atopic)
Intrinsic asthma (non-allergic asthma or idiosyncratic asthma)
Obstructive diseases : Chr.by
Obstruction to airflow out of the lungs
Due to partial or complete obstruction in airway.
Increase in lung compliance and
Decrease in lung elasticity.
Restrictive diseases : Chr by
reduced expansion of lung parenchyma with problems in getting air in the lungs.
Lung compliance is decreased
Elasticity is increased: once air is in the lungs it comes out rapidly on expiration.
Tumors of lung
Malignant tumors of lung
Primary
Metastatic
Metastatic lung cancer
More common* than primary lung cancer.
Breast cancer (MCC)
Renal Cell carcinoma
Choriocarcinomas
Colorectal carcinomas
Appear as: "Cannon Balls” On X rays
Respiratory symptoms most common cause of presentation to family doctor.
Rhinitis = common cold
Sinusitis = inflammation of paranasal air sinuses
Pneumonia , Asthma , Bronchitis
Bronchogenic carcinoma – MC cancer causing death in men and women.
Lungs are the major site of opportunistic infections in immuno-compromised individuals.
Tuberculosis
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
3. 3
• Metastasis is the MC malignancy of bone.
– Breast cancer is the MC primary site.
– Others include:
• Prostate ,Lung ,Kidney and thyroid
• Nature of metastasis
– Osteolytic:
• Destructive
• Most mets (breast**, lung, kidney etc)
– Osteoblastic:
• Reactive new bone formation
• Carcinoma prostate**, breast Ca.
8. 8
Primary Bone tumors: Clinical presentation
• Benign tumors:
– Usually asymptomatic
– Present as painless mass
• *Osteoid osteomas are painful,
• *Enchondromas may cause a stress #.
– Usually detected incidentally.
• Malignant tumors:
– Present with :
• Pain
• Swelling or a
• Pathological fracture
9. 9
Important parameters for diagnosis of
bone tumors
1. Age of patient
2. Bone involved
3. Specific area within the bone (epiphysis,
metaphysis, diaphysis)
4. Radiographic appearance
5. Gross and microscopic features
10. 10
Age and bone tumors
• Remember these general age ranges:
– Metastatic neuroblastoma*: infants &
toddlers
– Ewing's sarcoma: older children &
adolescents (5-20)
– Osteosarcoma: adolescents and young
adults(10—20).
– Giant cell tumors: young adults & middle age
(20-40)
– Chondrosarcoma: middle age (40-60)
– Multiple myeloma : middle to old age (>40)
– Metastatic cancer: middle and old age
13. 13
Risk factors for bone sarcoma
• Include
– some familial syndromes (e.g Li Fraumeni)
– radiation therapy.
• However, most cases are unrelated to any of
these.
• In the previously irradiated patient, the
commonest primary bone cancer:
– osteosarcoma **
14. 14
Treatment
• Benign tumors may be treated by
– curettage and
– packing with bone chips from elsewhere.
• Malignant tumors require
– resection,
– radiation, and/or chemotherapy.
• Osteosarcoma and Ewing's sarcoma often
respond well to chemotherapy.
15. 15
Classification of primary bone tumors
• Primary BT classified in to ten groups
1. Osteogenic (bone forming)
– Benign: osteoma, osteoid osteoma* and
osteoblastoma
– malignant: Osteosarcoma (osteogenic
sarcoma)*
2. Chondrogenic (cartilage forming)
– Benign: osteochondroma*, chondroma*,
chondroblastoma
– malignant: chondrosarcoma*
3. Unknown origin:
– Giant cell tumor* (benign / malignant)
– Ewing’s sarcoma* (malignant)
18. 18
Osteoma
• A benign bone forming tumor.
• Occurs in middle aged adults (40-50yrs)
• Sites:
– usually occurs in the skull (sinuses – most
common) ,facial bones and jaw.
• Usually harmless, they may impinge on the
brain, obstruct sinus drainage, or look ugly.
• Histologically resemble normal bone
• If multiple, suspect Gardener's syndrome
20. 20
• A benign painful* tumor of osteoblasts.
• Occurs in individuals 5-25 yrs old.
• Sites:
– Metaphysis/diaphysis of femur and tibia
– cortex of bone (size: <2cm*)
• Clinical:
– well-localized pain (Nocturnal).
– pain is relieved by aspirin
• Micro:
– Central nidus of osteoid surronded by dense sclerotic
rim of bone
• X ray reveals:
– a small radiolucent focus (nidus) surrounded by densely
sclerotic bone.
Osteoid osteoma***
23. 23
• *Osteoblastoma ("giant
osteoid osteoma"):
– Similar to osteoid
osteoma
– But is larger (>2cm)
and
– Arises in the
vertebral bodies
– Pain not worse at
night and not relived
by aspirin.
26. 26
Osteosarcoma (= osteogenic sarcoma)
• Cancer of the osteoblasts
• The malignant tumor cells make osteoid.
• The 2nd MC primary malignant tumor of bone
(1st is multiple myeloma).
• Age: (bimodal)
– 10-20 years old
• Arises de novo.
– >40 years old
• Usually secondary to risk factors (Paget’s
disease of bone etc.)
27. 27
• Location:
– Most in the
metaphyseal region
of long bones.
• Lower end of
femur (most
common)
• Upper end of tibia
• Upper end of
humerus
– Less commonly in flat
bones jaw.
29. 29
• Osteosarcoma: TYPES:
– Primary Osteosarcoma
• Arise in absence of associated bone
disease.
• In patients < 20 years
• From metaphyseal region of long bones.
• Genetic association:
– 2/3rd show inactivation of Rb gene**
– Common in Li-Fraumeni syndrome** (p53
gene inactivation)
– Secondary Osteosarcoma
• Occurs in older people
• Both in flat and long bones
• In a background of preexisting bone
disease
30. 30
Risk factors for osteosarcoma
• Paget’s disease of bone
– Osteosarcoma of the pelvic bones
• Irradiation (radium watch dial workers)
• Bone infarct
• Osteomyelitis
• Clinical features:
– Local pain, tenderness , swelling and
pathological fracture
35. 35
• Gross:
– Gray white mass with areas of
hemorrhage and necrosis
– Destroys cortex and invades adjacent
soft tissue
• Elevates the Periosteum , producing
Codman’s triangle on X ray.
• Sunburst appearance : due to
calcified osteoid extending into the
adjacent soft tissue.
38. 38
• Microscopy:
– Tumor cells produce osteoid.
– Tumor cells may be spindle, oval or round.
• Spread:
– Metastasize through blood stream lung
the most common site.
• Treatment:
– Surgery (limb sparing) with
– Preoperative and postoperative Chemotherapy.
• Prognosis
– five-year survival 50-60%.
41. 41
• Exostosis ("osteochondroma”):
– Most common** benign bone tumor.
• Tumor: Mushroom shaped
– Composed of outgrowth of bone (exostoses)
capped by benign proliferating cartilage.
• Age: 10-30
• Location: Usually located in the metaphysis of
long bone.
• Can be: solitary or multiple
• If Multiple then k/a osteochondromatosis:
– Hereditary multiple exostoses
– Increased risk of transformation into
chondrosarcoma (if multiple).
43. 43
• Chondromas: benign tumor composed of hyaline
cartilage
• If located within shaft of bone then k/a
enchondroma.
– Site: small bones of hand and feet (proximal
phalanges).
– Can be
• Solitary
• Multiple (called enchondromatosis)
– Chondrosarcoma risk with multiple
tumors.
• Ollier’s disease : multiple enchondromas.
• Maffucci's syndrome : multiple enchondromas
plus hemangiomas of soft tissues.
48. 48
Chondrosarcoma
• A malignant tumor of chondroblasts.
• MC primary malignant cartilaginous tumors.
• Age: 40-60 years
• Location:
– Central skeleton: ribs, shoulder and
Pelvic bones and
– Upper end of femur and humerus
• Can arise
– de novo or
– secondary to osteochondromatosis or
enchondromatosis.
51. 51
• Gross:
– grayish blue, glistening and semi-
translucent.
• Micro:
– composed of atypical chondrocytes and
chondroblasts often with multiple nuclei in
a lacuna.
• Biologic behavior and Prognosis
– depends on the grade of tumor.
• Metastasis
– Hematogenously to lungs
54. 54
Ewing's Sarcoma
• An extremely malignant tumor composed of
small round blue cells.
– Arises within the marrow cavity.
• Histogenesis uncertain: Current evidence:
– Probably of neuroectodermal origin.
– Reasons:
• Specific translocation : t(11;22)
• Same translocation also present in similar
tumor of soft tissue known as PNET
(primitive neuro-ectodermal tumor).
55. 55
• Age:
– Most occur in teenagers 5-20 yrs
• Genetics:
– classic translocation t(11;22) which produces
the EWS-FLI1 fusion gene.
• Gross:
– Arises in medullary cavity in the diaphysis of
long bones.
– Most common sites are the femur, pelvis and
the tibia.
– Penetrates the cortex to produce :
• White tan mass with necrosis and
hemorrhage.
60. 60
• Microscopy:
– Tumor composed of
• Sheets of "small round blue cells"
with little cytoplasm.
• Cells are loaded with glycogen.
• Glycogen can be seen by PAS stain.
• Homer Wright rosettes (tumor cells
arranged in circle about a central
fibrillary space)
61. 61
• X ray:
– Concentric “onion skin” layering of new
periosteal bone.
• Clinical features:
– It presents “as an infection” with
• fever,
• Painful enlarging mass often tender
• Heat over the tumor.
– Therefore simulates osteomyelitis.
• Prognosis:
– Radiation + Chemotherapy+ surgery 75% 5-
year survival.
62. 62
• Differential diagnosis:
– Other small round blue cell tumors
• metastatic neuroblastoma
• metastatic malignant lymphoma
• acute lymphoblastic leukemia
• Rhabdomysarcoma
• IHC will help differentiate ES from these
small round blue cell tumors (SRBCT).
66. 66
Giant cell tumor ("osteoclastoma")
• A locally aggressive potentially malignant tumor
composed of :
– multinucleated giant cells (nonneoplastic)
admixed with mononuclear cells (neoplastic).
• More common in females than males.
• Seen in patients 20-40 years of age
• Arises in the epiphysis and extends into
metaphysis
• Favored locations:
– Classical : epiphysis of long bone.
– Sites most commonly affected:
• Lower end of femur> Upper end of
tibia >Lower end of radius.
73. 73
• Gross: Cut section of the tumor:
– Solid red brown mass with hemorrhage and
cystic degeneration
• Microscopy: Two components
• Osteoclast like giant cells:
– Large with 20-30 nuclei.
– Are Not neoplastic.
– Formed due to fusion of monocytes.
• Mononuclear stromal cells.
– Are the neoplastic cells and determine
the behavior.
• X-ray:A lytic expansile lesion in the epiphysis.
– May have a “soap bubble” appearance.
• Clinical behavior: Unpredictable
76. 76
Fibrous cortical defects and
Non-ossifying fibromas
• Essentially the same disease except for a
difference in size.
– Fibrous cortical defects : 1-4 cm
– Non-ossifying fibromas : 5-10 cm.
• Both are benign tumor like lesions
78. 78
Fibrous cortical defects and
Non-ossifying fibromas
• Clinical:
– Extremely common: (1/3rd of normal children)
– Asymptomatic / fracture
– Occur in the long leg bones of children
(cortical aspect of metaphysis).
– Femur>tibia>fibula
– Made of fibroblasts,and lipid-laden
macrophages
• X ray:
– irregular, sharply demarcated radiolucent
defect in the metaphyseal cortex.
• Treatment:
– often resolves spontaneously
79. 79
Fibrous dysplasia
• Benign non-neoplastic process of bones.
• Characterized by
1. replacement of marrow by fibrous tissue.
2. presence of poorly formed woven bone
arranged in Chinese letter pattern.
• Primarily targets ribs, femur, or cranial bones
of children and young adults.