This document summarizes the case history, clinical examination, investigations, procedure, gross examination, microscopy, and discussion of a 65-year-old post-menopausal woman who presented with abdominal distention, breathlessness, and spotting. Key findings included an ovarian mass, elevated tumor markers, and staging laparotomy revealing a mixed epithelial tumor of the right ovary consisting of both benign Brenner's tumor and mucinous cystadenoma components. The document discusses the histological features and differential diagnosis of common benign ovarian tumors including serous cystadenoma, mucinous cystadenoma, dermoid cyst, fibroma, and Brenner's tumor.
This ppt is intended for teaching cervical pathology to medical graduates. It covers anatomy, basic inflammatory conditions, dysplasia and malignancy and its pathogenesis and diagnosis
Various types of benign conditions of the ovaries. The pathology, histopathology, clinical features, investigation plan and findings and management plan are mentioned.
This ppt is intended for teaching cervical pathology to medical graduates. It covers anatomy, basic inflammatory conditions, dysplasia and malignancy and its pathogenesis and diagnosis
Various types of benign conditions of the ovaries. The pathology, histopathology, clinical features, investigation plan and findings and management plan are mentioned.
Presentation about the the second most common type of ovarian tumors which have a very unique property of being similar to the testicular germ cell tumors.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
2. Case History
65 year old post-menopausal woman presented
with complaints of
• abdominal distention
• breathlessness
• spotting P/V intermittent for 6 month.
3. Clinical Examination
• P/A – Mass palpable the size of that of 28
weeks of gravid uterus occupying the
umbilical, hypogastric right and left lumbar
and iliac regions.
• Mass is non-tender, no warmth with regular
borders,surface smooth with variable
consistency
• Cervix, vagina – looks healthy.
4. • US Abdomen – A large abdominopelvic complex cystic
lesion - ? Mucinous Cystadenocarcinoma. Advised CECT
Abdomen for further evaluation.
• CECT Abdomen – Ovarian Solid Cystic Lesion likely to
represent Carcinoma Ovary.
• Tumor markers –
– CEA – 9.89 ng/mL (non-smokers upto 3.0 , smokers upto 5.0 )
– CA-125 – 34.09 U/ml ( < 35 U/ml)
• PAP Smear (G720/17) – Candidiasis and was Negative for
Intraepithelial Lesion and Malignancy.
Investigations
5. Procedure
• Patient underwent Staging Laprotomy under
SA and EA.
Patient underwent Total Abdominal
Hysterectomy with bilateral salpingo-
ophrectomy, Infracolic omentectomy was also
done.
6. SPECIMEN - GROSS EXAMINATION
• Received a container labelled
right ovarian tumor with right
Fallopian tube (984/17) -
– Partially cut open ovarian mass
measuring 19 x 14.5 x 14.5 cm
with attached stretched out
Fallopian tube measuring 2cm in
length.
– The external surface of the mass
was smooth.
– The cut sections showed
• multiloculated cyst (predominantly
cystic and partially solid areas
measuring 6 x 2.3 cm)
• 20-30 ml of mucinous fluid was
drained.
• Lumen of tube identified.
10. Specimen - Gross Examination
• Also received a container labelled uterus with cervix with
left ovary and left tube (985/17) .
– atrophic uterus with cervix measuring 8 x 4 x 3 cm with
attached tube measuring 4.5 cm and ovary measuring 2.5 x 1
cm.
– The external surface of uterus and cervix are unremarkable.
– The cut section of uterus and cervix shows
• Endocervical canal measuring 1.5 cm showing a Nabothian Cyst
• Endometrial canal measuring 2.5 cm occupied by a polyp measuring 1
x 0.5 cm. The endometrial thickness measured 0.5 cm and
endomyometrail thickness measured 1.5 cm on both sides.
– The cut section of tube and ovary shows
• Lumen of tube identified.
• Ovary shows corpus albicans.
11. Specimen - Gross Examination
• Also received container labelled omental
biopsy (986/17)
– Received single linear fibrofatty mass measuring
37 cm.
– No lymph nodes were identified
12. Specimen - Examination
• Also received peritoneal fluid for examination
• Examination of peritoneal fluid (NGC 110/17)
showed acellular smear
20. Microscopy (984/17)
• Sections studied from the cyst (A-E)showed multiloculated cyst
lined by intestinal type of columnar epithelium with underlying
subepithelium stroma consisting of ovarian stroma.
• Sections studied from thickened fibrous wall of cyst or solid areas
(F-K) comprises of predominantly solid nests of transitional
epithelium with occasional microcystic spaces containing
eosinophilic secretions in the background of fibrous stroma. The
individual tumor cells have moderate clear to eosinophilic
cytoplasm, vesicular nuclei with some nuclear grooves surface lined
by intestinal type of epithelium mainly. Foci of mucin secreting
columnar epithelium also seen.
• Sections studied from (Right) Fallopian tube (attached to ovarian
cyst) showed normal histology.
21. Microscopy (985/17)
Sections studied from
– Cervix (A,B) reveal endocervix showing chronic papillary
endocervicitis with squamous metaplasia and Nabothian
cyst.
– Endomyometrium (C,D) reveal
– Endometrium showing polyp and features of
secretory phase.
– Myometrium showing adenomyosis.
– (Left) tube showing normal histology.
– (Left) ovary showing corpus albicans.
27. SEROUS CYSTADENOMA
• Generally benign, most commonly seen in reproductive age group.
• Most common subtype of surface epithelial tumors.
• Bilateral – 10%
• Risk of malignancy : 10 – 15 % borderline malignant
20 -25% malignant
• GROSS : unilocular cyst with fibrous stroma , papillary components.
• MICRO : low columnar epithelium with cilia.
• Characteristic psammoma bodies (end products of degeneration of
papillary implants)are found.
• Associated fibrosis may lead to “cystadenofibroma”
• Lesions without cystic component - adenofibromas
28.
29. MUCINOUS CYSTADENOMA
• Round to ovoid unilateral multiloculated masses with smooth
capsules that are usually translucent or bluish to whitish gray.
• Have tendency to become large masses (upto 50cm)
• Interior divided by discrete septa into loculi containing clear ,
viscid fluid.
• Epithelium – tall, pale staining, secretary with basal nuclei and
goblet cells
• 5 – 10% are malignant.
30.
31. DERMOID CYST
• Often bilateral (15 -25%)
• GROSS: thick, opaque , whitish wall.
• CONTENTS: hair, bone, cartilage, and a large amount of greasy sebaceous
material.
• MICROSCOPICALLY : all the three germ layers (ectoderm, mesoderm and
endoderm)
• Malignant change occurs in 1-3%. Usually of a squamous type.
• Risk of torsion is 15%
• An ovarian cystectomy is almost always possible, even if it appears that
only a small amount of ovarian tissue remains
32.
33.
34. FIBROMA
• Most common benign, solid neoplasms of the ovary.
• Compose approx 5% of benign ovarian neoplasms and 20% of all solid
tumors of the ovary.
• Frequently seen in middle-aged women.
• Characterized by their firmness and resemblance to myomas
• Misdiagnosed as exophytic fibroids or primary ovarian malignancy
• Not hormonally active
• Fibromas may be associated with ascites or hydrothorax as a result of
increased capillary permeability thought to be a result of VEGF
• Meig’s syndrome (ovarian fibromas, ascites and hydrothorax) is
uncommon and usually resolves after surgical excision.
35.
36. THECOMA
• Solid fibromatous lesions that show varying degrees of yellow or
orange discoloration
• Almost always confined to one ovary
• Usually >40 years, 65% after menopause
• May be hormonally active and hence associated with estrogenic or
occasionally androgenic effects.
• Luetinised thecoma – younger, sclerosing peritonitis and ascites
• Leydeig cell thecoma – ass. with Reinke crystals
• Rarely malignant
37. BRENNER TUMOR
• Uncommon tumor grossly identical to fibroma
• .90% are unilateral
• Arise from Walthard cell rests ,also from surface epithelium, rete ovarii and
ovarian stroma.
• Grossly, they are solid, sharply circumscribed and pale yellow-tan in colour.
• On microscopy – markedly hyperplastic fibromatous matrix interspersed with
nests of epithelial cells showing coffee bean pattern
• Considered uniformly benign,but scattered reports of malignant Brenner’s is
available
• Endocrinologically inert, but could be associated with virilization and
endometrial hyperplasia
38.
39. Differential Diagnosis for Brenner’s tumor
Benign Brenner tumors are generally resembles
other solid ovarian masses such as
• Fibroma
• Fibrothecoma
• Pedunculated leiomyoma
40. Mixed Brenner-Mucinous Tumors
• Tumors containing both Brenner and mucinous components
are more common than previously appreciated.
• Believed to be variants of Brenner tumor and can be classified
as metaplastic Brenner tumor or mixed Brenner–mucinous
tumor.
• 1/4th of benign ovarian epithelial tumors that have a
mucinous component also contain a Brenner component.
• Conversely, 16% of tumors with a Brenner component contain
a mucinous component.
Editor's Notes
1. Benign epithelial tumors of the ovary can reach massive proportions. The serous cystadenoma seen here fills a surgical pan and dwarfs the 4 cm ruler
2.Here is a benign serous cystadenoma that demonstrates multiloculation. Note that the inner surface is, for the most part, smooth, with only a solitary papillation at the upper right.
3. Ultrasound imaging
4. Histopathological section: With few papillary projections from the surface
1.Cut open section of mucinous cystadenoma..
2. Histological section showing tall epithelial lining with pale staining nuclei at the basal pole.
3. Variable echogenicity in the contents of an adnexal multilocular cyst
The photo below shows a well-developed tooth arising from the right side of the mural nodule ("Rokitansky nodule") that contains most of the solid teratomatous elements. The central portion of the nodule contains mostly cutaneous tissues (skin, sweat glands, and hair follicles), while the neural tissues extend into the wall toward the left.
1. Mature cystic teratoma with typical long hyperechogenic lines and bright prominent spots representing hair in fluid.
2. Mature cystic teratoma with Rokitansky nodule or 'dermoid plug'(arrow) with posterior acoustic shadowing.
grayish white and firm
Cut section
Microscopically – stellate or spindle shaped cells arranged in fusiform pattern. Hyalinisation is frequent. The elongated fibroblastic tumor cells have spindle-shaped nuclei and may contain small amounts of lipid in their cytoplasm
Benign lesions can be managed by simple excision.
t/t of malignant brenner tumours is unsettled, various forms of chemotherapy have been used with little success.
Walthard cell rests are a benign cluster of epithelial cells most commonly found in the connective tissue of the Fallopian tubes, but also seen in the mesovarium, mesosalpinx and ovarian hilus. solid, sharply circumscribed and pale yellow-tan in colour. 90% are unilateral (arising in one ovary, the other is unaffected). The tumours can vary in size from less than 1 centimetre (0.39 in) to 30 centimetres (12 in). Borderline and malignant Brenner tumours are possible but each are rare.
Hyperplastic fibromatous matrix interspersed with nests of epitheloid cells
On high magnification, they exhibit characteristic coffee bean nuclei (clearly visible in image). On low magnification, they resemble urothelial cell nests.