This document summarizes an orthopedic case presentation. It describes a 53-year-old female patient who presented with a 1.5x1 cm swelling on her right ring finger that was painful. Examination and imaging found a lesion. Differential diagnoses included ganglion cyst, giant cell tumor of tendon sheath, and others. Biopsy revealed chondromyxoid fibroma. The patient underwent excision and curettage. Histopathology confirmed chondromyxoid fibroma.
arthroscopy of the knee joint is a relatively common orthopedic procedure to treat a host of sports injuries and other knee diseases. Commonly a 4 mm size scope is used via two standard arthroscopy portals. Arthroscopic examination of the knee confirms MRI findings. Synovial fluid and biopsy can be taken to confirm diagnosis.
arthroscopy of the knee joint is a relatively common orthopedic procedure to treat a host of sports injuries and other knee diseases. Commonly a 4 mm size scope is used via two standard arthroscopy portals. Arthroscopic examination of the knee confirms MRI findings. Synovial fluid and biopsy can be taken to confirm diagnosis.
A classification of bone tumours. Modified after Revised WHO Classification –Schajowicz (1994)
Osteoblastoma
Are larger: > 2 cm.
Periosteal reaction may be more prominent than encountered in osteoid osteomas
Fractures and fracture dislocations of the tarsometatarsal jointMurugesh M Kurani
Here I have discussed an article from Journal of Bone and Joint Surgery. The presentation includes classification, treatment, results and complications. Lets share and learn.
The presentation discusses evidence based medicine in the stream of Orthopaedics. Here I have discussed a case of Ipsilateral Intertronchanteric and Femoral shaft Fracture and its various treatment modalities. The presentation was done at J.N. Medical College Belagavi, India. Lets share, discuss and keep learning.
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
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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
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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.
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.
4. HISTORY OF PRESENTING ILLNESS
Patient was apparently alright 3 months back,
later she noticed a small swelling in the right ring
finger which was associated with mild
intermittent pain. Swelling gradually progressed
to attain present size of around 1.5x1 cm.
Since last 15days pain increased in severity and is
continuous in nature.
Pain is more during night time.
5. Pain increases on movements and relieves
upon rest
No h/o trauma/ fall
No h/o fever/ weight loss/ decreased appetite
No h/o intake of any medication
6. PAST HISTORY:
• No history of similar complaints in the past.
• No h/o -ASTHAMA/TB / brucellosis
• No h/o DM/HTN
FAMILY HISTORY:
No h/o similar complaints in the family
7. PERSONAL HISTORY
• Diet : vegeterian
• Appetite : Adequate
• Sleep : decreased because of pain
• Bowel & Bladder : Normal and regular
• No h/o of smoking /tobacco/alcohol intake
8. GENERAL PHYSICAL EXAMINATION
An elderly female patient , moderately built & nourished,
conscious and co-operative & well oriented to time, place &
person.
VITALS:
• PR: 82/min
• BP: 134/86 mm of Hg in supine
• RR: 19 /min
• Temp- afebrile 98*F
10. SYSTEMIC EXAMINATION
CVS: S1 S2 + ,no murmur
RS : B/L Normal vascular breath sounds present
B/L Air entry equal.
PA : Soft, Non tender,
Bowel sounds present, no organomegaly.
CNS: No focal neurological deficit.
11. LOCAL EXAMINATION
INSPECTION:
Localised ovoid swelling of
around 1.5X1 cm over middle
phalynx of right ring finger on
volar aspect. (parallel to long
axis of bone)
Skin over the swelling is
stretched.
No scar/ sinus/ redness.
No visible pulsations/ dilated
veins.
12. PALPATION
local rise of temperature.
Tenderness present over swelling.
Size: 1.5x1 cm, hard, fixed to underlying bone.
No distal neuro-vascular deficit.
14. INVESTIGATIONS:
Hb : 11.4g%
WBC : 6800 cells/cumm, N62, L 30, E 06, M 02
PLATELET COUNT : 3.05L/cumm
RBS : 116 mg%
UREA : 29mg%
CREATININE: 1.1 mg%
HIV, HBsAg, HCV : NON REACTIVE
15. X RAY OF RIGHT HAND
Sharply marginated,
lobulated,eccentrically
located lucent defect
in metaphysio-
epiphysial region of
middle phalynx of ring
finger.
16. MRI OF RIGHT HAND
IMPRESSION:
Well defined signal
abnormality along
palmar aspect of ring
finger in the region of
middle phalynx s/o
GCT of tendon
sheath d/d ganglion
cyst.
17. DIFFERENTIAL DIAGNOSIS
GANGLION CYST
GCT OF TENDON SHEATH
ENCHONDROMA
PERIOSTEAL CHONDROMA
SIMPLE BONE CYST
ANEURYSMAL BONE CYST
CHONDROBLASTOMA
CHONDROMYXOID FIBROMA
CHONDROSARCOMA
18. GCT TENDON SHEATH
A giant cell tumor of tendon sheath consists of
multinucleated giant cells, inflammatory cells, histiocytes,
and fibroblasts.
It develops in or near synovial joints, bursae, and tendon
sheaths and may represent a reactive inflammatory
process or a benign neoplasm.
AGE- It most frequently develops in people between 30 and 50
years of age.
SITE- It commonly appears in the hand and less commonly in
the foot, ankle, and knee.
Physical examination reveals a firm, small, lobulated mass
fixed to the underlying tissues or tendon sheaths.
Occasionally it can erode bone. This tumor may grow
slowly and recur following surgical excision.
19. GANGLION CYST
Ganglion cysts are unilocular or multilocular collections of translucent
fluid or gelatinous myxoid tissue surrounded by fibrous tissue.
AGE- They can occur in patients of any age and are located in a superficial
location adjacent to synovial joints or tendon sheaths.
SITE - They are commonly found near the wrist, hand, and knee.
Occasionally those that develop near the knee grow to a large size and
dissect through the surrounding soft tissues.
Enlargement of the limb or swelling caused by these unusual ganglia may
suggest the presence of a neoplasm. Although aspiration can remove the
fluid from a ganglion cyst, surgical resection is currently the most
predictable method of eradicating symptomatic lesions.
20.
21. ENCHONDROMA
An enchondroma is a benign hyaline cartilage
lesion located in the medullary cavity of
otherwise normal bones.
It frequently occurs in the bones of the
hands and feet but may appear in any
bone including the femur, tibia, and
humerus.
It is generally considered an asymptomatic,
indolent lesion.
Plain radiographs reveal a central, well-
circumscribed lucent region that may be
mineralized. Enchondromas resemble
bone infarcts. Further imaging studies are
not necessary, but enchondromas normally
show increased activity on a bone scan.
22. During skeletal growth the lesions may slowly enlarge.
Following completion of normal growth, they cease to
enlarge and the cartilage component calcifies to give a
stippled radiographic appearance.
In extremely rare cases, a chondrosarcoma can develop
from an enchondroma. Because enchondromas are usually
asymptomatic and do not enlarge after skeletal maturity, a
lesion that causes pain or enlarges in an adult strongly
suggests the possibility of malignant transformation.
Enchondromas generally do not require surgical treatment.
23. PERIOSTEAL CHONDROMA
A periosteal chondroma is a rare, subperiosteal lesion consisting of
hyaline cartilage.
It forms between the cortical bone and overlying periosteum, often
creating an indentation in the bone surface and a smooth bulge of
periosteum-covered cartilage that projects into the soft tissues.
AGE- Most patients are young or middle-aged adults.
Presumably periosteal chondromas develop from proliferation of
cartilage-forming periosteal cells.
SITE- They occur most frequently in the proximal humeral metaphysis,
phalanges, metacarpals, and metatarsals.
24. They usually present as a solitary, painful mass or as an
incidental radiographic finding.
Radiographs show a scalloped depression in the bone
cortex and may show the faint image of a soft tissue mass
containing speckled regions of calcification.
Periosteal chondromas can slowly enlarge, but they have
not been shown to be aggressive.
For symptomatic or enlarging lesions, surgical resection
provides definitive local control.
25. SIMPLE BONE CYST
Simple, or unicameral, bone cysts consist of fluid-filled
cavities within bone lined by a thin layer of fibrous tissue.
Age- They occur most commonly in children less than 15
years of age.
Site- Approximately 50% occur in the proximal humeral
metaphysis. Other common sites include the proximal
femur and iliac wing.
They may cause slight expansion of bone and thinning of
the cortex. As a result patients often present with a
pathologic fracture through the cyst.
26. Radiographically, simple bone cysts are centrally
located, lucent lesions of the metaphysis. As new bone
in skeletally immature patients grows away from the
cyst, the lesion may eventually reside in the diaphysis.
The current recommended treatment of simple cysts
includes observation with restriction of activity and
steroid injections. Intralesional curettage and bone
grafting is generally reserved for large cysts at high risk
for fracture in the proximal femur.
27. ANEURYSMAL BONE CYST(ABC)
Aneurysmal bone cysts (ABCs) consist of blood-filled cavities lined by
fibrous septae that include giant cells and areas of osteoid but no true
endothelial cells.
AGE- Approximately 85% of patients with ABCs present before age 20.
The most common symptoms are pain, swelling, and tenderness on
palpation of the involved bone.
SITE- ABCs commonly involve the metaphysis of long bones, posterior
elements of the vertebrae, pelvis, or scapula, but they can occur
throughout the skeleton.
ABCs can grow rapidly and frequently cause pathologic fractures. When
located in the spine, they can cause neurologic compromise.
28. Plain radiographs show a lytic lesion causing marked
expansion of the involved bone and occasional
periosteal new bone formation. An MRI scan often
reveals fluid-fluid levels.
They may stop expanding and begin to ossify after
reaching a certain size or they may regress
spontaneously.
Standard treatment is a confirmatory biopsy followed
by intralesional curettage and bone grafting.
29. CHONDROBLASTOMA
A chondroblastoma is a benign cartilage tumor
consisting of regions or “islands” of densely
packed polyhedral cells called chondroblasts
admixed with fibrous tissue and chondrocytes
forming a cartilage matrix.
Site- epiphysis of long bones in patients with
open physes. They occur most commonly in the
proximal humerus, distal femur, proximal tibia,
and proximal femur.
30. Radiographs typically show an eccentric,
epiphyseal lucency with punctate calcifications. A
sclerotic rim surrounds the lucent area.
The lesions rarely involve more than half of the
epiphysis and only occasionally extend into the
metaphysis.
Intralesional curettage and bone grafting is
indicated for a chondroblastoma.
32. HISTOPATHOLOGY REPORT
GROSS EXAMINATION:
Single, grey white, firm tissue,
measuring 1.2x0.8x0.7cm. Cut section
shows grey white appearance.
MICROSCOPIC EXAMINATION:
Mass lined by lobules of chondrocytes
surrounded by fibroblasts along with
central areas of ossification. No
evidence of malignancy in the sections
studied.
IMPRESSION:
CHONDROMYXOID FIBROMA- MIDDLE
PHALYNX OF RIGHT RING FINGER.
33. CHONDROMYXOID FIBROMA
Rare, slow growing, benign cartilagenous tumor <1%, malignant degeneration is rare.
Charecterised by GRM1 gene fusion or promoter swapping.
Associated with a translocation at t(1;5)
Described in 1943 by Jaffe and Lichtenstein, who differentiated the histologic
findings from chondrosarcoma, before 1943 it is considered a giant cell varient.
Site: metaphysis of long bones – distal femur, proximal tibia (60%)
flat bones – ileum, ribs, skull bone
hand bones.
Age – ranges from 3-70 years, 60% are late adolescents and young adults.
Sex – M>F
34. X - RAY- Sharply marginated,
lobulated,eccentrically located
lucent defect in the
metaphysis, may extend into
epiphysis.
Macroscopy: sharp
circumscribed, often lobulated,
firm, gray white or blue gray.
Microscopy: pseudolobular
architecture, spindle shaped or
stellate cells, abondant myxoid
stroma to chondroid stroma.
35. TREATMENT:
Intralesional curettage or resection. Resulting bony defect has to filled
using iliac bone graft and screw fixation. Recurrence rate 25%.
Wide en block excision may lower the recurrence, but add unnecessary
morbidity.
Local adjunct treatment agents, such as phenol, methylmethacrylate
and liquid nitrogen have not been shown to decrease the
recurrence rate.
Radiotherapy may be used in tumors that are considered unresectable.
36. CHONDROSARCOMA
A chondrosarcoma is a malignant tumor, may develop from an
enchondroma or osteochondroma but occurs more commonly in bones
with no known preceding cartilage lesion.
AGE- Chondrosarcomas occur in adults and the elderly.
SITE- most commonly in the pelvis, scapula, humerus, femur, and tibia.
Patients with multiple hereditary exostoses, Ollier's disease and Maffucci's
syndrome have a higher risk for malignant transformation of a
cartilaginous lesion.
Chondrosarcomas vary considerably in their behavior: some enlarge
rapidly, aggressively invade normal tissue, metastasize, and cause death,
but most are low grade tumors that enlarge slowly, cause little damage to
adjacent tissues, and metastasize only after many years.
37. Plain radiographs reveal bone destruction
as well as mineralization within the
tumor.
HISTOPATHO: Chondrosarcoma of low
grade may mimic Chondromyxoid
fibroma except for the lack of a
myxoid element.
Low grade chondrosarcoma: few
mitotic figures with a bland histologic
appearance, enlarged chondrocytes
with plump multinucleated lacunae.
High grade chondrosarcoma:
hypercellular stroma consisting of
charecteristic “blue balls” of a
cartilage lesion which permeate the
bone trabeculae.
38. Wide surgical excision is necessary and offers
the best possibility of cure, as radiation and
chemotherapy have not proven to be effective
methods of treatment for chondrosarcoma.
Locally recurrent disease is common and may
be difficult to treat.