1) Mediastinal masses can occur in the three compartments of the mediastinum and are diverse in pathology. 2) CT is usually the initial imaging modality of choice to determine the location and characteristics of the mass. 3) Tissue biopsy is often required before treatment planning to determine the specific diagnosis, as the approach depends on factors such as location, imaging features, and patient age.
retroperitoneal tumors esp. retroperitoneal sarcoma is most challenging condition to treat in retroperitoneal region inspite of using all treatment modalities.here is brief description of its management acc. to nccn , and other text book ref.
Imaging in small bowel tumors Dr. Muhammad Bin Zulfiqar
Here we will discuss CT and MR enterography. We will further discuss the use of negative contrast.
Four important tumors will be discussed.
retroperitoneal tumors esp. retroperitoneal sarcoma is most challenging condition to treat in retroperitoneal region inspite of using all treatment modalities.here is brief description of its management acc. to nccn , and other text book ref.
Imaging in small bowel tumors Dr. Muhammad Bin Zulfiqar
Here we will discuss CT and MR enterography. We will further discuss the use of negative contrast.
Four important tumors will be discussed.
Testicular tumors are rare.
1 – 2 % of all malignant tumors.
Most common malignancy in men in the 15 to 35 year age group.
Benign lesions represent a greater percentage of cases in children than in adults.
Most curable solid neoplasm
Small Bowel Tumor and Carcinoid Tumor
Brief Summary for UnderGraduates on classifications, common presentation, workup and treatment of small bowel tumor including carcinoids.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of 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 leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
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. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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
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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,
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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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,
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- Prix Galien International Awards Ceremony
6. Incidence
• 3% of all lesions of Chest.
Adults
• Thymomas and thymic cysts (26.5%),
• Neurogenic tumors (20.0%),
• Cysts (16.1%),
• Germ cell tumors (13.8%)
• Lymphomas (12.7%)
Children
• Neurogenic tumors (41.6%),
• Germ cell tumors (13.5%),
• Primary cysts (13.4%) & lymphomas (13.4%)
7. Clinical Presentation
• Incidental in > 50 % of the cases
1. Compression/ Infiltration S/S
Trachea
Oesophagus
Great Vessels
Lung
2. Non Specific like Fatigue/ Weight Loss
3. Paraneoplastic Syndrome: PRCA, Hypogamaglobulimia,
Smooth Muscle degenration
4. Myasthenia Gravis.
5. Pel Ebstein Fever
8. Work up
• CXR usually first imaging
• Location and content of tumor is of the most
important factor to reach diagnosis, apart from
clinical Exam & age.
Imaging
Tissue Diagnosis
9. Investigations
• Sniff Test (Daignostic Fluroscopy) - Sos
• CT Thorax/ MRI Thorax
• Extent & Resectabilty.
• Content
• Enhancement pattern
• PET CT (FDG)
• Thymic carcinoma
• Invasive Thymomas
• Problem solving
10. Other, based on clinical suspicion
• Parathyroid adenomas or functioning parathyroid carcinomas
may secrete parathormone.
• Pheochromocytomas may secrete various catecholamines (in
serum and urine), which may cause hypertension.
• Carcinomas may secrete carcinoembryonic antigen.
• Nonseminomatous germ cell neoplasms may secrete AFP or β-
human chorionic gonadotropin (β-HCG).
• Skin tests for tuberculosis, histoplasmosis, and
coccidioidomycosis may also yield positive results.
• Other diagnostic tests for mediastinal tuberculosis include
sputum cytology, CXR, and urine cytology
11. Direct Sx, without Biopsy
• Limited indication
• Threshold for Direct Sx reduced with emergence
of VATS.
• Cystic lesion
• Benign appearing solid tumors (neurogenic
tumors)
• mature teratomas
• Early stage thymomas.
12. Always needs Biopsy
• Poorly demarcated lesion of anterior and middle Ms.
• Eg. Thymomas, thymic carcinomas, seminomas,
nonseminomatous, germ cell tumors, and
lymphomas are quite similar in radiographic
appearance but are quite different in treatment
strategy.
• Neither guidelines nor standard of care approach
exist regarding Bx methods.
• Technique of Bx, depends on
• Location of tumor, Age and institutional expertise.
13. • Many methods are there.
• Avoid trans pleural Bx.
• Trucut preferred over FNAC
• Minimally invasive preferred over Invasive Approaches
• Limited indication when Surgical resection directly
indicated, without Bx.
14. • Ultrasound (US)-
guided
endoscopic biopsy
• EBUS TBNA middle
ms, but small tissue
sample and time
consuming/ technical
expertise.
• EUS FNA Posterior
Ms, may be useful
sometimes.
• Percutaneous
image-guided
needle biopsy
• US guided may be
used for ant ms mass,
through SC fossa
• CT guided more often
used, and can Bx
almost all lesion.
• Pneumothorax (8-
61%)
• Hemoptysis (1-6-3%)
15. • Parasternal anterior
mediastinotomy
• (Chamberlain’s approach )
• May be used, When Needle
Bx failed or not feasible, but
with advent of VATS, its
indication fallen significantly.
• 3-4 cm parasternal
Transverse incision.
• Risk of Injury to IMA.
• Useful for AP window and
para aortic masses.
• May be done, under LA.
• Cervical
mediastinoscopy and
videomediastinoscopy,
and extended CME.
• Under GA
• 2 cm incision @ 2cm
above, sternal notch.
• Pretracheal, paratracheal
and subcarinal lesion.
• Injur to lt RLN & great
vessels.
• VATS
• Can Bx almost all lesion with
examination of pleural
cavity.
• Under GA and DLT.
• Transpeural, so theoretical
risk of tumor seedling.
• Open surgical
procedures.
16. Approach
1. Is the mass actually in the
mediastinum or is it in Lung
2. Determine which compartment.
3. Radiological character, including
contents
4. Than Tissue Diagnosis as clinically
indicated.
That will narrow down DD and guide for Further Management
17. 1st Question
Mediastinal
• As these are lined by
mediastinal pleura they
often have
• smooth contour
• Tapered borders.
• Cross midlines.
Lung
• They are parechymal
• Surrounded by air
• May contain air
brochogram
• Will be on one side.
18. • Anterior MS 60% malignant
• Middle 30% malignant
• Post 15% malignant
Adults 50% malignant
Child 25% malignant
19. Antero superior
Ms 60%
MC thymoma
Middle Ms
20%
• MC mass
Cysts (20% of all
Ms Masses)
• Most common
tumor
Lymphoma
Posterior Ms
20%
Mainly
neurogenic
tumours
(Over all most
common 20%)
4”A”
1. Adenopathy
2. Awful primary
3. Aneurysm
4. Abnormal
developmental
4“Ts”:
1. Thymoma (MC 50
%) > 40yr
2. Teratoma
(GCT) 20% < 40 yr
3. Thyroid goiter
4. “Terrible”
lymphoma
1. Nerve sheath tumors
Sch/NF
2. Paraganglionic tumors
3. Meningoceles
4. Mesenchymal tumors
5. Lymphoma
6. Pheochromocytoma
7. Duplication cysts.
20. Fatty
masses
• Lipomas –
• 1.5-3% of all primary med masses.
• anterior mediastinum
• Homogenous, fat attenuation ( -100 HU)
• Liposarcoma
• Posterior mediastinum,
• Mostly symptomatic at present..
• CT Heterogeneus lesion with fat density areas.
• Thymolipoma
• Rare, 5% of thymic masses
• Asymptomatic
• CT large and well encapsulated mass with extensive fat
content (50-95%)and small amounts of thin fibrous septa
• DD are cardiomegaly, epicardial fat, pericardial cyst.
21. Cystic
masses
• 15-20 %
• Middle mediastinum, MC
• smooth walled,
homogenous attenuation,
non enhancing lesions,
with no infiltration
• Sometimes have
calcification, proteinaceous
or mucinous contents
• MRI T2 , high signal
intensity
• Bronchogenic cysts
• Congenital, tracheobronchial tree origin
• 40% symptomatic
• mc located near carina or paratracheal
area.
• Duplication Cyst
• Congenital, GI origin
• Mostly asymptomatic,
• Mediastinal neuroenteric
cysts
• anomalous protrusions of the
leptomeninges through intervertebral
foramen or defects in the vertebral body.
• They are associated with multiple vertebral
anomalies and with neurofibromatosis
• Pericardial Cyst
• 5-10 % primary Ms masses
• unilocular
• MC site right CP space
• Thymic Cyst
• 1% of Primary Ms masses
• congenital (unilocular) or acquired
(multilocular, thymoma/lymphoma/GCT)
• Lymphangioma
• 1-2% of Primary Ms masses
22. Thymoma
Clinical clues
• 40-50 % of MM
• 40-60 years
• a/w MG 30-50%.
• Hypo GG nemia 5%.
• PRCA 5%.
• 50% incidental.
• 35% invasive also.
• S Ach R Ab titre.
Radiological clues
• Ant Ms, AP window.
• Well defined encapsulated
homogenous mass.
• May appear heterogeneous
due to necr/Hg/cyst
changes
• Punctate, ring like
calcification 20%
• LN always Neg
• Rarely infiltrative
• CT helps to Diff Thymic
Hyperplasia.
23. Thymic Carcinoma
• 50+
• Uncommon
• Symptomatic often.
• MG never seen
• Infiltrating mass, with Blood vessel invasion
• LN+ high.
• May be Pleural nodules and lung mets.
• More cystic/necrotic component.
• Rarely Thymic Carcinoid or thymolipoma, Dx is by Tissue Dx.
• Thymic cyst
• Thymic hyperplasia.
24. Lymphoma
Clinical clues
• Ant > middle > post
• Secondary > HD > NHL
(85%/15%)
• Bimodal distribution
(20/50+)
• 20-30% of MM
• 20-30% have B symptom
• A/W Gen LAP
Radiological clues
• Homogenous, enhancing,
lobualated but infiltrative
masses
• Pleural effusion and LN
+
25. Thyroid
Clinical clues
• Middle age.
• F >> M.
• 10% on MM.
• Calcification 25%.
• Can be cervical goiter
with retrosternal
extension or >>
goiter/tumor of
ectopic/remnant thyroid.
Radiological clues
• Enhancing, Inhomogenous
lobulated, encapsulated mass,
with areas of
calcification/cystic
degeneration.
• Thyroid cancer infiltrative
and LN+.
• Can be diagnosed without
biopsy by Radioactive iodine
scan.
• No treatment unless
symptomatic, usually pressure
symptoms or malignancy.
26. Germ Cell Tumor
• Ant Ms is MC site of Extra
gonadal GCTs.
• 15 % of all Anterior Ms
Masses in adults
• 25-30% of all ant ms
masses in Children.
• MC age 30-40 for SGT, 15-
30 For NSGCT.
• Less commonly seen in
Post Ms.
• NSGCT (Teratoma MC
type) >> SGT
• Uncommon
• Large
heterogeneous
infiltrative masses
• Areas of necrosis
and Hg
• Pleural &
pericardial
Effusion common.
• Seminoma too are
like NSCGCT
Other NSGCT/Seminoma
27. Teratoma
Clinical clues
• Young < 30 years
• Mature teratoma
benign
• 70% of GCT
• CXR large lobulated,
well-circumscribed
protrude into one lung
field.
Radiological clues
• CT heterogeneous
anterior Ms mass
• Fluid-containing cystic
areas, fat, and
calcification occur
frequently.
• The findings of fat and
fluid levels produced
by high lipid content in
the cyst fluid are
diagnostic
28. Imaging
• MRI has certain indication
• It better delineate soft
tissue and vascular
involvement.
• Its better differentiate solid
from Cystic masses.
• Available for patient of
contrast allergy.
• For intraspinal ext. of post
Ms tumors.
PET is not standard, May be used for
• differentiating thymoma
from hyperplasia in
myasthenia gravis
• useful for predicting the
grade of malignancy in
thymic epithelial tumors.
CXR, often available but hardly informative
CECT chest is Imaging Modality of Choice,
29. • Radioisotope scanning has been of specific aid in
establishing a definitive diagnosis for ectopic thyroid and
parathyroid tumors.
• Infants and child Paravertebral mass,
• Norepinephrine and epinephrine level. (NB & gNB)
• Young adult Ant ms mass
• b HCG, LDH and AFP
• Anterior MS mass with suspected thymoma (>40yr A
mm)
• S Ach R Ab titre
• S soluble IL 2 level elevated in Ms Lymphoma.
• Thymic carcinoids produce ACTH & Cortisol
hypokalmia.
30. Neurogenic tumors
• Posterior Ms
• 20% of Ms mass adults/ 35% child.
• Originate in neural crest
• Mostly benign and asymptomatic. 70-80%
Peripheral nerve tumors 70%
• schwannomas (Benign), MC
• Neurofibroma nonencapsulated (benign)
• Neurilemmoma –: “Dumb bell Tumor”, neural sheath origin
• SG tumors 25%
• Ganglioneuroma
• Ganglineuroneurobalstoma.
• Paraganglia- paraganglioma (rare/benign)
31. Schwannoma
• Post M
• 20-30 year
• Incidental, symptomless
• CT well defined,
Markedly convex mass
• Dumbbell/ hourglass
configuration
• Cystic/ hmg/ calcifi
common.
• Multiple lesion NF2
SGT
• Post MM
• Child/ young adult
• Well defined/ill defined
mass
• Oriented along AL
surface of several
vertebrae
• Whorled appearance.
33. Conclusion
• MM are diverse and management depend on exact Dx
• CT is IOC.
• MRI may used as problem solving modality and adds value
sometimes.
• Role of PET CT is not well defined.
• Biopsy is Often Required before Definitive Mx.
• Bx options are many and best option should be chosen
according individual case to case basis.