This document discusses renal cell carcinoma in a 55-year-old male factory worker presenting with hematuria, loin pain, and a loin mass. It describes the patient's investigations, pathology findings of clear cell renal cell carcinoma, staging according to AJCC TNM classification, and treatment options including radical or partial nephrectomy depending on tumor size and extent. The prognosis is outlined with 5-year survival rates ranging from 65% for stage 1-2 disease to 10% for stage 4 metastatic renal cell carcinoma.
Tumors of the appendix are rare. They pose both a diagnostic and therapeutic dilemma to the surgeon. The paper discusses the various intricacies of these lesions.
Liver Tumors and Hepatocellular carcinoma supported by Hepatoblastoma. Most of the text are from Robbins Pathological basis of disease 9E, Goljan Review of pathology.
Urethral strictures are more commonly seen in the anterior urethra. They are commonly seen secondary to gonococcal urethritis or trauma. The normal urethral lumen is 4mm or less in diameter and has small thin walls. A stricture appears as a segment of narrowed lumen with irregularity and thickening of the wall due to fibrosis and scarring.
Tumors of the appendix are rare. They pose both a diagnostic and therapeutic dilemma to the surgeon. The paper discusses the various intricacies of these lesions.
Liver Tumors and Hepatocellular carcinoma supported by Hepatoblastoma. Most of the text are from Robbins Pathological basis of disease 9E, Goljan Review of pathology.
Urethral strictures are more commonly seen in the anterior urethra. They are commonly seen secondary to gonococcal urethritis or trauma. The normal urethral lumen is 4mm or less in diameter and has small thin walls. A stricture appears as a segment of narrowed lumen with irregularity and thickening of the wall due to fibrosis and scarring.
Urology- Hematuria, Renal/Ureteric colic and Bladder Outlet ObstructionSelvaraj Balasubramani
In this PPT you can learn all important problems in Urology for undergraduate medical students. They are
1. Hematuria--> Renal cell carcinoma and Bladder carcinoma
2. Renal/Ureteric colic--> Urolithiasis
3. Bladder outlet obstruction--> Benign Prostatic Obstruction
you can also watch my YouTube channel playlist on Urology in the following link: https://www.youtube.com/playlist?list=PLxyHif1Z9-uXzZkDec1nDRwzPpW6V-G06
Radiological investigation of billiary tact 01Kajal Jha
The name biliary tract is used to refer to all of the ducts, structures and organs involved in the production, storage and secretion of bile.
Bile canaliculi >> Canals of Hering >> intrahepatic bile ductule (in portal tracts / triads) >> interlobular bile ducts >> left and right hepatic ducts >>
These merge to form the common hepatic duct
This exits the liver and joins with the cystic duct from gall bladder
Together these form the common bile duct which joins the pancreatic duct
These pass through the ampulla of Vater and enter the duodenum
Adrenal Gland and its Disorders with surgical management.Manish Shetty
Short and brief description of adrenal gland and its disorder.
it involves the basic anatomy, physiology and metabolism of adrenal hormones.
.Adrenal gland tumor like adrenal cortical tumor phaechromocytoma, incidentalaoma are mentioned in this PPT.
it explains the clinical symptoms, investigation and desired management of adrenal gland disorders.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
Embracing GenAI - A Strategic ImperativePeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
Normal Labour/ Stages of Labour/ Mechanism of LabourWasim Ak
Normal labor is also termed spontaneous labor, defined as the natural physiological process through which the fetus, placenta, and membranes are expelled from the uterus through the birth canal at term (37 to 42 weeks
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
2. NAME- Mr X
AGE- 55 YEARS
SEX- MALE
ADDRESS- MANGALORE
OCCUPATION- FACTORY WORKER
PRESENTING COMPLAINTS
HEMATURIA
LOIN PAIN
MASS IN LOIN
INSPECTION LOIN MASS
PALPATION MOBILE,NODULAR,
HARD,MOVES WITH
RESPIRATION
PERCUSSION DULL RENAL ANGLE
3.
4.
5.
6.
7.
8.
9. PATHOLOGY
GROSS– UNILATERAL, UPPER POLE,
LARGE ,GOLDEN YELLOW ,CIRCUMSCRIBED
CUT SECTION - AREA OF NECROSIS,CYSTIC CHANGE,
FOCI OF HAEMORRHAGE,THROMBUS
11. TYPE INCIDENCE GENETICS HISTOLOGY
GRANULAR CELL
TYPE
8% SPORADIC
&
FAMILIAL
ABUNDANT
ACIDOPHILIC
CYTOPLASM
MARKED ATYPIA
CROMOPHOBE TYPE 5% MULTIPLE
CROMOSOMES
LOSS,
HYPODIPLOIDY
•MIXTURE PALE
CLEAR CELL WITH
PERINUCLEAR HALO
•GRANULAR CELL
SARCOMATOID TYPE 1.5%
-------
WHORLS OF
ATYPICAL
ANAPLASTIC
SPINDLE CELLS
COLLECTING DUCT
TYPE
0.5 TUBULAR &
PAPILLARY PATTERN
12. LYMPHATIC
SPREAD
PROLIFERATIVE TROMBUS
EXTENDS INTO IVC
CANNON BALL SECONDARIES
IN LUNG
VARICOCELE DUE TO
BLOCKED LEFT RENAL VEIN
BRAIN,BONE
HILAR & PARA AORTIC
LYMPHNODE
PERINEPHRIC PAD OF FAT,CALYCES
RENAL PELVIS
16. Investigations
1. Urine :- RBCs
2. IVU:- Shows mass lesion and irregular filling defect
3. U/S abdomen:- size, extension, lymph node, status of renal vein, spread to liver.
4. Ct scan:- Confirmatory
status of renal vein and ivc
lymph node status and tumour extension
5. CECT: Early lesions, function, spread and venous status.
6. Renal angiogram:- to access the vascularity.
Seldinger’s technique via transfemoral.
Pharmaco angiogram- tumour blush
Also therapeutic embolisation.
7. MRI/MR ANGIOGRAM:- Tumour thrombus in IVC
8. Chest x-ray:- cannon ball mets
9. Ct chest:-
10. Bone scan.
11. Peripheral smear, serum calcium, haematocrit and ESR
17.
18. A, Magnetic resonance scan
of kidneys without
administration of
gadolinium suggests
anterior right renal mass.
B, After intravenous
administration of
gadolinium-labeled
diethylene-triamine-penta-
acetic acid, MRI shows
enhancement of this mass
indicative of malignancy.
19.
20. Tissue Diagnosis
• Tissue diagnosis obtained from nephrectomy or
biopsy
Papillary (chromophilic) renal cell
carcinoma extending into the
collecting system with histological
findings
21. AJCC (AMERICAN JOINT COMMITTEE
ON CANCER STAGING): TNM STAGING
• TX:- PRIMARY TUMOUR CAN NOT BE ASSESSED
• T0:- NO PRIMARY TUMOUR.
• T1: <7CM limited to kidney
T1a: 0-4CM, T1b: 4-7cm
• T2: >7CM, limited to kidney.
• T3: T3a:- extends to adrenals, perinephric fat
(not gerota’s fascia).
T3b: entends into renal vein or IVC below
diaphragm.
T3c: extends into IVC above diaphragm.
• T4: invades Gerota’s fascia and extends beyond.
22. • N0:- no lymph nodes
• N1:- spread to single region of lymph nodes.
• N2:- spread to more than a group of lymph
nodes.
• M0:- no blood spread.
• M1:- distant spread, lungs 75%, soft tissue,
bones, liver, cns and skin
28. 2. Large fixed tumours:- palliative nephrectomy or debulking is
adviced, why?
3. Bilateral RCC: Bilateral partial nephrectomy is
done.
Renal artery is temporarily ocluded using
vascular clamps and kidney cooled, why?
Resected specimen send for frozen section
biopsy.
retained partial capsule is sutured after heamostasis
arterial clamp released.
32. • Chemotherapy: Vinblastine and progesterone
• Interferons and interleukins.
• Antiangiogenic drugs like endostatin and
angiostatin under trial.
• Humanised monoclonal antibodies like
bevacizumab under trial.
• Laporoscopic approach becoming popular.
Difference?
33. Prognosis
Factors:- 1. tumour size >4cm
2. entension into renal vein
3. presence of secondaries
4. local extension
5. hypercalcaemia and stauffer’s
syndrome.
5 years survival: stage 1 and 2 is 65%
stage 3 is 40%
stage 4 is 10%