Sacrococcygeal teratomas are benign or malignant tumors composed of germ cells that most commonly occur in the sacrococcygeal region. They can be classified as mature teratomas containing fully differentiated tissues, immature teratomas with incompletely differentiated tissues, or malignant teratomas containing malignant elements. Diagnosis involves prenatal ultrasound, postnatal radiological imaging and tumor marker testing. Treatment is complete surgical excision of the tumor and coccyx to prevent recurrence, with chemotherapy potentially used for malignant components. Long term follow up monitors for recurrence or complications.
The document discusses different procedures for inguinal lymph node dissection, including standard, modified, and radical dissection. It describes key aspects of modified inguinal lymphadenectomy such as a shorter skin incision and preservation of structures like the saphenous vein. Complications of inguinal node dissection are also outlined, ranging from minor issues like lymphocele and wound infection to major complications including debilitating lymphedema, flap necrosis, and blood clots. The document provides details on surgical techniques, postoperative care, and risks associated with dissection of lymph nodes in the groin area.
1) Transanal total mesorectal excision (TME) is a novel technique for resection of rectal cancers.
2) TME involves excising the rectum and the surrounding mesorectum in one block through the anus to minimize local recurrence.
3) This "down-to-up" transanal approach aims to improve on open TME by reducing morbidity and impairment of function compared to traditional surgery.
This document discusses evaluation and diagnosis of breast lumps. It begins by listing common benign and malignant causes of breast lumps. It then describes the gold standard triple assessment approach to diagnosis, which involves clinical examination, imaging such as mammography, and biopsy such as fine needle aspiration. The document further discusses breast anatomy, classifications and molecular subtypes of breast tumors, epidemiology and risk factors for breast cancer, signs and symptoms, and prognostic factors. It provides examples of famous individuals who were diagnosed with breast cancer. Finally, it presents three clinical case scenarios and asks the reader to provide a provisional diagnosis in each case based on presented history and examination findings.
Locally advanced breast cancer refers to stage IIIA and IIIB breast cancer where the cancer has spread locally but not to distant sites. It is typically treated with a multi-pronged approach including neoadjuvant chemotherapy to shrink the tumor followed by surgery if possible. Post-operatively, patients receive adjuvant chemotherapy, radiation therapy, and hormone therapy if the cancer is hormone receptor positive. The goal of neoadjuvant chemotherapy is to downstage the tumor to allow for breast conserving surgery rather than mastectomy in some cases. Prognosis depends on response to neoadjuvant chemotherapy and surgical margins. Inflammatory breast cancer, a rare but aggressive form of locally advanced disease, has a poorer prognosis despite intensive treatment
This document discusses benign breast disorders and their management. It begins by classifying benign breast disorders according to age group and type, such as fibroadenomas which commonly occur in younger women. Specific disorders are then discussed in more detail such as their presentation, risk of malignancy, investigations and treatment options. These include fibroadenomas, cysts, epithelial hyperplasia, papillomas and fat necrosis. Surgical and non-surgical management strategies are provided depending on the disorder.
The document discusses the BI-RADS (Breast Imaging-Reporting and Data System) which classifies breast lesions identified on mammography, ultrasound, or MRI into categories based on assessment and risk of malignancy. It describes the 6 BI-RADS assessment categories ranging from BI-RADS 0, where additional imaging is needed, to BI-RADS VI for a known biopsy-proven malignancy. Key descriptors are provided for describing masses, calcifications, architectural distortion and other findings. The goal of BI-RADS is to standardize breast imaging reporting and ensure appropriate clinical management based on cancer risk.
The document describes the anatomy and physiology of the breast as well as common breast conditions. It discusses the structure of the breast including lobes, lobules, ducts, and surrounding tissues. It then covers common benign and malignant breast diseases like fibroadenomas, cysts, mastitis, and ductal carcinoma in situ. The document concludes with descriptions of clinical exam findings, imaging tests, biopsy procedures, and management of various breast abnormalities.
This document discusses several hamartomatous polyposis syndromes:
Peutz-Jeghers syndrome is characterized by gastrointestinal hamartomas and mucocutaneous pigmentation. Patients have an increased risk of gastrointestinal cancers and other malignancies. Cowden's disease (multiple hamartoma syndrome) involves hamartomas of various tissues and an increased risk of breast, thyroid, and GI cancers. Juvenile polyposis typically presents in childhood and can involve the entire GI tract. Cronkhite-Canada syndrome presents in older adults and is characterized by diffuse GI polyposis, skin abnormalities, diarrhea, and weight loss. Radiologic findings help identify and characterize polyps in these various syndromes.
The document discusses different procedures for inguinal lymph node dissection, including standard, modified, and radical dissection. It describes key aspects of modified inguinal lymphadenectomy such as a shorter skin incision and preservation of structures like the saphenous vein. Complications of inguinal node dissection are also outlined, ranging from minor issues like lymphocele and wound infection to major complications including debilitating lymphedema, flap necrosis, and blood clots. The document provides details on surgical techniques, postoperative care, and risks associated with dissection of lymph nodes in the groin area.
1) Transanal total mesorectal excision (TME) is a novel technique for resection of rectal cancers.
2) TME involves excising the rectum and the surrounding mesorectum in one block through the anus to minimize local recurrence.
3) This "down-to-up" transanal approach aims to improve on open TME by reducing morbidity and impairment of function compared to traditional surgery.
This document discusses evaluation and diagnosis of breast lumps. It begins by listing common benign and malignant causes of breast lumps. It then describes the gold standard triple assessment approach to diagnosis, which involves clinical examination, imaging such as mammography, and biopsy such as fine needle aspiration. The document further discusses breast anatomy, classifications and molecular subtypes of breast tumors, epidemiology and risk factors for breast cancer, signs and symptoms, and prognostic factors. It provides examples of famous individuals who were diagnosed with breast cancer. Finally, it presents three clinical case scenarios and asks the reader to provide a provisional diagnosis in each case based on presented history and examination findings.
Locally advanced breast cancer refers to stage IIIA and IIIB breast cancer where the cancer has spread locally but not to distant sites. It is typically treated with a multi-pronged approach including neoadjuvant chemotherapy to shrink the tumor followed by surgery if possible. Post-operatively, patients receive adjuvant chemotherapy, radiation therapy, and hormone therapy if the cancer is hormone receptor positive. The goal of neoadjuvant chemotherapy is to downstage the tumor to allow for breast conserving surgery rather than mastectomy in some cases. Prognosis depends on response to neoadjuvant chemotherapy and surgical margins. Inflammatory breast cancer, a rare but aggressive form of locally advanced disease, has a poorer prognosis despite intensive treatment
This document discusses benign breast disorders and their management. It begins by classifying benign breast disorders according to age group and type, such as fibroadenomas which commonly occur in younger women. Specific disorders are then discussed in more detail such as their presentation, risk of malignancy, investigations and treatment options. These include fibroadenomas, cysts, epithelial hyperplasia, papillomas and fat necrosis. Surgical and non-surgical management strategies are provided depending on the disorder.
The document discusses the BI-RADS (Breast Imaging-Reporting and Data System) which classifies breast lesions identified on mammography, ultrasound, or MRI into categories based on assessment and risk of malignancy. It describes the 6 BI-RADS assessment categories ranging from BI-RADS 0, where additional imaging is needed, to BI-RADS VI for a known biopsy-proven malignancy. Key descriptors are provided for describing masses, calcifications, architectural distortion and other findings. The goal of BI-RADS is to standardize breast imaging reporting and ensure appropriate clinical management based on cancer risk.
The document describes the anatomy and physiology of the breast as well as common breast conditions. It discusses the structure of the breast including lobes, lobules, ducts, and surrounding tissues. It then covers common benign and malignant breast diseases like fibroadenomas, cysts, mastitis, and ductal carcinoma in situ. The document concludes with descriptions of clinical exam findings, imaging tests, biopsy procedures, and management of various breast abnormalities.
This document discusses several hamartomatous polyposis syndromes:
Peutz-Jeghers syndrome is characterized by gastrointestinal hamartomas and mucocutaneous pigmentation. Patients have an increased risk of gastrointestinal cancers and other malignancies. Cowden's disease (multiple hamartoma syndrome) involves hamartomas of various tissues and an increased risk of breast, thyroid, and GI cancers. Juvenile polyposis typically presents in childhood and can involve the entire GI tract. Cronkhite-Canada syndrome presents in older adults and is characterized by diffuse GI polyposis, skin abnormalities, diarrhea, and weight loss. Radiologic findings help identify and characterize polyps in these various syndromes.
This document summarizes information about sentinel lymph node biopsy for breast cancer. It discusses the history and technique of sentinel lymph node biopsy. It describes that the sentinel lymph node is the first lymph node to receive drainage from the primary tumor site, usually in the axilla. The document outlines the procedure for sentinel lymph node biopsy and evaluating biopsy specimens. It discusses studies that have shown sentinel lymph node biopsy is an accurate method for staging breast cancer and that completion axillary lymph node dissection may not be needed in all cases with limited sentinel lymph node involvement.
This document provides information on the management of soft tissue sarcoma. It discusses the clinical presentation, patterns of spread, imaging, histology, grading, staging, prognostic factors and management of soft tissue sarcomas. The key points are:
1) Soft tissue sarcomas most commonly present as painless swellings in the extremities and can invade locally along fascial planes. Imaging like MRI is important for assessing tumor extent.
2) Histologically, the most common subtypes are undifferentiated pleomorphic sarcoma and liposarcoma. Grading systems consider tumor differentiation, mitosis and necrosis.
3) Staging is based on tumor size, depth, nodal status and metastasis
Postoperative Radioiodine Ablation in Thyroid CancerMamoon Ameen
This document discusses thyroid cancer, including the different types, pathology, clinical presentation, staging, and treatment options. The main types discussed are papillary carcinoma (70-80% of cases), follicular carcinoma (15% of cases), and anaplastic/undifferentiated carcinoma (5-10% of cases). Treatment involves surgery, radioactive iodine therapy, and thyroid hormone suppression. Radioactive iodine therapy utilizes iodine-131 to destroy remaining thyroid tissue or known cancer metastases based on the cancer's ability to uptake iodine. Precautions are needed after radioactive iodine therapy to avoid exposing others to radiation. Long term follow-up with thyroid scans and thyroid biomarker monitoring is important to
1) Locally advanced breast cancer involves large tumors that have often spread to nearby lymph nodes but not distant sites. This makes the cancer inoperable with surgery alone.
2) Left untreated, locally advanced breast cancer can cause skin and tissue damage from ulceration, bleeding, and infection at the breast as well as pain, swelling, and blockages from spread to lymph nodes in the armpit.
3) Treatment options include chemotherapy to shrink the tumor and make it operable, radiation therapy to the breast and nearby lymph nodes, and hormone therapy for hormone receptor-positive cancers.
This document provides an overview of mammography presented by Sumanjali N. of Manipal Hospital in Whitefield, Bengaluru. It begins with an introduction to mammography and breast anatomy. It then discusses breast cancer and various imaging modalities used including mammogram, ultrasound, tomosynthesis, PET mammogram, MR mammogram, and thermography. The role of a mammography technologist is outlined. Standard mammographic views and the breast imaging reporting and data system (BI-RADS) for assessing findings are described. Common mammographic artifacts are also reviewed. The presentation concludes by emphasizing the importance of screening mammography in early breast cancer detection and reassurance of patients.
This document provides information about orchitis and orchiectomy procedures. It begins by defining orchitis as the inflammation of the testis and describes its symptoms. It then discusses the anatomy of the testes and some common causes of orchitis, including mumps, infections, trauma, and complications from other procedures. The remainder of the document focuses on orchiectomy procedures, including a bilateral orchiectomy to treat prostate cancer, the surgical steps involved, and follow up care and investigations.
The document describes a hysterosalpingography procedure used to evaluate the uterine cavity and fallopian tubes. Key points include: HSG involves injecting radiopaque contrast medium under fluoroscopy to visualize the uterus and tubes. It is commonly used to investigate infertility. The procedure involves catheterizing the cervix and injecting contrast. Findings are interpreted to evaluate for abnormalities like tubal blockages. Common findings and their differential diagnoses are discussed. Risks are generally minor but can include infection, reaction to contrast, or radiation exposure.
Retroperitoneal lymph node dissection (RPLND) is a surgical procedure used to treat testicular cancer. It involves removing lymph nodes in the retroperitoneum which are the first draining sites of metastasis from testicular cancer. Over time, the procedure has evolved from open approaches to minimally invasive techniques. Key developments included mapping of lymphatic drainage patterns, adoption of nerve-sparing approaches to preserve ejaculation, and use of modified or extended templates based on tumor staging. While RPLND remains an important treatment option, ongoing debates include its role compared to surveillance for very small residual masses after chemotherapy and optimal surgical extent. Complication rates also vary based on whether performed for primary staging or post-
Oncoplastic Breast surgery is simultaneous application of lumpectomy and reconstructive techniques. The word ‘oncoplastic’ is derived from the Greek words ‘onco’ (tumour) and ‘plastic’ (to mould).
Approximately 10% to 30% of patients submitted to BCS alone are not satisfied with the aesthetic outcomes like “swan beak/ parrot beak deformities. The main reasons are related this is the tumour resection which can produce asymmetry, retraction, and volume changes in the breast.
Recently, increasing attention has been focused on oncoplastic procedures since the immediate application of plastic breast surgery techniques provide a wider local excision while still achieving the goals of a better breast shape and symmetry to obtain oncologically sound and aesthetically pleasing results. Thus, by means of customized techniques the surgeon ensures that oncologic principles are not jeopardized while meeting the needs of the patient from an aesthetic point of view.
This document provides an overview of testicular cancer, including:
1. Testicular cancer most commonly affects men aged 20-40 and is the most common cancer in that age group. It has very good survival rates due to effective diagnostic techniques, tumor markers, and multimodal treatments.
2. Risk factors include cryptorchidism, Klinefelter syndrome, trauma, and genetic factors. Cryptorchidism increases risk by 14-48 times.
3. Types include seminomas, embryonal carcinomas, teratomas, and others. Seminomas and non-seminomas are treated differently.
4. Diagnosis involves physical exam, ultrasound, tumor markers like AFP and H
This document discusses colorectal cancer and provides an outline of topics to be covered, including clinical anatomy of the colon and rectum, definition and epidemiology of colorectal cancer, risk factors and pathogenesis, screening, pathology and staging, clinical presentation, investigations, treatment, and follow up. It then goes on to provide details on the clinical anatomy of the colon and rectum, definition of colorectal cancer, epidemiology, risk factors, screening recommendations, adenoma-carcinoma pathogenesis model, hereditary and non-hereditary forms, pathology and staging systems, patterns of spread, clinical presentation, and diagnostic workup.
This document provides information about breast anatomy, lymph node drainage patterns, biopsy procedures for breast lesions, variations of breast surgery for local tumor control, types of mastectomies including indications, and steps for performing simple and modified radical mastectomies. It discusses breast lobe and lobule anatomy, lymph node areas near the breast, recommended biopsy incision lines, and classifications of mastectomy including total/simple, modified radical, and skin-sparing types. The document also outlines pre-operative management, operative procedure steps for mastectomies including anesthesia, positioning, and closure techniques.
This document provides information on breast oncoplastic surgery techniques:
- Oncoplastic surgery (OPS) integrates plastic surgery with breast-conserving cancer surgery to allow for wider excisions without compromising breast shape. It ranges from simple reshaping to advanced mammoplasty techniques.
- Key factors in determining the appropriate OPS approach are excision volume, tumor location, breast density, and glandular composition. Excisions over 20% of breast volume or from certain locations risk deformity. OPS allows excision of up to 1000g compared to 80g for standard surgery.
- OPS techniques are classified into Level I involving reshaping and Level II involving skin excision and reshaping using
This document discusses rectal prolapse, including its anatomy, causes, clinical presentation, diagnosis, and treatment options. It describes the rectum's blood supply and drainage. Rectal prolapse can be complete or partial and is more common in older females. Surgical correction is the primary treatment and can involve perineal or abdominal approaches. Perineal procedures have higher recurrence rates than abdominal procedures like fixation of the rectum to the sacrum or pubis.
The document discusses the role of various prophylactic surgeries in cancer prevention. It covers surgeries to reduce risk of breast cancer, ovarian cancer, colon cancer, gastric cancer, and medullary thyroid cancer for patients with genetic mutations or family histories that increase cancer risk. For each cancer type, it describes genetic factors, screening guidelines, timing of risk-reducing surgeries, and surgical options. The goal of these surgeries is to prevent cancer or detect it at an early stage through procedures such as mastectomy, salpingo-oophorectomy, colectomy, and thyroidectomy.
Management of breast lumps with awareness to breast carcinoma إyusor (1)home
this power point deal with breast lumps benign and malignant one .. it is talk about how to deal with patient have alump in here breast in detail from history to risk fectors .. investigation and management and also deal with awareness to breast cancer .. hope to be useful .. enjoy:)
The document discusses various types of primary retroperitoneal masses. It describes the anatomy of the retroperitoneum and states that 70-80% of primary retroperitoneal neoplasms are malignant. The masses are divided into solid neoplastic masses including mesodermal neoplasms (such as liposarcomas, leiomyosarcomas, and malignant fibrous histiocytomas), neurogenic tumors, and germ cell/sex cord/stromal tumors. Characteristics of common subtypes such as liposarcoma, leiomyosarcoma, and schwannoma are provided. Imaging features on CT and MRI to identify and characterize these masses are also discussed.
This document provides information about germ cell tumors of the ovary. It begins by defining germ cells and explaining that germ cell tumors are composed of different histological types derived from primordial germ cells. It then discusses the basis of germ cell tumors and provides details about specific tumor types like dysgerminoma and endodermal sinus tumor. Dysgerminoma is described as the most common malignant germ cell tumor, often occurring in younger women. Its histological features, diagnosis, and high chemosensitivity and radiosensitivity are summarized. Endodermal sinus tumor is outlined as the third most common malignant germ cell tumor characterized by elevated AFP levels.
This document discusses germ cell tumors of the ovary. It begins by explaining that germ cell tumors originate from primordial germ cells and make up about 90-95% of ovarian malignancies in young women. It then covers the various subtypes of germ cell tumors, including their incidence rates, typical patient demographics, clinical presentations, diagnostic markers, pathological classifications, treatment approaches, and prognosis. Dysgerminoma is discussed as the most common subtype, while immature teratoma, endodermal sinus tumor, embryonal carcinoma, and choriocarcinoma are also described in terms of their defining characteristics and management. Throughout, the focus remains on applying knowledge from testicular germ cell tumor research
This document summarizes information about sentinel lymph node biopsy for breast cancer. It discusses the history and technique of sentinel lymph node biopsy. It describes that the sentinel lymph node is the first lymph node to receive drainage from the primary tumor site, usually in the axilla. The document outlines the procedure for sentinel lymph node biopsy and evaluating biopsy specimens. It discusses studies that have shown sentinel lymph node biopsy is an accurate method for staging breast cancer and that completion axillary lymph node dissection may not be needed in all cases with limited sentinel lymph node involvement.
This document provides information on the management of soft tissue sarcoma. It discusses the clinical presentation, patterns of spread, imaging, histology, grading, staging, prognostic factors and management of soft tissue sarcomas. The key points are:
1) Soft tissue sarcomas most commonly present as painless swellings in the extremities and can invade locally along fascial planes. Imaging like MRI is important for assessing tumor extent.
2) Histologically, the most common subtypes are undifferentiated pleomorphic sarcoma and liposarcoma. Grading systems consider tumor differentiation, mitosis and necrosis.
3) Staging is based on tumor size, depth, nodal status and metastasis
Postoperative Radioiodine Ablation in Thyroid CancerMamoon Ameen
This document discusses thyroid cancer, including the different types, pathology, clinical presentation, staging, and treatment options. The main types discussed are papillary carcinoma (70-80% of cases), follicular carcinoma (15% of cases), and anaplastic/undifferentiated carcinoma (5-10% of cases). Treatment involves surgery, radioactive iodine therapy, and thyroid hormone suppression. Radioactive iodine therapy utilizes iodine-131 to destroy remaining thyroid tissue or known cancer metastases based on the cancer's ability to uptake iodine. Precautions are needed after radioactive iodine therapy to avoid exposing others to radiation. Long term follow-up with thyroid scans and thyroid biomarker monitoring is important to
1) Locally advanced breast cancer involves large tumors that have often spread to nearby lymph nodes but not distant sites. This makes the cancer inoperable with surgery alone.
2) Left untreated, locally advanced breast cancer can cause skin and tissue damage from ulceration, bleeding, and infection at the breast as well as pain, swelling, and blockages from spread to lymph nodes in the armpit.
3) Treatment options include chemotherapy to shrink the tumor and make it operable, radiation therapy to the breast and nearby lymph nodes, and hormone therapy for hormone receptor-positive cancers.
This document provides an overview of mammography presented by Sumanjali N. of Manipal Hospital in Whitefield, Bengaluru. It begins with an introduction to mammography and breast anatomy. It then discusses breast cancer and various imaging modalities used including mammogram, ultrasound, tomosynthesis, PET mammogram, MR mammogram, and thermography. The role of a mammography technologist is outlined. Standard mammographic views and the breast imaging reporting and data system (BI-RADS) for assessing findings are described. Common mammographic artifacts are also reviewed. The presentation concludes by emphasizing the importance of screening mammography in early breast cancer detection and reassurance of patients.
This document provides information about orchitis and orchiectomy procedures. It begins by defining orchitis as the inflammation of the testis and describes its symptoms. It then discusses the anatomy of the testes and some common causes of orchitis, including mumps, infections, trauma, and complications from other procedures. The remainder of the document focuses on orchiectomy procedures, including a bilateral orchiectomy to treat prostate cancer, the surgical steps involved, and follow up care and investigations.
The document describes a hysterosalpingography procedure used to evaluate the uterine cavity and fallopian tubes. Key points include: HSG involves injecting radiopaque contrast medium under fluoroscopy to visualize the uterus and tubes. It is commonly used to investigate infertility. The procedure involves catheterizing the cervix and injecting contrast. Findings are interpreted to evaluate for abnormalities like tubal blockages. Common findings and their differential diagnoses are discussed. Risks are generally minor but can include infection, reaction to contrast, or radiation exposure.
Retroperitoneal lymph node dissection (RPLND) is a surgical procedure used to treat testicular cancer. It involves removing lymph nodes in the retroperitoneum which are the first draining sites of metastasis from testicular cancer. Over time, the procedure has evolved from open approaches to minimally invasive techniques. Key developments included mapping of lymphatic drainage patterns, adoption of nerve-sparing approaches to preserve ejaculation, and use of modified or extended templates based on tumor staging. While RPLND remains an important treatment option, ongoing debates include its role compared to surveillance for very small residual masses after chemotherapy and optimal surgical extent. Complication rates also vary based on whether performed for primary staging or post-
Oncoplastic Breast surgery is simultaneous application of lumpectomy and reconstructive techniques. The word ‘oncoplastic’ is derived from the Greek words ‘onco’ (tumour) and ‘plastic’ (to mould).
Approximately 10% to 30% of patients submitted to BCS alone are not satisfied with the aesthetic outcomes like “swan beak/ parrot beak deformities. The main reasons are related this is the tumour resection which can produce asymmetry, retraction, and volume changes in the breast.
Recently, increasing attention has been focused on oncoplastic procedures since the immediate application of plastic breast surgery techniques provide a wider local excision while still achieving the goals of a better breast shape and symmetry to obtain oncologically sound and aesthetically pleasing results. Thus, by means of customized techniques the surgeon ensures that oncologic principles are not jeopardized while meeting the needs of the patient from an aesthetic point of view.
This document provides an overview of testicular cancer, including:
1. Testicular cancer most commonly affects men aged 20-40 and is the most common cancer in that age group. It has very good survival rates due to effective diagnostic techniques, tumor markers, and multimodal treatments.
2. Risk factors include cryptorchidism, Klinefelter syndrome, trauma, and genetic factors. Cryptorchidism increases risk by 14-48 times.
3. Types include seminomas, embryonal carcinomas, teratomas, and others. Seminomas and non-seminomas are treated differently.
4. Diagnosis involves physical exam, ultrasound, tumor markers like AFP and H
This document discusses colorectal cancer and provides an outline of topics to be covered, including clinical anatomy of the colon and rectum, definition and epidemiology of colorectal cancer, risk factors and pathogenesis, screening, pathology and staging, clinical presentation, investigations, treatment, and follow up. It then goes on to provide details on the clinical anatomy of the colon and rectum, definition of colorectal cancer, epidemiology, risk factors, screening recommendations, adenoma-carcinoma pathogenesis model, hereditary and non-hereditary forms, pathology and staging systems, patterns of spread, clinical presentation, and diagnostic workup.
This document provides information about breast anatomy, lymph node drainage patterns, biopsy procedures for breast lesions, variations of breast surgery for local tumor control, types of mastectomies including indications, and steps for performing simple and modified radical mastectomies. It discusses breast lobe and lobule anatomy, lymph node areas near the breast, recommended biopsy incision lines, and classifications of mastectomy including total/simple, modified radical, and skin-sparing types. The document also outlines pre-operative management, operative procedure steps for mastectomies including anesthesia, positioning, and closure techniques.
This document provides information on breast oncoplastic surgery techniques:
- Oncoplastic surgery (OPS) integrates plastic surgery with breast-conserving cancer surgery to allow for wider excisions without compromising breast shape. It ranges from simple reshaping to advanced mammoplasty techniques.
- Key factors in determining the appropriate OPS approach are excision volume, tumor location, breast density, and glandular composition. Excisions over 20% of breast volume or from certain locations risk deformity. OPS allows excision of up to 1000g compared to 80g for standard surgery.
- OPS techniques are classified into Level I involving reshaping and Level II involving skin excision and reshaping using
This document discusses rectal prolapse, including its anatomy, causes, clinical presentation, diagnosis, and treatment options. It describes the rectum's blood supply and drainage. Rectal prolapse can be complete or partial and is more common in older females. Surgical correction is the primary treatment and can involve perineal or abdominal approaches. Perineal procedures have higher recurrence rates than abdominal procedures like fixation of the rectum to the sacrum or pubis.
The document discusses the role of various prophylactic surgeries in cancer prevention. It covers surgeries to reduce risk of breast cancer, ovarian cancer, colon cancer, gastric cancer, and medullary thyroid cancer for patients with genetic mutations or family histories that increase cancer risk. For each cancer type, it describes genetic factors, screening guidelines, timing of risk-reducing surgeries, and surgical options. The goal of these surgeries is to prevent cancer or detect it at an early stage through procedures such as mastectomy, salpingo-oophorectomy, colectomy, and thyroidectomy.
Management of breast lumps with awareness to breast carcinoma إyusor (1)home
this power point deal with breast lumps benign and malignant one .. it is talk about how to deal with patient have alump in here breast in detail from history to risk fectors .. investigation and management and also deal with awareness to breast cancer .. hope to be useful .. enjoy:)
The document discusses various types of primary retroperitoneal masses. It describes the anatomy of the retroperitoneum and states that 70-80% of primary retroperitoneal neoplasms are malignant. The masses are divided into solid neoplastic masses including mesodermal neoplasms (such as liposarcomas, leiomyosarcomas, and malignant fibrous histiocytomas), neurogenic tumors, and germ cell/sex cord/stromal tumors. Characteristics of common subtypes such as liposarcoma, leiomyosarcoma, and schwannoma are provided. Imaging features on CT and MRI to identify and characterize these masses are also discussed.
This document provides information about germ cell tumors of the ovary. It begins by defining germ cells and explaining that germ cell tumors are composed of different histological types derived from primordial germ cells. It then discusses the basis of germ cell tumors and provides details about specific tumor types like dysgerminoma and endodermal sinus tumor. Dysgerminoma is described as the most common malignant germ cell tumor, often occurring in younger women. Its histological features, diagnosis, and high chemosensitivity and radiosensitivity are summarized. Endodermal sinus tumor is outlined as the third most common malignant germ cell tumor characterized by elevated AFP levels.
This document discusses germ cell tumors of the ovary. It begins by explaining that germ cell tumors originate from primordial germ cells and make up about 90-95% of ovarian malignancies in young women. It then covers the various subtypes of germ cell tumors, including their incidence rates, typical patient demographics, clinical presentations, diagnostic markers, pathological classifications, treatment approaches, and prognosis. Dysgerminoma is discussed as the most common subtype, while immature teratoma, endodermal sinus tumor, embryonal carcinoma, and choriocarcinoma are also described in terms of their defining characteristics and management. Throughout, the focus remains on applying knowledge from testicular germ cell tumor research
- Ovarian germ cell tumors (OGCTs) are derived from primordial germ cells and can be benign or malignant, comprising 20-25% of ovarian neoplasms. Common types include teratomas, dysgerminomas, yolk sac tumors, and embryonal carcinomas.
- Teratomas are the most common OGCT and can be mature/benign, immature/malignant, or contain malignant transformations. Diagnosis involves tumor markers and imaging. Staging follows FIGO guidelines.
- Treatment prioritizes fertility-sparing surgery like unilateral salpingo-oophorectomy. The role of lymphadenectomy is debated but adjuvant chemotherapy is often used given high
This document provides information on pathology of the testis, including cryptorchidism and testicular tumors. Some key points:
- Cryptorchidism occurs when one or both testes fail to descend into the scrotum, increasing risks of infertility, trauma and cancer. Untreated cryptorchidism leads to tubular atrophy and fibrosis in the undescended testis.
- Risk factors for cryptorchidism include prematurity, being first or second born, and certain pregnancy complications. Two phases of testicular descent are controlled by different hormones.
- Undescended testes have a higher risk of developing germ cell tumors like seminoma and non-seminomatous tumors including
This document provides an overview of the management of testicular tumors. It discusses the epidemiology, relevant anatomy, classification, risk factors, pathogenesis, and treatment of germ cell tumors, which account for 90-95% of primary testicular cancers. It describes the various histologic types including seminoma, embryonal carcinoma, teratoma, choriocarcinoma, and yolk sac tumor. Patterns of spread are also reviewed. Serum tumor markers such as AFP, HCG, and LDH are important in diagnosis and monitoring.
This document discusses teratomas, which are tumors derived from all three embryonic layers that may occur in gonadal or extragonadal locations. Sacrococcygeal teratoma is the most common type, occurring in 1 in 2-5 in 100,000 live births. Teratomas are thought to arise from primordial germ cells that migrate abnormally during development. Clinical presentation depends on location, but may include abdominal or scrotal masses. Diagnosis involves biopsy and imaging. Treatment typically involves surgical excision, with chemotherapy or radiotherapy also used. Prognosis depends on factors like location and gestational age.
This document discusses teratomas, which are tumors derived from all three embryonic layers that may occur in gonadal or extragonadal locations. Sacrococcygeal teratoma is the most common type, occurring in 1 in 2-5 in 100,000 live births. Teratomas are thought to arise from primordial germ cells that migrate abnormally during development. Clinical presentation depends on location, but may include abdominal or scrotal masses. Diagnosis involves biopsy and imaging. Treatment typically involves surgical excision, with chemotherapy or radiotherapy also used. Prognosis depends on factors like location and gestational age.
Teratomas constitute the most common type of germ cell tumor of the ovary. They can be divided into mature (benign), immature (malignant), and monodermal subtypes. Mature teratomas typically contain tissue derivatives like skin, hair, and bone. Immature teratomas and monodermal teratomas can show malignant potential. Dysgerminoma is the ovarian counterpart of testicular seminoma and expresses markers like OCT-3. Yolk sac tumors are characterized by Schiller-Duval bodies and produce alpha-fetoprotein. Choriocarcinomas are aggressive and produce chorionic gonadotropins but usually arise in combination with other germ cell tumors
TESTICULAR TUMOURS & MALIGNANT TUMOUR OF PENISDr. Roopam Jain
This document provides an overview of male genital system tumours, focusing on testicular tumours. It discusses the classification, histogenesis, clinical features, diagnosis, spread, tumour markers, prognosis, and characteristics of the main types of testicular tumours - germ cell tumours (seminomas, embryonal carcinomas, yolk sac tumours, choriocarcinomas, teratomas), sex cord-stromal tumours (Leydig cell tumours, Sertoli cell tumours), and mixed forms. Key information on etiology, morphology, markers, and treatment approach is provided for each tumour type.
This document provides an overview of male genital system tumours, focusing on testicular tumours. It discusses the classification, histogenesis, clinical features, diagnosis, spread, tumour markers, prognosis, and characteristics of the main types of testicular tumours - germ cell tumours (seminoma, embryonal carcinoma, yolk sac tumour, choriocarcinoma, teratoma), Leydig cell tumours, and Sertoli cell tumours. It describes the gross and microscopic morphological features of each tumour type.
Testicular tumours are divided into three main groups: germ cell tumours, sex cord-stromal tumours, and mixed forms. Germ cell tumours account for 95% of cases and are further classified as seminomas and non-seminomas. Seminomas and non-seminomas have distinct characteristics and prognoses. Common germ cell tumour subtypes include embryonal carcinoma, yolk sac tumour, choriocarcinoma, and teratoma. Tumour markers such as HCG and AFP help diagnose and monitor germ cell tumours. Mixed germ cell tumours contain more than one histologic type and typically have a worse prognosis.
This document summarizes different types of male genital tract tumors, specifically focusing on testicular tumors. It discusses that testicular tumors are divided into germ cell tumors, sex cord-stromal tumors, and mixed forms. The vast majority are germ cell tumors, which are further divided into seminomatous and non-seminomatous types. Various tumor types are described including their etiology, clinical features, spread patterns, tumor markers, prognosis, and morphological features.
1. Testicular tumours are divided into three main types: germ cell tumours, sex cord-stromal tumours, and mixed forms. Germ cell tumours account for 95% of cases.
2. Germ cell tumours are further classified as seminomas and non-seminomas. Seminomas have a better prognosis than non-seminomas.
3. Common germ cell tumours include seminoma, embryonal carcinoma, yolk sac tumour, choriocarcinoma, teratoma, and mixed forms. Tumour markers like HCG and AFP help diagnose and monitor these tumours.
Primordial germ cells migrate during fetal development and can become arrested, resulting in extragonadal germ cell tumors like sacrococcygeal teratomas. Sacrococcygeal teratomas are the most common extragonadal germ cell tumors in neonates, occurring more frequently in females. They may be partially or completely external (Altman types I and II) or primarily internal with extension into the pelvis or abdomen (types III and IV). Complete surgical excision including coccygectomy is the primary treatment, with chemotherapy for malignant histology, and alpha-fetoprotein monitoring post-surgery to detect recurrence.
Pediatric solid tumors are a diverse group of cancers that arise in children. They account for 60% of pediatric malignant neoplasms and can originate from mesoderm, endoderm or ectoderm tissues. The most common types are brain tumors, neuroblastoma, rhabdomyosarcoma, Wilms' tumor, and osteosarcoma. Presentation depends on tumor location and type but may include masses, compression symptoms, metastases, and paraneoplastic effects. Diagnosis involves imaging, biopsy and laboratory tests. Treatment involves surgery, chemotherapy and/or radiation depending on tumor characteristics and stage. Prognosis depends on specific tumor type and stage.
Epithelial ovarian cancer is the fifth most common cause of cancer death in women. The peak incidence is around age 60. Serous carcinomas are the most common type and often originate from the fallopian tubes. Symptoms are often vague until late stages, making early detection challenging. Screening methods have not proven effective at reducing mortality from ovarian cancer. Surgical staging and optimal debulking surgery along with chemotherapy are the mainstay of treatment.
This document discusses ovarian tumors. It notes that ovarian tumors can be cystic or solid, functional, benign or malignant. In reproductive-aged women, most ovarian enlargements are functional cysts, while 25% prove to be nonfunctional neoplasms of which 90% are benign. Ovarian masses in postmenopausal patients or those unresponsive to birth control present a higher risk of malignancy. Evaluation involves examination and imaging like ultrasound. Common benign ovarian tumors include serous cystadenomas, mucinous cystadenomas, dermoid cysts, and granulosa cell tumors. Complications can include torsion, rupture, hemorrhage, and infection. Ovarian cancer is the fifth most common cancer in
This document discusses cryptorchidism, testicular torsion, and testicular neoplasms. Cryptorchidism is the failure of one or both testes to descend into the scrotum. It affects 1% of males and increases the risk of testicular cancer and infertility. Testicular torsion occurs when the spermatic cord twists, cutting off blood flow to the testis. It requires urgent surgery to untwist the cord. Testicular tumors are most often painless enlargements of the testis. Seminomas and non-seminomatous germ cell tumors are the main types and differ in aggressiveness and spread. Treatment involves surgery and chemotherapy with good cure rates.
The document discusses retroperitoneal masses, which can be classified as solid or cystic, neoplastic or non-neoplastic. Common solid neoplastic masses include liposarcoma, leiomyosarcoma, and malignant fibrous histiocytoma. Neurogenic tumors and lymphomas also occur. Presentation is usually nonspecific symptoms or a large abdominal mass. Investigation involves blood tests, imaging like CT, and biopsy. Wide surgical resection is the standard treatment when possible.
Gestational Trophoblastic Disease (GTD) refers to a spectrum of conditions originating from the placental trophoblast, ranging from benign moles to malignant choriocarcinoma. GTD includes hydatidiform mole, invasive mole, placental site trophoblastic tumor, and choriocarcinoma. Risk factors include young or older age, Asian or Latin American ethnicity, previous molar pregnancies, and low socioeconomic status. Diagnosis involves beta-hCG levels, imaging, and histology. Treatment depends on the disease stage and prognosis but may include surgical evacuation, chemotherapy, and radiotherapy with the goal of cure even in metastatic cases. Prognostic scoring systems like FIGO and
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
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
Hirschsprung disease is a developmental disorder of the enteric nervous system that is characterized by the absence of ganglion cells in the myenteric and submucosal plexuses of the distal intestine.
Because these cells are responsible for normal peristalsis, patients with Hirschsprung disease present with functional intestinal obstruction at the level of aganglionosis.
Some patients present later in childhood, or even during adulthood, with chronic constipation.
This is most common among breast-fed infants, who typically develop constipation around the time of weaning.
Although most children who present after the neonatal period have short-segment disease, this history may also be found in those with longer segment or even total colonic involvement, particularly if the child has been exclusively breast-fed.
The etiology of HAEC is controversial.
The most common theory is that stasis caused by functional obstruction due to the aganglionic bowel permits bacterial overgrowth with secondary infection.
Infectious agents such as Clostridium difficile or Rotavirus have been postulated as being causative, but there are few data to support a specific pathogen.
Can occur in either pre or post operative period (sometimes both)
Thoracotomy is the surgical procedure with an incision made to access the pleural space and the contents of the thoracic cavity. Given the structures to be accessed with in the cavity, different incisions have been established to easy the procedure and these incisions qualify the types of thoracotomies to be studied hereunder.
PRE OP OPTIMIZATION FOR SPECIFIC FACTORS
The outcome of surgical procedures is not measured only by clinical end points but also shorter stays and lower costs. Patients’ discharge is delayed commonly due to inadequate pain relief, infection, arrhythmias, prolonged air leak and debility. Many complications that occur from thoracic operations can be anticipated. An aggressive preoperative work up mitigates morbidity and shortens convalescence.
APPROACH CONSIDERATIONS
There are about three principles that can guides the choice of the thoracotomy incision to be used
I. Adequate exposure must be achieved. The choice of incision is aided by a thorough understanding of the surface anatomy and a comprehensive review of the radiographic images that are obtained preoperatively.
II. Chest-wall function and appearance should be preserved to the extent possible. This principle include non-spreading video-assisted thoracoscopic surgery (VATS) procedures, muscle-sparing techniques, avoidance of excessive rib retraction, and rib preservation when possible.
III. The third principle is that closure must be meticulous and appropriate. Strict layered closure is the rule for thoracic surgical incisions. Every effort should be made to approximate the individual divided chest-wall muscles in appropriate layers; otherwise, a significant delay in the recovery of range of motion (ROM) may result.
Care must be taken to avoid over approximating the ribs and to prevent an override; this will help minimize postoperative pain.
POST-OPERATIVE CARE AND MONITORING
This presentation is about Anorectal Malformation.
No specific cause of anorectal malformation has been described.
The average incidence worldwide is 1 in 5000 live births.
Families have a genetic predisposition, with anorectal malformations being diagnosed in succeeding generations.
A slight male preponderance exists
Imperforate anus without fistula occurs in 5% of patients.
Interestingly, 50% of them also have Down syndrome
Patients with Down syndrome and anorectal malformations have this type of defect 95% of the time
Cardiovascular anomalies are present in approximately one third of patients but only 10% of these require treatment.
The most common lesions are: Atrial septal defect and patent ductus arteriosus followed by tetralogy of Fallot and ventricular septal defect
Bone infections
OSTEOMYELITIS
(Acute, subacute and chronic)
Etiology
Pathophysiology
Presentation
Diagnosis
Management and complications
Osteomyelitis has long been one of the most difficult and challenging problems confronted by orthopaedic surgeons.
Currently, morbidity and mortality from osteomyelitis are relatively low because of modern treatment methods, including the use of antibiotics and aggressive surgical treatment.
This document discusses rectal prolapse, including its definition, anatomy, risk factors, diagnosis, and management options. Rectal prolapse is a protrusion of the rectum through the anus. It is more common in women, the elderly, and those with conditions causing chronic straining. Diagnosis involves history, examination, and imaging tests. Treatment includes non-operative options like fiber supplements, as well as surgical procedures like the Delorme procedure, Altemeier procedure, and abdominal approaches involving rectopexy. Perineal procedures are less invasive but abdominal approaches have lower recurrence rates. The optimal treatment depends on the individual patient's characteristics and risk factors.
Approximately 75% of abdominal wall hernias occur in the groin.
The lifetime risk of inguinal hernia is 27% in men and 3% in women.
And hence Of inguinal hernia repairs, 90% are performed in men, and 10% are performed in women.
The incidence of inguinal hernia in men has a distribution, with peaks before the first year of life and after age 40.
Indirect inguinal and femoral hernias occur more commonly on the right side.
This is attributed to a delay in atrophy of the processus vaginalis after the normal slower descent of the right testis to the scrotum during fetal development.
The predominance of right-sided femoral hernias is thought to be caused by the tamponading effect of the sigmoid colon on the left femoral canal
The prevalence of hernias increases and the likelihood of strangulation and need for hospitalization increase with aging.
SEPTIC ARTHRITIS AS AN INFECTIOUS PROCESS, DESCRIBING THE APPLIED ANATOMY, THE ORGANISMS INVOLVED, STAGES , PRESENTATION ALL THE WAY DOEN TO THE MANAGEMENT PROTOCALS
Mercurius is named after the roman god mercurius, the god of trade and science. The planet mercurius is named after the same god. Mercurius is sometimes called hydrargyrum, means ‘watery silver’. Its shine and colour are very similar to silver, but mercury is a fluid at room temperatures. The name quick silver is a translation of hydrargyrum, where the word quick describes its tendency to scatter away in all directions.
The droplets have a tendency to conglomerate to one big mass, but on being shaken they fall apart into countless little droplets again. It is used to ignite explosives, like mercury fulminate, the explosive character is one of its general themes.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
10 Benefits an EPCR Software should Bring to EMS Organizations Traumasoft LLC
The benefits of an ePCR solution should extend to the whole EMS organization, not just certain groups of people or certain departments. It should provide more than just a form for entering and a database for storing information. It should also include a workflow of how information is communicated, used and stored across the entire organization.
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
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DECLARATION OF HELSINKI - History and principlesanaghabharat01
This SlideShare presentation provides a comprehensive overview of the Declaration of Helsinki, a foundational document outlining ethical guidelines for conducting medical research involving human subjects.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
3. Introduction
• Germ cell tumours are benign or malignant tumours that are
comprised mostly of germ cells.
• Germ cells are the cells that develop in the embryo and become the
cells that make up the reproductive system in either sex.
4. Cont …
• The term germ cell tumour (GCT) encomprises a larger group
including the mature and the immature teratomas, germinomas,
embryonal carcinomas and choriocarcinomas.
• The germ cell tumours may arise in the gonads or in extragonadal
sites, including the brain, face, neck, mediastinum, retroperitoneum,
and sacrococcygeal region.
6. TERATOMAS
• Teratoma, from the Greek teratos (‘of the monster’) and onkoma
(‘swelling’)
• Arise due to abnormal differentiation of the fetal germ cells that
arises from the fetal yolk sac
• The tumour is composed of all three germ cells layers ( i.e ectoderm,
mesoderm and endoderm) and has thus been reported to contain
hair, limbs, thyroid tissues etc.
8. Cont…
• The tumor sometimes consists of more organized tissue, such as small
bowel, limbs, and even a beating heart : These have been called
FETIFORM
• When the mass includes vertebrae or notochord and a high degree of
structural organization, the term FETUS IN FETU is used
9. Etiology
• The etiology of SCT is unknown, however different theories have been
put forward to explain the pattern of its occurrence :
Theories
I. Cell migration theory
II. Primitive streak/Node theory
III. Incomplete twinning theory
10. I. Cell migration theory
• Teratomas are thought by some to arise from totipotent primordial
germ cells.
• These cells develop among the endodermal cells of the yolk sac near
the origin of the allantois and migrate to the gonadal ridges during
weeks 4 and 5 of gestation
• Some cells may miss their target destination and give rise to a
teratoma anywhere from the brain to the coccygeal area, usually in
the midline.
12. II. Primitive streak/Node theory
• During week 3 of development, midline cells at the caudal end of the
embryo divide rapidly and, in a process called gastrulation giving rise
to all three cell layers of the embryo
• By the end of week 3, the primitive streak shortens and disappears.
• This theory explains the more common occurrence of teratomas in
the sacrococcygeal region.
14. III. Incomplete twining
• Less popularized theory
• Although not confirmed in all series, this finding, combined with
reports of simultaneous twin pregnancy or sequential familial
occurrences of fetus-infetu and teratoma, supports the theory that
teratomas may be just one end of the spectrum of conjoined twinning
15. Epidemiology
• Sacrococcygeal teratomas are the most common extra-gonadal tumor
in neonates, accounting for up to 70% of all teratomas in childhood
• Incidence is 1/35000 – 40000 live births
• A 3 to 4:1 female to male ratio is generally reported
• SCTs with malignant elements generally are not seen in infants
• Incidence of malignant element tend to increase with age as 90% of
lesions are benign at birth
18. Pathology : Histology
• Comprised of cells that represents all three cell germ layers
• They have solid, cystic or mixed components
• Unlike teratomas in other locations, SCTs often do not have capsule or
pseudo-capsulated which accounts for the difficultness in achieving
tumor free margin
• Sampling of entire tumour is essential to ensure no immature neural
elements of occult foci of malignancy are present
20. Other pathological classifications
1. Matured teratoma
Consists of fully differentiated tissues from various somatic cells.Can include
fully functional glandular structures such as pancreatic langer- hans . Can
have fully developed hairs, bones and teeth.
Rare Mallignant Transformation (1-3% Reported)
2. Immature teratoma
With small fraction of cells with incomplete differentiated tissue structures
Has prominent solid components with cystic elements and it is usually filled
with lipid constituents therefore demonstrate fat density on CT or MRI
Mallignant Transformation Is Common
21. Cont…
3.Mallignant Teratoma
• Contain malignant element ( Between 11 – 35% of all SCTs are
malignant) and many of these will have elevated tumor markers
• The most common malignant element is the YOLK sac element which
produces AFP
• Microfoci of malignant element can be missed on pathological
sectioning, therefore screening with AFP and B-hcg has become part
of initial evaluation to patients with SCTs
26. Associated anomalies and presentations
• Teratomas are usually isolated lesions.
• A well-recognized association is the Currarino triad of anorectal
malformation, sacral anomaly, and a presacral mass
• The female preponderance for patients with this triad is only 1.5:1,
which is less than the 3:1 ratio noted in isolated SCTs.
• A familial predisposition is noted in 57% of cases and has an
autosomal dominant inheritance pattern.
• By far the most common is anal or anorectal stenosis.
27. • Malignant transformation of a presacral teratoma in the context of
the Currarino triad have appeared, and the risk of malignant
transformation has been estimated at 1%
• This malignant transformation can occur well into adulthood ( one
case reported at 69 yrs and the youngest one at 13yrs)
• Hirschsprung disease has been incorrectly diagnosed in some cases
because constipation is a frequent presenting symptom of the
Currarino triad
28. Other anomalies
Urogenital anomalies, such as:
• hypospadias,
• Vesicoureteral reflux,
• vaginal or uterine duplications
Other syndrome has been associated with non sacrococygeal lesions
like klinefelter syndrome, trisomy 13,trisomy 21,congenital heart
defects and Beckwith widemann syndrome
29. Common presentations
• Most sacrococcygeal teratomas are visible externally and are
therefore diagnosed clinically at birth.
• It might be asymptomatic in infancy or present with obstructive
symptoms unto the rectum or urinary bladder
• A small number of children will present with weakness, pain or
paralysis
• In utero : Featal distress, congestive heart failure leading to hydrops
fetalis, intratumoral hemorrhage and even pre term delivery.
30. Ddx
The differential diagnosis of a sacrococcygeal teratoma is mainly
meningocele or myelomeningocele.
• However, myelomeningocele can be distinguished on the basis of its
more completely cystic nature and its less abundant internal
component.
• In addition, pressure on a myelomeningocele will often be noticeably
transmitted to the anterior fontanelle.
34. Pre natal diagnosis : USS
• The routine application of prenatal ultrasound has increased the
prenatal diagnosis of sacrococcygeal teratomas and allowed for
accurate identification of their site and details of any intrapelvic
extension or urinary tract obstruction.
• Repeated ultrasound assessment of tumor size also helps determine
the mode of delivery.
• Cesarean section delivery is advocated for tumors larger than 5 cm so
as to avoid dystocia, tumour rupture and more adversely death
35. Cont …
• Finally, ultrasound may be used to prognosticate lesions.
• Polyhydramnios(27 percent), placentomegaly, and hydrops fetalis are poor
prognostic indicators.
• Polyhydramnios is associated with premature labor.
• 20% of tumors diagnosed prenatally develop hydrops from high output
cardiac failure secondary to vascular steal of blood flow through
arteriovenous channels within the tumor, which is associated with a near-
100% mortality
36. Diagnosis & evaluation in the neonate and
children
• Consider gross clinical diagnosis: and hence most require evaluations
even after clinical dx
I. Radiological investigations
II. Laboratory investigatiions
40. 2. CT SCAN & MRI
• Detailed preoperative assessment of the lesion, any abdominal or
pelvic extension, and its relationship to the adjacent structures, is
made by computed tomography (CT) and/or magnetic resonance
imaging (MRI).
43. 3. XRAY
• Can be usefully to asses the presence of an associated anomalies
especially The curarino triad
• Can hence asses the presence of hemisacrum, bifid sacrum, no
sacrum and even the anal/rectal stenosis (with the aid of a contrast) .
46. Laboratory evaluation
• Most common produced tumour markers AFP and B-hcg should be
evaluated as the baseline diagnostic workup to look for malignant
components
• Also can be used to asses and monitor tumour relapse during post op
period
48. Prenatal management
• Following intrauterine diagnosis of the tumor, management is based
on fetal lung maturity and the presence or absence of placentomegaly
and hydrops fetalis (the latter conditions being associated with almost
100 percent mortality).
• Upon fetal lung maturity without placentomegaly and/or hydrops
fetalis, early elective delivery by Cesarean section is indicated.
49. Fetal intervention
• Fetal interventions like amniodrainage, cyst aspiration, relief of
bladder outflow obstruction can be performed in those cases were
hydrops and prematurity is present.
• Intrauterine endoscopic laser ablation ,radiofrequency ablation can
also be done
50. Consideration of open fetal surgery for debulking of SCTs is only
considered in very selective cases such as:
• Type 1 SCT
• GA of 20 – 30 weeks
• Absence of placentomegally
• An early hydrops
51. Postnatal
• The main stay of Rx is early and en-block excision of the lesion
provided that:
I. The risk of malignant change in benign lesions increases with
Age
Incompletely excised residual lesion
II. The tumour’s rich vascularity makes it vulnerable to spontenous
ulceration and hemorrhage if left unexcised
52. Preoperative preparation and
anesthesia
1. Appropriate imaging (ultrasonography/CT/MRI) to delineate the
anatomy and extent of the lesion, as the surgical approach will be
dictated by whether the lesion has intra-abdominal or intrapelvic
extension.
2. Serum assays of tumor markers (AFP/β-hCG) for postoperative
comparisons.
3. Adequate intravenous access and blood products should be secured
before starting the operation, especially with large tumors, where there
may be brisk intraoperative blood loss.
Other vascular access, including an arterial line for blood pressure
monitoring, and central venous line monitoring are beneficial.
53. Cont …
4. General anesthesia is mandatory : High-output cardiac failure
secondary to arteriovenous channels in the tumor may limit the use of
inhalation agents, which have known cardiodepressant effects.
5. Broad-spectrum antibiotics should be given as a prophylaxis
6. The stomach is emptied with a nasogastric tube and an indwelling
bladder catheter is inserted.
56. Stage 3:
• Removal of tumor and coccyx
en- bloc and ligation of sacral
vessels
• Failure to remove the coccyx is
associated with a 30–40 percent
incidence of recurrence, with
more than 50 percent of cases
becoming malignant.
57. Cont…
• This dissection can be facilitated
if necessary by placing a finger in
the rectum.
• Rarely, the tumor completely
surrounds the rectum, making
total excision very difficult.
• The excised tumor is sent for
histological examination to
identify the presence of any
malignant components as well
as to ensure tumor-free margins.
58. Stage 4: Pelvic floor reconstruction
• The pelvic floor is reconstructed
by suturing the superior and
posterior portions of the levator
muscles to the presacral fascia,
behind the rectum.
• This allows the anus to assume a
near-normal configuration and
therefore the best possibility of
achieving good fecal continence
59. Stage 5: Closure
• The gluteus maximus muscles
are apposed in the midline using
interrupted sutures.
• A drain may be left in place in
the perirectal space prior to this
closure, and brought out
through a separate stab incision.
60. Modifications for extensive or intra-abdominal
tumors
• In type III tumors where there
is significant intraabdominal
involvement, the pelvic
excision must be preceded by
a laparotomy.
• In these cases, the operation
commences with the patient
in a supine position, with a
rolled gauze pad under the
buttocks, thus raising the
pelvic floor.
• A lower midline or transverse
lower abdominal incision
approach is used, depending
on the extent of the intra-
abdominal component of the
tumor.
• The tumor is dissected free
from the lower abdominal and
pelvic viscera, and the sacral
vessels can be controlled
through this approach.
61. …
• The abdominal wall is then
closed, and the patient is turned
prone to complete the operation
as described above
62. Role of laparoscopy
• Laparoscopy can be used for the resection or mobilization of intra-
abdominal or pelvic portions of the SCT.
• This is combined with the external resection of the tumor and for
litigation of the sacral vessels.
63. Role of Chemotherapy ( neo and adjuvant)
• Malignant lesions respond poorly with surgery alone, with a 10
percent salvage rate.
• Adjuvant chemotherapy, particularly platinum-containing regimens,
e.g. cisplatin, bleomycin, vinblastine, and/or VP-16 (etoposide),
addressing the specific malignant element, has improved survival
with such lesions.
• This regimen may shrink the tumor, making it amenable to secondary
resection.
• Resected tumors should also be examined for malignant elements,
which may require subsequent chemotherapy.
65. Follow-up
It is important to monitor all patients with physical examination,
including
• Rectal examination
• Serum markers (AFP, B-hcg and CA 125)
• Note: AFP levels decreases and reaches adult levels @ 8 months
when ?
• Initial is day 5 to 7 post op (for tumour markers AFP – t1/2 =6 days))
then
• Every 2 or 3 months for At least 3 years ( both DRE and markers) ,
because most recurrences occur within 3 years of operation
66. Cont …
• In addition to tumor recurrence, long-term complications associated
with sacrococcygeal teratomas are common:
40% will encounter mild bowel dysfunction (incontinence or
constipation),
10% percent will have urinary incontinence or neuropathic bladders,
often associated with similar bowel symptoms.
• These patients required treatment and constant vigilance to prevent
further problems.
67. References
• Ashcraft 7th edition
• Operative Pediatric Surgery 7th Ed 1
• Coran Pediatric Surgery, 7th ed, 2012
• Operative Pediatric Surgery 2nd Ed
• Paediatric Surgery For Africa V-II
• Altman RP, Randolph JG, Lilly JR. Sacrococcygeal teratoma: American
Academy of Pediatrics Surgical Section Survey-1973. J Pediatr Surg.
1974;9:389–398.
• Derikx JP, De Backer A, van de Schoot L, et al. Factors associated with
recurrence and metastasis in sacrococcygeal teratoma. Br J Surg.
2006;93:1543–1548.