This document discusses a case of adenoid cystic carcinoma in the parotid gland based on cytology findings. It describes the smear as showing cellular pleomorphism, anisonucleosis, nuclear notches, pulled out tadpole shapes and chromatin granulation. Syncytial groups and rosettes were also seen. The diagnosis was adenoid cystic carcinoma. The discussion section provides overview information on salivary gland tumors, including classification of malignant and benign tumors, epidemiology, risk factors, presentation and signs of salivary gland masses.
Melanoma
Cutaneous Melanoma
also known as malignant melanoma, is a type of cancer that develops from the pigment-containing cells known as melanocytes.
Classification Of Melanoma
I : De novo melanoma
A. Melanoma in situ (MIS)
B. Lentigo maligna melanoma (LMM)
C. Superficial spreading melanoma (SSM)
D. Nodular melanoma (NM)
E. Acral-lentiginous melanoma (ALM)
F. Melanoma of the mucous membranes
G. Desmoplastic melanoma
II Melanoma arising from precursors
Melanoma arising in dysplastic nevomelanocytic nevi
B. Melanoma arising in congenital nevomelanocytic nevi
C. Melanoma arising in common NMN
Etiology And Pathogenesis
The etiology and pathogenesis of cutaneous melanoma are unknown.
Epidemiologic studies demonstrate a role for genetic predisposition and sun exposure in melanoma development.
The major genes involved in melanoma development reside on chromosome 9p21.
Etiology
UVR, mostly of the UVB spectrum (290–320 nm) that induces mutations in suppressor genes. The propensity for multiple BCC may be inherited. Associated with mutations in the PTCH gene in many cases.
Predisposing Factors
Genetic markers (CDKN2a mutation)
Skin type I/II
Family history of dysplastic nevi or melanoma
Personal history of melanoma
Ultraviolet irradiation, particularly sunburns during childhood and intermittent burning exposures
Number (>50) and size (>5 mm) of melanocytic nevi
Congenital nevi
Number of dysplastic nevi (>5)
Dysplastic melanocytic nevus syndrome
Immune suppression (debatable)
Number (>50) and size (>5 mm) of melanocytic nevi
Congenital nevi
Number of dysplastic nevi (>5)
Dysplastic melanocytic nevus syndrome
Immune suppression (debatable)
Six Signs of Malignant Melanoma (ABCDE Rule):
A- Asymmetry in shape—one-half unlike the other half.
B- Border is irregular—edges irregularly scalloped, notched, sharply defined.
C- Color is not uniform; mottled—haphazard display of colors; all shades of brown, black, gray, red, and white.
D- Diameter is usually large.
E- Elevation is almost always present and is irregular—surface distortion is assessed by side-lighting. others use E for Enlargement— a history of an increase in the size of lesion is one of the most important signs of malignant melanoma.
Lentigo Maligna Melanoma (LMM)
Melanoma
Cutaneous Melanoma
also known as malignant melanoma, is a type of cancer that develops from the pigment-containing cells known as melanocytes.
Classification Of Melanoma
I : De novo melanoma
A. Melanoma in situ (MIS)
B. Lentigo maligna melanoma (LMM)
C. Superficial spreading melanoma (SSM)
D. Nodular melanoma (NM)
E. Acral-lentiginous melanoma (ALM)
F. Melanoma of the mucous membranes
G. Desmoplastic melanoma
II Melanoma arising from precursors
Melanoma arising in dysplastic nevomelanocytic nevi
B. Melanoma arising in congenital nevomelanocytic nevi
C. Melanoma arising in common NMN
Etiology And Pathogenesis
The etiology and pathogenesis of cutaneous melanoma are unknown.
Epidemiologic studies demonstrate a role for genetic predisposition and sun exposure in melanoma development.
The major genes involved in melanoma development reside on chromosome 9p21.
Etiology
UVR, mostly of the UVB spectrum (290–320 nm) that induces mutations in suppressor genes. The propensity for multiple BCC may be inherited. Associated with mutations in the PTCH gene in many cases.
Predisposing Factors
Genetic markers (CDKN2a mutation)
Skin type I/II
Family history of dysplastic nevi or melanoma
Personal history of melanoma
Ultraviolet irradiation, particularly sunburns during childhood and intermittent burning exposures
Number (>50) and size (>5 mm) of melanocytic nevi
Congenital nevi
Number of dysplastic nevi (>5)
Dysplastic melanocytic nevus syndrome
Immune suppression (debatable)
Number (>50) and size (>5 mm) of melanocytic nevi
Congenital nevi
Number of dysplastic nevi (>5)
Dysplastic melanocytic nevus syndrome
Immune suppression (debatable)
Six Signs of Malignant Melanoma (ABCDE Rule):
A- Asymmetry in shape—one-half unlike the other half.
B- Border is irregular—edges irregularly scalloped, notched, sharply defined.
C- Color is not uniform; mottled—haphazard display of colors; all shades of brown, black, gray, red, and white.
D- Diameter is usually large.
E- Elevation is almost always present and is irregular—surface distortion is assessed by side-lighting. others use E for Enlargement— a history of an increase in the size of lesion is one of the most important signs of malignant melanoma.
Lentigo Maligna Melanoma (LMM)
guideline for long case presentation,include history,examination,,investigation,treatment option,surgical procedure of superficial parotidectomy,short discussion about plemorphic adenoma
Invasive Squamous Cell Carcinoma (SCC)
SCC of the skin is a malignant tumor of keratinocytes, arising in the epidermis.
SCC usually arises in epidermal precancerous lesions and, depending on etiology and level of differentiation, varies in its aggressiveness.
The lesion is a plaque or a nodule with varying degrees of keratinization in the nodule and/or on the surface.
Thumb rule:
Undifferentiated SCC: is soft and has no hyperkeratosis;
Differentiated SCC: is hard on palpation and has hyperkeratosis.
Exposure:
Sunlight. Phototherapy, PUVA (oral psoralen + UVA). Excessive photochemotherapy can lead to promotion of SCC, particularly in patients with skin phototypes I and II or in patients with history of previous exposure to ionizing radiation or methotrexate treatment for psoriasis.
Lesions :
Indurated papule, plaque, or nodule ; adherent thick keratotic scale or hyperkeratosis ; when eroded or ulcerated, the lesion may have a crust in the center and a firm, hyperkeratotic, elevated margin
Clark levels
level I, intra-epidermal;
level II, invades papillary dermis;
level III fills papillary dermis;
level IV, invades reticular dermis;
level V, invades subcutaneous fat.
Understanding Head and Neck Cancer: EpidemiologyAgencia Chat
José I Almodóvar, MD
Presidente Sociedad de Otorrinolaringología de Puerto Rico
Head & Neck Cancer
Diagnosis Treatment and Rehabilitation
Sheraton Puerto Rico Convention Center
September 25, 2010
guideline for long case presentation,include history,examination,,investigation,treatment option,surgical procedure of superficial parotidectomy,short discussion about plemorphic adenoma
Invasive Squamous Cell Carcinoma (SCC)
SCC of the skin is a malignant tumor of keratinocytes, arising in the epidermis.
SCC usually arises in epidermal precancerous lesions and, depending on etiology and level of differentiation, varies in its aggressiveness.
The lesion is a plaque or a nodule with varying degrees of keratinization in the nodule and/or on the surface.
Thumb rule:
Undifferentiated SCC: is soft and has no hyperkeratosis;
Differentiated SCC: is hard on palpation and has hyperkeratosis.
Exposure:
Sunlight. Phototherapy, PUVA (oral psoralen + UVA). Excessive photochemotherapy can lead to promotion of SCC, particularly in patients with skin phototypes I and II or in patients with history of previous exposure to ionizing radiation or methotrexate treatment for psoriasis.
Lesions :
Indurated papule, plaque, or nodule ; adherent thick keratotic scale or hyperkeratosis ; when eroded or ulcerated, the lesion may have a crust in the center and a firm, hyperkeratotic, elevated margin
Clark levels
level I, intra-epidermal;
level II, invades papillary dermis;
level III fills papillary dermis;
level IV, invades reticular dermis;
level V, invades subcutaneous fat.
Understanding Head and Neck Cancer: EpidemiologyAgencia Chat
José I Almodóvar, MD
Presidente Sociedad de Otorrinolaringología de Puerto Rico
Head & Neck Cancer
Diagnosis Treatment and Rehabilitation
Sheraton Puerto Rico Convention Center
September 25, 2010
Salivary gland tumours are a relatively rare and morphologically diverse group of lesions. So here are slides containing information about salivary gland tumours with images.
Cutaneous manifestations of internal malignancy and paraneoplastic syndromes gamal sultan
cutaneous manifestations are extremely valuable marker because they may well be the presenting manifestation of an underlying neoplasm.
Increased clinician awareness could prove beneficial for the patient by promoting earlier screening and diagnosis, as well as increased intervention measures, thereby significantly affecting the chances of survival and/or improving the quality of life of the patient
Oral squamous cell carcinoma is a malignant tumor that may occur anywhere within the oral cavity. It is locally invasive, infrequently metastasizes to ipsilateral regional lymph nodes, and rarely spreads to distant sites. Risk increases dramatically when alcohol use exceeds 6 oz of distilled liquor, 15 oz of wine, or 36 oz of beer/day. The combination of heavy smoking and alcohol abuse is estimated to raise the risk 100-fold in women and 38-fold in men.
Purpose:
The purpose of this webinar is to help participants learn how to prevent oral squamous cell carcinoma.
SICKELE CELL DISEASE MANAGEMENT INITIATIVE FOR LESOTHOSEJOJO PHAAROE
Sickle cell disease (SCD) is highly prevalent in sub-Saharan Africa, including Lesotho where it accounts for substantial morbidity and mortality. SCD is a life-threatening genetic disorder that is best managed when diagnosed early by newborn screening. The incidence and cases are not reported in Lesotho. Newborn screening which is paramount for early diagnosis and enrolment of affected children into a comprehensive care programme is not available in Lesotho. Up to now, this strategy has been greatly impaired in resource-poor countries, because screening methods are technologically and financially intensive; affordable, reliable, and accurate methods are needed. We aimed to test the feasibility of implementing a sickle cell disease screening programme using innovative point-of-care test devices into existing immunization programmes in primary health-care settings.
Goal; increase sickle cell disease awareness, diagnosis and management in Lesotho from 0- 20% by 25%
Mission: To improve care of all Sickle Cell Disease patients for their better future and to lower the prevalence of the disease through multi=sectoral, multi-faced coordinated approach towards screening and awareness strategies
Vision: Eliminate sickle cell disease as a public health problem in Lesotho. There is need for increasing the awareness about the disease in the community, implementation of mass screening activities for early identification, building a strong network of diagnosis and linkages, implementing robust monitoring system, strengthening the existing primary health care mechanism to incorporate SCD related strategies, capacity building of primary, secondary and tertiary health care teams and building cost-effective intensive interventions at higher care facilities.
SICKELE CELL DISEASE MODULE 3 SEJOJO.pptx TO BE PRESENTED. IN TRAININGS.pptxSEJOJO PHAAROE
Sickle cell anemia is a genetic disorder whereby red blood cells are abnormally shaped, causing problems with the flow of blood through the body as well as transport of oxygen throughout the body
inheritance is Autosomal because its a blood disorder and systemic disorder
its caused by mutation on B-chain of the globulin chain , where red blood cells (RBCs) become sickle/crescent shaped
Cells get destroyed in narrowed thin blood capillaries , RE system and cause anaemia Blockage in thin layers body
OVEARVIEW OF NON-COMMUNICABLE DISEASES IN LEOTHO SEJOJO PHAAROE
Chronic non infectious diseases that are silent and persecute mankind . non-communicable disease (NCD) is a disease that is not transmissible directly from one person to another. NCDs include Parkinson's disease, autoimmune diseases, strokes, heart diseases, cancers, diabetes, chronic kidney disease, osteoarthritis, osteoporosis, Alzheimer's disease, cataracts, and other
Demands for Haemophilia tratment centres to fullfull universal health access...SEJOJO PHAAROE
Haemophilia ia a rare disease that affect 1: 10 000 people. Demands for services, medication and access to cheap effective clotting factors is a human right for people living with haemophilia. A haemophilia registry is a demand from the Government at large .. Essential drug list should also contain haemophilia medication.
we need to be contacted for more information
www.thinktankent.com
resilience is the order of the day when life knocks you down
If you have been experiencing some of the following signs and symptoms most of the day, nearly every day, for at least two weeks, you may be suffering from depression:
Persistent sad, anxious, or “empty” mood
Feelings of hopelessness, or pessimism
Irritability
Feelings of guilt, worthlessness, or helplessness
Loss of interest or pleasure in hobbies and activities
Decreased energy or fatigue
Moving or talking more slowly
Feeling restless or having trouble sitting still
Difficulty concentrating, remembering, or making decisions
Difficulty sleeping, early-morning awakening, or oversleeping
Appetite and/or weight changes
Thoughts of death or suicide, or suicide attempts
Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment
pump up your energy
www.thinktankent.com
info@thinktankent.com
‘Freedom from pain should be seen as a right of every cancer patient and access to pain therapy as a measure of respect for the right in Lesotho
There are several barriers to effective pain control in both A focus on essential pain medicationaccessibility and Pain management cancer and / or HIV/AIDS. Such barriers could be patient related; clinician-related; societal/health system; and political and/or legal-related.
The role of the government in strengthening accreditation readySEJOJO PHAAROE
June 9, 2015 marks World Accreditation Day as a global initiative, jointly established by the International Accreditation Forum (IAF) and the International Laboratory Accreditation Cooperation (ILAC), to raise awareness of the importance of accreditation.
This year’s theme focuses on how accreditation can support the delivery of health and social care.
the day was celebrated across the world with the hosting of major national events, seminars, and press and media coverage, to communicate the value of accreditation to Government, Regulators and the leaders of the business community.
What international support for quality improvement is available to Lesotho national health care initiatives?
• To what extent do national governments around the world specify quality improvement in legislation and published policy?
• What are the distinguishing structures and activities of national approaches to quality improvement within countries?
• What resources (in the form of organizations, funding, training and information) are available nationally?
What maintenance or implementation pathways are available , to prove to the world that Lesotho health care services are of excellence???
Vector borne infectious diseases in the face of climate changeSEJOJO PHAAROE
To understand how climate might affect the incidence of vector-borne diseases, one must first examine the life cycles of the diseases and the environmental parameters associated with each stage
A vector-borne disease is one in which the pathogenic microorganism is transmitted from an infected individual to another individual by an arthropod or other agent, sometimes with other animals serving as intermediary hosts.
The transmission depends upon the attributes and requirements of at least three different living organisms:
- the pathologic agent,
-the vector, and the human host.
intermediary hosts such as domesticated and/or wild animals often serve as a reservoir for the pathogen until susceptible human populations are exposed
We recommend proactive planning
more surveillance of direct impacts, such as changes in the reproduction rate of the vector or the agent, the biting frequency of the vector, and the amount of time the host is exposed to the vector due to changes in temperature, rainfall, humidity, or storm patterns.
Even less information is available to evaluate the impacts of societal and individual activities on the transmission of vector-borne diseases.
Changes in hydrology, agriculture, forestry, and infrastructure in response to global warming may also indirectly affect the interrelationship among the disease agent, vectors, and hosts
Ist Think Tank Entreprenuers Forum in Lesotho ( invitation , call for papers ...SEJOJO PHAAROE
In front of the current main disruptive changes the world is facing, entrepreneurship, creating both wealth and social justice, is key for shaping the world.
It embraces the regionality of the entrepreneurial ecosystem
•Business Entrepreneurs
•Social Entrepreneurs
•Philosophers
•Policy Makers
•Experts
•Academics
•Youth empowerment
•Research scientists
•Health professionals
It is altogether a Think Tank and a Do Tank
•We will share the latest trends and issues about global entrepreneurship.
•We will develop ideas and recommendations aimed at promoting and spreading entrepreneurship regionally .
•We will facilitate and implement entrepreneurial initiatives on a local or global scale
•By Creating Innovative and High-Growth Companies, to generate millions of jobs around the planet;
•Developing Entrepreneurship at the Bottom of the Pyramid, to alleviate poverty and create new markets;
•Implementing Entrepreneurial Education, to disseminate entrepreneurial mindset, skills and competencies throughout society, on a lifelong basis
WE ARE CALLING FOR PAPERS, AND USE THE REGISTRATION FORM ATTACHED FOR YOUR TRAVEL , AND LEETES OF RELEASE AND ACCOMODATION
Post exposure prophylaxis- HEALTH SECTOR WELLNESS SERVICES SEJOJO PHAAROE
HIV and HIV transmission
Indicators for PEP
Pre—requisite for PEP
-baseline and follow up tests
Pre-requisite for PEP Provision
PEP package
ARV- Treatment and adherence
Formative study on hiv workplace for health workers - copySEJOJO PHAAROE
Heterogeneity of the HIV epidemic in Lesotho
Formative Assessment: MOHSW
SECTORAL RESPONSE -MOHSW
ACTIONS TAKEN AND TOOLS AVAILABLE - TO DATE
DISSEMINATION- tools
ADVOCACY FOR BUY IN- - PPP
WELLNESS CHAMPIONS AND STRUCTURES
ADVOCACY-WELLNESS ACTIVITIES
M/E Tools
Cost benefit analysis
Learning and sharing
Action Research : Sejojo Phaaroe
3D MEDIA
Overview of medical laboratory regulatory council, objectives 2013SEJOJO PHAAROE
There is an urgent need for professional regulation in the region , because of staff mobilty, and professional demands and aspirations for continous professional development and harmony in ethical practices. Lesotho Medical Regulatory Council is advocated , and this will operate within the Legal Framework of the Health Professional Council
Innovative Medicines Initiative, Call for Proposal 2013 for Health , Pharmacueticals, Nursing , and Laboratory Medicines in Lesotho- EU Horizon 2020 and FP7 Funding
General intro-presentation-of-2013-call-orientations en sejojo disseminate
Salivary Gland Cytology case of adenoid cyst carcinoma
1. Cases:
12 FNA- 7
Parotid
Preparation –2 pap QD
Clinical: male , 52 years. Parotic swelling ,
Screened and reported by: Sejojo Phaaroe. M.T; C.T (I.A.C); M.I.B.M.S
Cytology:
This is a sanguineous and a mucinous back grounded smear with some cells in glandular groups, 3
dimensional syncytia, and rosettes configurations are present. There is marked cellular
pleomorphism , anisonucleosis, nuclear noses, pulled out tad poled and indentations. Cells exhibit
salt and pepper coarse chromatin granulation - slide 5682 ( red and green colour)
5684
Cell syncytia, cell pleomorphism, noses, and macro-nucleation seen.
Bi- Nucleation , , mitotic figures with promonent nucleoli seen .
5658
Mixed mesenchymal cells with pulled out cells, some cells are single lying, the size of the single lying
lymphocyte.
Diagnosis: Adenoid cystic carcinoma
Final diagnosis: Malignant:
Screened by: Sejojo Phaaroe. MT; CT (IAC); MIBMS
2. Discussions
The major salivary glands are the parotid glands, submandibular glands and sublingual
glands. There are also a large number (600-1,000) of minor salivary glands widely distributed
throughout the oral mucosa, palate, uvula, floor of the mouth, posterior tongue, retromolar
and peritonsillar area, pharynx, larynx and paranasal sinuses. Tumours affecting salivary
glands may be benign or malignant and are diverse in their pathology.
80% of salivary gland neoplasms arise in the parotid glands, 10-15% in the
submandibular glands and the remainder in the sublingual and minor salivary glands.1
About 80% of parotid neoplasms are benign but the relative proportion of malignancy
increases in smaller glands. About half of submandibular gland neoplasms and most
sublingual and minor salivary gland tumours are malignant.
Classification
Malignant tumours
The malignant tumours most commonly affecting the major salivary glands are
mucoepidermoid carcinoma, acinic cell carcinoma and adenoid cystic carcinomas. Among
the minor salivary glands, adenoid cystic carcinoma is the most common. Malignant tumours
are designated high-grade or low-grade dependent on their histology.
High-grade:
o Mucoepidermoid carcinoma (grade III): mucoepidermoid carcinoma is the
most common malignancy of the parotid gland and is the second most
common of the submandibular gland (after adenoid cystic carcinoma). It
represents about 8% of all parotid tumours.
o Adenocarcinoma - poorly differentiated carcinoma and anaplastic carcinoma;
represents 2-3% of salivary tumours.
o Squamous cell carcinoma.
o Malignant mixed tumours.
o Adenoid cystic carcinoma.
Low-grade:
o Acinic cell tumours: represent 1% of all salivary gland neoplasms. 95% arise
in the parotid gland.
o Mucoepidermoid carcinoma (grades I or II).
Benign tumours
Pleomorphic adenoma (most common): also called benign mixed tumour, is the most
common tumour of the parotid gland and causes over a third of submandibular
tumours. They are slow-growing and asymptomatic.
Warthin's tumour: second most common benign salivary gland neoplasm,
representing about 6-10% of all parotid tumours. They rarely occur in other glands
and 12% are bilateral. They present most often in the 6th decade in women and the
7th decade in men.2
Rarities including oncocytomas and monomorphic adenomas.
3. Regional metastases from skin or mucosal malignancies may present as salivary gland
masses. 1-3% of patients with cutaneous squamous cell carcinoma of the head and neck
experience metastatic spread to the parotid-area lymph nodes. Lymphomas may occasionally
present in a salivary gland.3 In children, most parotid tumours are benign and are
haemangiomas.4
Epidemiology1
Neoplasms of salivary glands have an incidence of about 1 to 2 per 100,000 per
annum in England and Wales, with about 470 new cases diagnosed every year.5
They are fewer than 1% of all cancers and 3-6% of all tumours of the head and neck.
Tumours are most common in the 6th decade of life.
Malignancy typically presents after age 60, whilst benign lesions usually occur after
age 40.
Benign tumours are more common in women, but malignant tumours have an equal
sex distribution.
Certain ethnic groups, e.g. Inuit populations, have a higher rate of salivary gland
tumours which is maintained even after migration to a low incidence area. The
responsible environmental or genetic factors are unknown.6
Risk factors
Radiation to the neck increases the risk of malignancy of salivary glands with a 15- to
20-year latency.7
Smoking is an important risk factor for the development of Warthin's tumours but its
relationship to malignant parotid tumours is less clear.8 Warthin's tumours are eight
times more common in smokers compared with non-smokers.
Some studies have suggested an association between high use of mobile phones and
an increased risk of benign and malignant parotid tumours9, although others have
found no evidence of such a relationship.10
Presentation1
In England and Wales, about 13% patients with salivary gland cancer present with early
disease, 17% with locally advanced, 7% with lymph node involvement and 28% with
metastatic disease (and unknown staging in 35%).5
Symptoms
Most salivary gland neoplasms are a slowly enlarging painless mass:
o Parotid neoplasms most commonly occur in the tail of the gland as a discrete
mass in an otherwise normal gland.
o Submandibular neoplasms often appear with diffuse enlargement of the gland.
o Sublingual tumours produce a palpable fullness in the floor of the mouth.
o Minor salivary gland tumours vary according on the site of origin - painless
masses on the palate or floor of the mouth are the most common form but
laryngeal salivary gland tumours can produce airway obstruction, dysphagia,
4. or hoarseness. In the nasal cavity or paranasal sinus they cause nasal
obstruction or sinusitis.
Facial palsy with a salivary gland mass indicates malignancy.
Pain can occur with both benign and malignant tumours. Pain may arise from
suppuration or haemorrhage into a mass or from infiltration of adjacent tissue.
Signs
Use bimanual palpation of the lateral pharyngeal wall for deep lobe parotid tumours and the
extent of submandibular and sublingual masses.
Clinical features of a salivary gland mass suggestive of malignancy are:
o Hardness.
o Fixation.
o Tenderness.
o Infiltration of surrounding structures, e.g. facial nerve, local lymph nodes.
o Overlying skin ulceration.
Cranial nerve palsy