This document provides definitions and information about different types of swellings, tumors, and cysts. It discusses benign tumors such as papillomas, fibromas, lipomas, and neural tumors. It also covers malignant tumors including carcinomas, soft tissue sarcomas, and different sarcomas like synovial sarcoma and angiosarcoma. Additionally, it summarizes various cystic swellings that can occur, categorizing them as congenital, acquired, or cystic tumors. Treatment options are mentioned for many of the conditions.

1. Swellings,Tumours and Cysts
Dr.Lakshmisasi.P
BDS

2. Contents
• Definition
• Benign tumours
• Neural tumours
• Malignant tumours
• Soft tissue sarcoma
• Cystic swellings

3. Tumour:
A tumour is a new growth consisting of cells of
independent growth arranged atypically and serves no
function.
Types:
benign
malignant

4. Benign tumours
Papilloma:
• Arising from skin or mucous membrane.
• Characterized by finger like projections with a
central core of connective tissue, blood
vessels, lymphatics and lining epithelium.
• Can be called hamartoma or skin tag.
• An example of over growth of fibrous tissue.

5. Types
1. Skin papilloma:
a. squamous papiloma: occurs in the skin,
cheek, tongue, etc.
which are soft seen in elderly patients on the
eyelid.
can also be congenital, multiple, sessile or
pedunculated.
b. Basal cell papilloma (seborrhoeic
keratosis): seen on the trunk of
elderly patients as brownish elevated patch of
skin, which gives a
semitransparent, oily appearance.

6. 2. Arising from mucous membrane of visceral
organs:
a. Transitional cell papilloma in the urinary
bladder as a cause of haematuria.
b. Columnar cell papilloma in the rectum as a
cause of mucous diarrhoea.
c. Cuboidal cell papilloma in the gall bladder.
d. Squamous papilloma in the larynx can cause
respiratory obstruction.
e. Papilloma of breast (duct papilloma) causes
bleeding per nipple.

7. Pedunculated papilloma
with its pedicle
Papilloma tongue. Note:
papilloma can also occur
in mucous membrane like oral
cavity, urinary and gallbladder,
rectum

8. Treatment:
Excision, only if papilloma causes discomfort, or if it is symptomatic.
Complications:
Skin papilloma can get secondarily infected resulting in pain and
swelling.
Papilloma in the breast, rectum, tongue and gall bladder can undergo
malignant change.

9. Fibroma:
Clinically, it presents as a firm subcutaneous swelling.
Types:
Soft fibromas — Less fibrous tissue
Hard fibromas — More fibrous tissue
Neurofibroma — Fibroma mixed with nerve fibres
Fibrolipoma — Fibroma mixed with fat
Myofibroma — Fibroma mixed with muscle fibres
Angiofibroma — Fibroma mixed with blood vessels
Treatment :
Excision because of the chance of developing into a sarcoma.

10. Lipoma:
a benign tumour arising from fat cells of adult type.
Types:
Painful lipomas are called as neurolipomas. Dercum‘s disease is tender
deposition of fat especially on the trunk, is also called as adiposis dolorosa. It is
basically multiple neurolipomatosis.
Fibrolipoma.
Nevolipoma.
Lipomas attain large size in thigh, shoulder, retro peritoneum, back and often
may turn into
sarcoma.
Sites:
1. subcutaneous
2. subfascial
3. intramuscular
4. intermuscular
5. parosteal
6. subserosal
7. submucosal
8. extradural Pedunculated lipoma

11. Large lipoma over nape
of the neck
Gross feature of specimen of
lipoma

12. Clinical features:
• Localized swelling, which is lobular, nontender, semifluctuant,
mobile, with edge slipping between the palpating fingers, with free
skin.
• Mostly pedunculated.
• Not transilluminant
Differential diagnosis:
• Neurofibroma
• Cystic swellings
Complications:
• Sarcomatous changes----liposarcoma
• Myxomatous changes
• Calcification
Treatment:
• Excision

13. Neural tumours
Neuroma:
• They are uncommon benign tumours which occur in
relationship with sympathetic nervous system or spinal cord.
They can be classified into true neuromas and false neuromas.
True neuroma:
1.Ganglioneuroma:
consist of ganglion cells and nerve fibres of sympathetic
chain. They are slow growing tumours. When present in the
neck as a parapharyngeal mass, it can cause dysphagia. These
tumours can occur in the neck, retroperitoneum or
mediastinum.
2.Neuroblastoma:
consists of poorly differentiated cells. It occurs in young
children. It is interesting to know that this tumour can undergo
spontaneous regression.

14. 3. Myelinic neuroma:
very rare. It arises in relationship with spinal cord made up of
myelinic fibres. Does not contain any ganglion cells.
False neuroma:
These tumours arise from the connective tissue of the sheath of
nerve endings. They occur following nerve injuries,
lacerations, or after amputation. They are of 2 types.
1. End neuroma: occurs after amputation due to the
proliferation of nerve fibres from the distal cut end of the
nerve.
2. Lateral neuroma: occurs due to partial injury to the
nerve on the lateral aspect.
Treatment:
Excision

15. Neurofibroma
• a benign tumour arising from the connective tissue of the
nerve sheath. Typically, it produces a fusiform swelling in the
direction of the nerve fibres.
Clinical types:
1. Single subcutaneous neurofibroma
Commonly affects the peripheral nerves, such as ulnar nerve,
vagus nerve or cutaneous nerves.
clinical features:
Tingling and numbness, paraesthesia in the distribution of
the nerve.
Round to oval swelling in the direction of nerve fibre.
Consistency is firm. Sometimes, it is hard.
Being a subcutaneous swelling, the skin can be lifted up.
Treatment : excision

16. 2. Generalized neurofibromatosis von recklinghausen’s :
autosomal dominant disorder.
whole body is studded with cutaneous nodules of varying
sizes. Soft and nontender. coffee brown pigmentation is
characteristic of this condition (Cafe-au-lait spots).
A cerebellopontineangle tumour -- Cafe-au-lait spots can be
associated with involvement of cranial nerves VIIIth
neve(auditory nerve) acoustic neuroma.
3. Plexiform neurofibromatosis (trigeminal) :
The branches of 5th cranial nerve are commonly affected. It
can also involve the peripheries. The affected part is grossly
thickened due to the fibro-myxomatous degeneration.

17. 4. Elephantiasis neuromatosa:
This condition affects the limbs. It represents an advanced
stage of plexiform variety. Gross thickening of subcutaneous
tissue gives the appearance of elephant’s leg.
5. Pachydermatocoele:
This refers to the plexiform lesions mainly found in the neck
as a thickened, coiled single mass.

18. Neurilemmoma(schwannoma)
• a benign tumour arising from Schwann cells.
• soft, lobulated, well encapsulated tumours. They are benign
and do not turn into malignancy.
• can also be seen in mediastinum and retroperitoneum.
Hamartoma
• Greek word --- fault or misfire.
• A tumour like developmental malformation of the tissues of a
particular part of the body wherein it is arranged haphazardly.
Characteristic features:
Being a developmental anomaly, they are seen at birth or
in early
Childhood.

19. Malignant tumours
Types:
a. Carcinoma – arises from epithelium
b. Sarcoma -- arises from soft tissues or bone which are derived from
mesoblast or mesenchymal tissues.
CARCINOMA
ORIGIN
• Ectodermal—Skin cancer
• Endodermal—Gut cancer
• Mesodermal—Renal carcinoma
TYPES
• Squamous cell carcinoma
• Basal cell carcinoma
• Glandular

20. Soft tissue sarcomas
• These are malignant tumours which are fatal if untreated or mistreated.
• CT scan, MRI, incision biopsy (details later) are the key investigations.
Stages of soft tissue sarcoma
1. Grade (G)
• G1 — Well differentiated
G2—Moderately differentiated
G3 — Poorly differentiated
G4 — Undifferentiated
2. Primary tumour (T)
T1 Tumour ≤ 4–5 cm in greatest dimension
T2 Tumour ≥ 5 cm in greatest dimension
3. Regional lymph nodes (N)
N0 -- no nodal metastasis
N1 -- regional lymph node metastasis present
4. Distant metastasis (M)
M0 -- no distant metastasis
M1 --- distant metastasis present.

21. carcinoma sarcoma
1. Cell of origin Ectodermal or endodermal Mesodermal
2. Age group Elderly, 40–60 years Young, 10–30 years
3. Rate of growth Slow Fast
4. Presentation Non-healing ulcer,
cauliflower-like growth
with everted edges and
induration
Fleshy mass, red and
vascular, dilated veins
over the surface, local rise
of temperature presenting as a
fleshy mass
—Inoperable
5. Spread Lymphatic spread is very
common, both by emboli
and permeation.
Blood spread occurs very
early and results in cannon
ball secondaries in lung.
6. Microscopy Cell nests or epithelial
pearls are seen in well
differentiated cancers
Malignant cells resemble
their cell of origin. Thus,
spindle-shaped cells are
found in fibrosarcoma
7. Treatment Surgery or radiotherapy Surgery,radiotherapy and
chemotherapy
Comparison of carcinoma and sarcoma

22. SYNOVIAL SARCOMA :
• Any rapidly growing tumour in the region of joint/or near the tendons in
young patients (20–40 years), synovial sarcoma is to be considered.
• Common site: shoulder, wrist, knee etc.,
• Hard, painful mass.
• Spread : blood and lymphatic route .
• Calcifications are shown in x ray.

23. Angiosarcoma
• High grade and aggressive tumours.
• Arises from skin and subcutaneous tissye rather than deeper tissues.
• Common site: head and neck, breast and liver.

24. Rhabdomyosarcoma
• Most common soft tissue sarcoma seen in children
• Arises from striated muscle.
• Site: head and neck 70% genitalia 15-20%.
kaposi’s sarcoma
• Common site: legs.
• Other sites: chest, arm, neck in epidemic from.
• It presents as multiple pigmented sarcoma
nodules in the leg.
•It is interesting to note that Kaposi’s
sarcoma is not seen in transfusion related
‘AIDS’.
•Purplish to red subcutaneous nodules in
the leg followed by ulceration with
bleeding is the manifestation.
•Combination chemotherapy with
doxorubicin and etoposide and interferon
has been used to control the disease.

25. Cystic swellings
• A cyst is a swelling containing fluid.
• True cysts are lined by endothelium or epithelium.
They contain clear serous fluid, mucoid material, pus,
blood, lymph or toothpaste like material.
• The false cysts do not have lining epithelium.

26. Classification of cyst:
1.Congenital cyst
a. sequestration dermoid cyst
b. branchial cyst
c. thyroglossal cyst
d. lymphangioma
e. Cysts of embryonic remnants: Cyst of urachus, vitellointestinal duct cyst.
2. Acquired cyst
a. Retention cyst — Sebaceous cyst, galactocoele, spermatocoele, Bartholin’s gland
cyst
b .Distension cyst — Thyroid cyst, ovarian cyst
c. Exudation cyst — Hydrocoele
d. Degenerative cysts — Tumour necrosis
e. Traumatic cyst — Haematoma, implantation dermoid cyst
f. Cystic tumours — Cystadenoma of pancreas, cystadenoma of the ovary
3. Parasitic cyst
a. cysticercosis
b. hydatid cyst

27. Dermoid cyst
• A cyst lined by squamous epithelium containing desquamated
cells.
• The contents are thick and sometimes tooth paste-like which
is a mixture of sweat, sebum and desquamated epithelial cells
and sometimes even hair.
Clinical types:
I. Congenital/sequestration dermoid:
Dermoid cyst occurs in the line of embryonic fusion of these
processes, due to dermal cells being buried in deeper plane.
The cells which are sequestrated in the subcutaneous plane
proliferate and liquify to form a cyst. As it grows, it indents the
mesoderm (future bone) which explains the bony defects
caused by dermoid cyst in the skull or facial bones.

28. Thus, they can occur anywhere in the midline of the body or the
face.
1. Median nasal dermoid cyst: At the root of the nose at the
fusion lines of frontal process.
2. External and internal angular dermoid cyst: At the fusion
lines of frontonasal and maxillary processes.
3. In the suprasternal space of Burns.
4. Sublingual dermoid cyst.
5. Pre-auricular dermoid cyst — in front of the auricle.
6. Post-auricular dermoid cyst behind the auricle.

29. II. Implantation dermoid cyst:
• common in women, tailors, agriculturists who sustain
repeated minor sharp injuries.
• Following a sharp injury, a few epidermal cells get implanted
into the subcutaneous plane. There, they develop into an
implantation dermoid cyst. Hence, it is typically found in
fingers, palm and sole of the foot. As the cyst develops in the
areas where the skin is thick and keratinised, it feels firm to
hard in consistency.
III. Teratomatous dermatoid cyst:
• Teratoma is a tumour arising from totipotential cells. Thus, it
contains ectodermal, endodermal and mesodermal elements
- hair, teeth, cartilage, bone, etc.
• Common sites are ovary, testis, retroperitoneum,
mediastinum

30. IV. Tubulo embryonic dermatoid cyst:
• They arise from ectodermal tubes. A few examples are
thyroglossal cyst, post-anal dermoid cyst.
• Ependymal cyst of the brain.
Treatment:
• Excision of the cyst.
Implantation dermoid at the dorsum
of the left hand near the web between the index
and the middle fingers.
Feeling for erosion
of the skull in case of a dermoid
cyst.

31. Epidermoid cyst
• Also called sebaceous cyst.
• This occurs due to obstruction to one of the sebaceous ducts, resulting in
accumulation of sebaceous material. Hence, this is an example of
retention cyst.
Clinical features:
• Slow growing, appear in early aduthood or middle age.
• Hemispherical or spherical swelling located in the dermis. The central
keratin filled punctum which is a dark spot is diagnostic feature of this
cyst.
• Smooth surface, round borders, soft and putty in consistency, non-tender.
• Sign of moduling.
• Sign of indentation.
Treatment:
• Incision and avulsion of cyst with the wall. Very often, during dissection,
the cyst wall ruptures. Care should be taken to excise the entire cyst wall.
If not, recurrence can occur.
• When it is small it can be excised along with the skin.