This document provides information on Arbuda (tumor) and Tumour. It discusses the types and causes of Arbuda, including Vata, Pitta, Kapha, Rakta, Mamsa, and Medas. It describes the characteristics and treatment of Raktaj and Mansaj Arbuda. It defines Tumour and provides a classification of benign and malignant tumors. It compares characteristics of benign and malignant tumors and discusses spread of malignant tumors. It also summarizes some common benign tumors including Papilloma, Adenoma, Fibroma, Lipoma, and Hemangioma.

1. Lecture on
Arbud
or
Tumour
By- Dr. Alok Verma

2. Arbuda
• गात्रप्रदेशे क्वचिदेव दोषााः सम्मूच्छिता माांसमचिप्रदूष्य |
वृत्तां चथिरां मन्दरुजां महान्तमनल्पमूलां चिरवृदध्यपाकमध ||१३||
क
ु विचन्त माांसोपियां तु शोफ
ां तमर्ुिदां शास्त्रचवदो वदचन्त |१४|
Su.Ni. 11
• The vitiated doshas in whole body goes to mansa dhatu and produces,
oval, fixed, painless/less painful, mass with deep rooted and slowly
growing without suppuration causes swelling, may known as Arbuda.

3. Types
• वातेन चपत्तेन कफ
े न िाचप रक्त
े न माांसेन ि मेदसा ि ||१४||
तज्जायते तथय ि लक्षणाचन ग्रन्िेाः समानाचन सदा िवचन्त |१५|
Raktaj:
• दोषाः प्रदुष्टो रुचिरां चसराथतु सम्पीडध य सङ
ध को्य गतथ्वपाकमध ||१५||
सास्रावमुन्नह्यचत माांसचपण्डां माांसाङ
ध क
ु रैराचितमाशुवृचममध |
स्रव्यजस्रां रुचिरां प्रदुष्टमसा्यमेतद्रुचिरा्मक
ां थयातध ||१६||
रक्तक्षयोपद्रवपीचडत्वातध पाण्डु ििवेतध सोऽर्ुिदपीचडतथतु |१७|

4. Mansaj:
• मुचष्टप्रहाराचदचिरचदितेऽङ
ध गे माांसां प्रदुष्टां प्रकरोचत शोफमध ||१७||
अवेदनां चथनग्िमनन्यवणिमपाकमश्मोपममप्रिाल्यमध |
प्रदुष्टमाांसथय नरथय र्ाढमेतद्भवेन्माांसपरायणथय ||१८||
माांसार्ुिदां ्वेतदसा्यमुक्त
ां ... |१९|
• ..सा्येष्वपीमाचन चववजियेत्तु |
सम्प्रस्रुतां ममिचण य्ि जातां स्रोताःसु वा य्ि िवेदिाल्यमध ||१९||
• These arbuda develops due to blunt injury/ hit by closed fist. These are
painless, smooth margins, nonsuppurative, hard,fixed, skin colured. This
happen usually in the people who ate lots of mans.
• These are Asadhya, even if the sadhya arbuda is present on marma sthan,
continuous discharging, present in shrotasa and fixed then these became
asadhya.

5. Few terms
• यज्जायतेऽन्यतध खलु पूविजाते ज्ञेयां तद्यर्ुिदमर्ुिदज्ञैाः |
यदधवन्वजातां युगपतध क्रमावा चवरर्ुिदां त्ि िवेदसा्यमध ||२०||
Medoj:
• न पाकमायाचन्त कफाचिक्वान्मेदोर्हु्वा्ि चवशेषतथतु |
दोषचथिर्वादधग्रिना्ि तेषाां सवािर्ुिदान्येव चनसगितथतु ||२१||

6. Arbuda Samanya chikitsha
• Upnaah with the doshs samaka medicine accordingly.
• Raktavsechana ( Shringa,Alabu,Jaluka, siravedha)
• Vaman and Virchana
• Ksharkarma
• Lekhana karma
• Agnikarma
• Shastra karma
• If there is wound then treatment of vranachikitsha.

7. TUMOUR
Definition
• Tumour or Neoplasm is the growth of new cells which proliferate
without relation to the need of body. This occurs due to abnormal
reproduction or abnormal differentiation.
• The term tumour must be used for the new growth only nor for any
swelling.

8. Few terms should clearly understood in
respect to tumour……………..
• Metaplasia: There is change in one well differentiated tissue in to other differentiated cells. This
usually occurs due to chronic irritation. For e.g. Squamous Metaplasia occurs as simple columnar epithelium
of gall bladder changes in to squamous epithelium, which is precancerous condition.
• Dystrophy: This is defined as a disorder, usually congenital, of the structure, function of any organ or
tissue. Term dysplasia may be used sometime for the abnormal development of the tissue.
• Anaplasia: This is a condition where, collection of the cell, which does not resembles to any kind of
tissue.
• Teratoma: These are the tumors arising form the totipotent cells, i.e. the cells which are capable to
differentiate in to any kind of tissue. That’s why in teratoma there is presence of all three Germ layer
(Ectoderm, mesoderm, endoderm).

9. Classification
• Tumours are broadly classified as Benign and
Malignant.
Benign :
• Any capsulated tumour, which has no tendency
to invade the surrounding tissue. These Tumours
proliferates slowly and have little evidence of
mitosis. The cell are usually well differentiated.
Malignant:
• Invasiveness is the characteristic feature of
malignant Tumours. The edge is therefore ill-
defined in contrast to well defined in benign
tumours. The term cancer is exclusive for it’s
invading property.

10. Comparison
S.N. Character /
factor
Benign Malignant
1 Age At any age Usually after 40 yrs
2 Size Usually small, may be enormous Usually large size
3 Growth Slow growing, expansile type of
growth, progress of growth is irregular
tend to cease.
Rapidly growing, invasive type,
progress is relentless till death.
4 Histology Well differentiated, well formed stroma
with little tendency of bleeding and
necrosis. Cells regular few mitosis.
Poorly differentiated, sometime
anaplastic, poorly formed stroma with
high tendency of bleeding and necrosis.
Often numerous mitosis.
5 Fixity Not fixed to nearby structure Usually fixed
6 Surrounding
structure
Not involved Involving to surrounding structure is
characteristic.
8 Metastasis Never Frequent
9 Cause of death Usually not fatal, death may occur due
to mechanical pressure.
Combination of mechanical and
destructive effects, secondary infection,
starvation, blood loss, etc.

11. Classification of malignant cancer
Classification on the basis of growth of cancer:
• Carcinoma-in-situ.
• Locally malignant tumour
• Dormant cancer
• Latent cancer

12. Varieties of benign and malignant tumour
Tissue origin Benign Malignant
Epithelium
1. Covering epithelium
Squamous Squamous- cell papilloma Squamous- cell carcinoma
Transitional Transitional-cell papilloma Transitional-cell carcinoma
Columnar Columnar -cell papilloma Adenocarcinoma
2. Compact secreting epithelium Adenoma, if cyst then cystadenoma
Or papillary cystadenoma.
Adenocarcinoma if cyst
cystadenocarcinoma
3. Others epithelium Basal cell carcinoma, salivary and mucous gland tumour are different
from both benign and malignant.
Connective tissue
Fibrous tissue Fibroma Fibrosarcoma

13. Tissue origin Benign Malignant
Nerve sheath
Fat
Smooth muscles
Striated muscles
Cartilage
Bone
Osteoblast
Osteoclast
Meninges
Lymphoid and hematopoietic
tissue
Neurofibroma
Lipoma
Leiomyoma
Rhabdomyoma
Chondroma
Osteoma
Osteoclastoma
Meningioma
Benign Lymphoma
Neurofibrosarcoma
Liposarcoma
Leiomyosarcoma
Rhabdomyosarcoma
Chondrosarcoma
Osteosarcom
Malignant osteoclastoma
Meningiosarcoma
Lymphosarcoma.
Fetal trophoblast Hydatidiform mole Chorion-epithelioma
Embryonic tissue
Totipotent cells
Notochord
Benign Teratoma
------------------
Malignant teratoma
Chordoma
Hamartoma
Melanotic
Angeiomatic
Benign melanoma
Benign angioma
Malignant melanoma
Angiosarcoma

14. Etiological factors of malignant tumour
• Although the exact etiology of cancer is unknown, but there are few
predisposing factors to develop cancer. The cause is not one for all cancers.
• Hydrocarbons
• Sex hormones
• Radiations
• Viruses
• Co-carcinogens
• Heredity
• Chronic irritation
• Trauma
• Diet
• Geography

15. Spread of malignant tumours
There are six various routes of spread of malignant tumours……….
1. Local or direct spread
2. Invasion by lymphatics
3. Through blood vessels
4. Through serous cavities
5. Natural passages
6. Inoculation

16. Some benign tumours
• Papilloma
• Lipoma
• Adenoma
• Fibroma
• Hemangioma
• Neurofibroma

17. Papilloma
• It is common benign sessile or pedunculated tumour containing layers of skin. It may be arises form
epithelial surfaces may be epidermis or mucous membranes. It contains blood vessels and lymphatics.
• The various examples:-
• From epidermis- papilloma of skin
• Squamous cell type
• Congenital, infective papilloma or infective warts, soft papilloma, keratin horn
• Basal cell type
• Senile warts on trunk, face, arms and arm pits
• From mucous membrane
• Squamous: tongue, cheek, lips, esophagus etc.
• Transitional: pelvis of ureter, Bladder
• Columnar: colon, rectum, stomach, small, intestine
• From wall of duct
• From wall of cyst
Treatment
Excision may be form for the cosmetic reason. In Infective warts of HPV antiviral therapy may help up to
some extent but excision is the ultimate option.

19. Adenoma
• This is benign tumour of glandular tissue. Usually arises from secretory gland.
Adenoma are usually encapsulated, causes pressure atrophy over surrounding
structure.
• Adenoma arises from secretary glands of mucous membrane becomes,
pedunculated then called Polyps. Commonly found in large intestine & rectum.
These often tends to be malignant.
• Adenoma found in glandular structure as breast, prostate, salivary glands and
other endocrine glands.
• These tumors tend to be malignant.
There are two variants:
Fibroedenoma found in breast
Cystadenoma found in ovary, pancreas, parotid gland & kidney.
Treatment
Complete excision.

20. Fibroma
• It is a rare tumour. It consists of collections of
fibroblasts between which there is variable amount of
collagen. It is of two types hard or soft. Hard fibroma
has more common collagen, whereas the soft fibroma
is predominantly cellular.
• Many fibroma are combined with other mesodermal
tissue such as fat, muscles, nerve sheath.
Treatment
Complete excision.

21. Lipoma
• This is most commonest in all benign tumours. It is composed of fat
cells of adult type. It can occur anywhere in the body, that is why also
called as universal tumour or ubiquitous tumour.
• The commonest site are subcutaneous tissue trunk, back of neck,
limbs.
• There are three variety:-
1. Encapsulated variety
2. Diffuse variety
3. Multiple lipoma

22. Complication
• A lipoma when present long time may undergo certain changes. This is
particularly true in cases of lipoma in the subcutaneous tissue of the
thigh, buttock or retroperitoneal lipoma.
• These changes may be-
1. Degeneration
2. Saponification
3. Calcification
4. Malignant or sarcomatous changes.

23. Variety of Lipoma
Lipoma can occur in different anatomical situations…
• Subcutaneous
• Sub fascial
• Intermuscular lipoma
• Sub-serous lipoma
• Sub-mucous lipoma
• Intra- articular
• Sub-synovial lipoma
• Periosteal lipoma
• Extradural lipoma
• Intra-glandular lipoma

24. Subcutaneous Lipoma
• Pathology
• Clinical feature
• History
• Age
• Duration
• Symptoms
• Examination
• Position color
• Temperature & tenderness
• Size & shape
• Surface
• Consistency
• Trans-illumination test
• Mobility “slip sign” +ve

25. Treatment
Cleaning & Draping
Linear incision
Separate from adjoining tissue
Keep stay suture if required
Little traction by stay suture
Extract mass with capsule
Achieve heamostasis
Pour antibiotic solution
Close cavity
Close skin with interrupted

26. Hemangioma
• A development malformation of blood vessels it is not typical tumour. It
may be considered as example of Hamartoma.
• Hamartoma is development malformation which consists tumour like
overgrowth in which the particular body tissue is arrange, haphazardly,
usually with an excess of one or more of it’s components. The large number
of lesions fall in the general category of hamartoma. These lesions are
benign pigmented moles, majority of angioma, and Neurofibroma.
• There are three types of hemangioma
1. Capillary hemangioma
2. Venous or cavernous hemangioma
3. Arterial or Plexiform hemangioma

27. Capillary hemangioma
• There are three variety of capillary hemangioma—
• Strawberry angioma
• Port-wine stain
• Salmon patch

28. Strawberry angioma (strawberry naevus)
Characteristics:
• A typical history of appear a red mark after 1to 3 weeks of birth.
• Gradually increase in size and becomes like strawberry in few months.
• Usually involve subcutaneous tissue, skin, muscle and rarely sub
mucous.
• On examination a swelling slight protrude from skin, sessile, dark red
lesion. The swelling is compressible, apulsatile, the surface is irregular
may covered with scabs on ulceration.
• After first birthday hemangioma starts regresses and disappear before
age of 8-9yrs.

29. Port wine stain
Characteristics:
• It present since birth and remain for rest of life.
• Size increases in proportion to the body surface area.
• Most commonly present on face, shoulder, neck and
buttock.
• Colour is deep purple-red which later on becomes pale.
• Lesions are flat no elevation color diminishes on
pressure and reappear on releasing pressure.

30. Salmon patch
Characteristics:
• Present since birth and disappear before 1st birthday.
• Mostly seen over forehead or occiput or anywhere in midline of body.

31. Treatment
• Wait and watch, as most of capillary hemangioma disappear in 7-8 yrs.
• If patient insisted, cosmetic treatment includes
• Excision of lesion with skin graft
• Carbon Dioxide snow application
• Injection of hot water, hypertonic solution or sclerosant
• X-Ray therapy
• Injection of steroids.

32. Venous/cavernous hemangioma
It consist of multiple dilated venous channels. It is spongy
swelling.
Characteristics:
It is present since birth and does not show any tendency to
involusion but it may goes larger with time.
These are usually bluish colour as content is venous blood.
These are non-pulsatile.
Compressibility present.
Common site are face, cheek, ears, mucous membrane of
lips, tongue may be in the organs, like liver, kidney and
brain.

33. Treatment
Conservative treatment
• More often conservative treatment is enough.
• Injection of sclerosing agent in to lesion. In this respect 3% sodium
morrhuate is quit effective. The injection is given once week for few
times up to 6 weeks if necessary.
• Cauterization may be effective in hemangioma.
Surgery
• Surgery is better treatment if swelling is small and localized. The
feeding vessels are first ligated and whole lesion is excised. Diathermy
may be used to control hemorrhage.

34. Spider naevus
• It is solitary dilated skin arterioles feeding
a number small branches which grows in
radial manner.
• It is an acquired condition associated with
some generalized disease.
• Such lesions are presents on face, trunk
and arms.
• Compressibility present
• Usually associated with chronic liver
disease ( cirrhosis, tumour) and tumours
producing estrogens.

35. Arterial or Plexiform Hemangioma
It is a type of congenital arteriovenous fistula.
These swelling are pulsatile and arteries and
veins become arterialized. Feeling like a bag of
pulsating earthworms.
Treatment
• Ligation of vessels.
• Therapeutic embolism of the feeding artery
• After ligation of feeding vessels excision of
the lesion with diathermy.

36. Neurofibroma
• These tumour arises from the connective tissue of the nerve sheath.
This is a development disorder and is often considered as hamartoma
and not a typical tumour. Such disorder often runs in families.
• Majority of the Neurofibroma arises from endoneurium, the innermost
connective tissue layer of nerve fiber.
There are two varieties of Neurofibroma.
• Local
• Generalized

37. Local Neurofibroma
• Single Neurofibroma is usually found in the subcutaneous tissue, found in extremities
on median nerve, ulnar nerve etc.
• Clinical feature
• Swelling is main feature may accompany paresthesia and pain on pressure. The
swelling is smooth with well defined margin on skin with subcutaneous tissue.
• Mobility is only sidewise from the axis of nerve fiber.
• These Neurofibroma may also occur other than skin, like cranial nerve, dorsal nerve
root of ganglion, intramuscular and sometime bones.
• May goes in to cystic degeneration or malignant changes
• Treatment
• Excision of lesion without injuring nerve is treatment of choice, sometime removal is
not possible then that particular section of nerve is removed followed by end to end
anastomosis of nerve is good option. Recurrence may happen after resection.

38. Generalized Neurofibroma
Also known as Von Recklinghausen’s
disease of nerve.
There are multiple Neurofibroma arising
from the cranial, spinal or peripheral
nerve.
This is autosomal dominant inherited
disease. This arises from endoneurium.
Von Recklinghausen’s disease of bone*

39. Clinical feature
• There are multiple nodules of varying size can be seen
over face, neck , trunk and limbs. Majority of the
Neurofibroma present since birth, number and size
increases as age progresses. The nodule vary in
consistency from soft to hard. Each nodule has clear
margins.
• The other neurological abnormalities are not common.
• Often the skin over nodule becomes hyper pigmented.
• Sometime some skeletal deformities also present.
• In Approx 5% cases malignant changes may be present.

40. Treatment
• The number of Swellings are numerous so, excision of all is almost
impossible, but the swelling can be excised if it is painful, large,
causing mechanical discomfort and having pressure effect.
• The swelling but be excised and send for HPE, if malignant changes
are suspected.
• No medical cure is available till now.

41. Some less common Neurofibromatosis
• Plexiform neurofibromatosis
• Elephantiasis neurofibromatosa
• Cutaneous neurofibromatosis.
Plexiform neurofibromatosis
Cutaneous neurofibromatosis
Elephantiasis neurofibromatosa

42. Malignant tumours
Malignant tumours of skin and epidermis are
• Basal cell carcinoma
• Squamous cell carcinoma
Malignant tumours of secreting epithelium or underlying glands are
• Glandular carcinoma
Malignant tumours of transitional epithelium
• Transitional cell carcinoma
The melanomas

43. Basal cell carcinoma
• This is a locally invasive carcinoma of the basal layers of
epidermis. This is low grade malignancy.
• White, Elderly people are usually affected, more commonly in
males.
• It may be ulcerative (rodent ulcer), Nodular or Cystic type.
• Commonly This arises from the basal layer of epidermis but
some time it may arise from basal cells of hair follicle and
sweat glands.
• It spread with local invasion, it destroys the tissue comes in
contact with. That is why this tumour is called rodent ulcer.

44. Clinical feature
• Main complain is chronic painless, non-healing ulcer, later may be itch. These
ulcers are deep so may bleed due to erosion of vessels. After being secondary
infected it may cause pain.
• Most common site is face and other are outer/inner canthus of eye, nose,
nasolabial fold or fore head.
• As the common presence of tumour on face also called as tear ulcer.
• Tumour always starts with nodule, later on the center of nodule undergoes in
necrosis and develops the ulcer.
• Treatment
• Radiotherapy
• Surgery
• Cryosurgery
• Local chemotherapy
• laser

45. Squamous cell carcinoma
• This is carcinoma of squamous cell of the skin. This
carcinoma may be starts from the skin or may be arises
from any pre- existing lesion like-
• Longstanding chronic ulcer.
• Senile keratosis
• Bowen’s disease
• Leukoplakia
• Skin expose to irradiation.
• Chronic skin lesion as lupus vulgaris, eczema, warts.
• It may also develop from pre-existing basal cell carcinoma.

46. Site
• This tumour can develop any place in body where there is squamous or
transitional epithelium
• Anywhere in skin as face, dorsum of hand, feet, etc
• Junction of skin and mucous membrane e.g. Lips, nostril, eyelids, genitals.
• Mucous membrane lined by stratified squamous epithelium. e.g. Tounge,
mouth, esophagus, vagina.
• Occasionally seen in layers having columnar epithelium for e.g. bronchus,
gallbladder.
• After metaplasia it may be occur in various organ like kidney, ureter and
urinary bladder.

47. • It is of two types
• Proliferative
• Ulcerative
• Spread
• Local
• Lymph
• Blood
• Clinical feature
• Usually seen above 40 yr
• Have Occupational relation
• Usually painless, nodule or ulcer.
• May have enlarge lymph nodes
• Treatment
• Surgery
• Radiotherapy