- A 2.5 year old female presented with a 1 month history of abdominal pain and 2 days of vomiting. On examination, a 7x7 cm firm mass was palpated in the left flank.
- Imaging showed a large solid mass arising from the left kidney, extending into the inferior vena cava and right atrium.
- The patient underwent chemotherapy, followed by left nephrectomy with removal of thrombus from the renal vein and inferior vena cava. Histopathology revealed a mixed type Wilms tumor.
- Follow up showed no residual mass and the patient was discharged on oral chemotherapy.
Adrenocortical carcinoma is a rare and aggressive cancer with a bimodal age distribution. Complete surgical resection is the primary treatment when possible. For localized disease, adjuvant mitotane or radiation may be used, while mitotane is the standard medical therapy for metastatic disease. Despite aggressive treatment, the 5-year survival rate remains poor at 20-47% due to the high risk of local recurrence and metastasis. Close monitoring after treatment is important to detect recurrence early.
This document discusses leptomeningeal metastasis (LM), also known as neoplastic meningitis. LM occurs when cancer spreads to the membranes surrounding the brain and spinal cord. The document covers the epidemiology, pathophysiology, clinical presentation, diagnosis, and treatment of LM. Key points include that LM most often originates from breast, lung, or skin cancers and presents with neurological deficits affecting the brain, cranial nerves, or spinal cord. Diagnosis involves MRI, lumbar puncture for cerebrospinal fluid analysis, and ruling out other causes. Prognosis is generally poor with median survival of only a few months.
This document provides an overview of common pediatric solid tumors, including definitions, epidemiology, etiology, types, symptoms and signs, staging, diagnosis, treatment, and prognosis for each tumor type. The tumors discussed include lymphomas, nephroblastoma (Wilms tumor), neuroblastoma, hepatoblastoma, and hemangioma. For each tumor type, the summary defines the tumor, discusses prevalence and risk factors, describes common subtypes, and outlines the standard diagnostic and treatment approaches.
Management of malignant spinal cord compressionShreya Singh
This document summarizes the management of malignant spinal cord compression. It defines MSCC as cancer growth in or near the spine that presses on the spinal cord. Symptoms include back pain, motor deficits, and sensory deficits. Treatment involves corticosteroids, surgery, and radiotherapy. Surgery plus radiotherapy provides better outcomes than radiotherapy alone for patients with good performance status and at least 3 months life expectancy. Standard radiotherapy is 30 Gy in 10 fractions. Shorter courses are used when survival is poor. Surgery may be indicated for instability, intractable pain, or radioresistant cancers.
Nephroblastoma, also known as Wilms tumor, is the most common renal cancer in children. It arises from primitive renal cells that failed to differentiate normally. Clinically, it presents as an asymptomatic abdominal mass often found during bathing. Diagnosis involves imaging tests and biopsy. Staging determines prognosis and guides treatment, which typically involves surgery to remove the tumor along with chemotherapy and sometimes radiation therapy. With current multi-modal therapy, the cure rate for Wilms tumor is over 85%.
- Angiomyolipoma is a rare, benign renal tumor composed of blood vessels, smooth muscle, and fat that accounts for less than 10% of renal tumors. It occurs more frequently in women and individuals with tuberous sclerosis. Symptoms include flank pain, masses, and hemorrhage. Diagnosis is based on imaging showing a fat-containing renal lesion. Treatment options range from observation to surgery depending on size and symptoms.
This document provides an overview of neuroblastoma, including its clinical presentation, pathology, risk grouping, diagnostic workup, prognostic factors, and management. Some key points:
- Neuroblastoma arises from neural crest tissue and is the most common extracranial solid tumor in children. Over 70% present with metastases.
- Risk grouping systems include INSS (International Neuroblastoma Staging System) and more recently INRG (International Neuroblastoma Risk Group) staging.
- Prognostic factors include age, stage, pathology, MYCN status, and other biomarkers.
- Treatment depends on risk but may include surgery, chemotherapy, radiation, stem cell transplant, and immunotherapy. Precise management
Renal Cell Carcinoma Diagnosis And ManagementRHMBONCO
This document provides an overview of renal cell carcinoma (RCC), including its epidemiology, pathology, clinical presentation, evaluation and staging, prognosis, and treatment options. RCC incidence has been rising and is more common in men than women. Surgery is the main treatment for localized RCC, while targeted therapies like sorafenib and sunitinib have improved outcomes for metastatic RCC compared to previous chemotherapy options. Ongoing clinical trials are exploring adjuvant and neoadjuvant therapies to improve prognosis.
Adrenocortical carcinoma is a rare and aggressive cancer with a bimodal age distribution. Complete surgical resection is the primary treatment when possible. For localized disease, adjuvant mitotane or radiation may be used, while mitotane is the standard medical therapy for metastatic disease. Despite aggressive treatment, the 5-year survival rate remains poor at 20-47% due to the high risk of local recurrence and metastasis. Close monitoring after treatment is important to detect recurrence early.
This document discusses leptomeningeal metastasis (LM), also known as neoplastic meningitis. LM occurs when cancer spreads to the membranes surrounding the brain and spinal cord. The document covers the epidemiology, pathophysiology, clinical presentation, diagnosis, and treatment of LM. Key points include that LM most often originates from breast, lung, or skin cancers and presents with neurological deficits affecting the brain, cranial nerves, or spinal cord. Diagnosis involves MRI, lumbar puncture for cerebrospinal fluid analysis, and ruling out other causes. Prognosis is generally poor with median survival of only a few months.
This document provides an overview of common pediatric solid tumors, including definitions, epidemiology, etiology, types, symptoms and signs, staging, diagnosis, treatment, and prognosis for each tumor type. The tumors discussed include lymphomas, nephroblastoma (Wilms tumor), neuroblastoma, hepatoblastoma, and hemangioma. For each tumor type, the summary defines the tumor, discusses prevalence and risk factors, describes common subtypes, and outlines the standard diagnostic and treatment approaches.
Management of malignant spinal cord compressionShreya Singh
This document summarizes the management of malignant spinal cord compression. It defines MSCC as cancer growth in or near the spine that presses on the spinal cord. Symptoms include back pain, motor deficits, and sensory deficits. Treatment involves corticosteroids, surgery, and radiotherapy. Surgery plus radiotherapy provides better outcomes than radiotherapy alone for patients with good performance status and at least 3 months life expectancy. Standard radiotherapy is 30 Gy in 10 fractions. Shorter courses are used when survival is poor. Surgery may be indicated for instability, intractable pain, or radioresistant cancers.
Nephroblastoma, also known as Wilms tumor, is the most common renal cancer in children. It arises from primitive renal cells that failed to differentiate normally. Clinically, it presents as an asymptomatic abdominal mass often found during bathing. Diagnosis involves imaging tests and biopsy. Staging determines prognosis and guides treatment, which typically involves surgery to remove the tumor along with chemotherapy and sometimes radiation therapy. With current multi-modal therapy, the cure rate for Wilms tumor is over 85%.
- Angiomyolipoma is a rare, benign renal tumor composed of blood vessels, smooth muscle, and fat that accounts for less than 10% of renal tumors. It occurs more frequently in women and individuals with tuberous sclerosis. Symptoms include flank pain, masses, and hemorrhage. Diagnosis is based on imaging showing a fat-containing renal lesion. Treatment options range from observation to surgery depending on size and symptoms.
This document provides an overview of neuroblastoma, including its clinical presentation, pathology, risk grouping, diagnostic workup, prognostic factors, and management. Some key points:
- Neuroblastoma arises from neural crest tissue and is the most common extracranial solid tumor in children. Over 70% present with metastases.
- Risk grouping systems include INSS (International Neuroblastoma Staging System) and more recently INRG (International Neuroblastoma Risk Group) staging.
- Prognostic factors include age, stage, pathology, MYCN status, and other biomarkers.
- Treatment depends on risk but may include surgery, chemotherapy, radiation, stem cell transplant, and immunotherapy. Precise management
Renal Cell Carcinoma Diagnosis And ManagementRHMBONCO
This document provides an overview of renal cell carcinoma (RCC), including its epidemiology, pathology, clinical presentation, evaluation and staging, prognosis, and treatment options. RCC incidence has been rising and is more common in men than women. Surgery is the main treatment for localized RCC, while targeted therapies like sorafenib and sunitinib have improved outcomes for metastatic RCC compared to previous chemotherapy options. Ongoing clinical trials are exploring adjuvant and neoadjuvant therapies to improve prognosis.
Wilms' tumor is the most common pediatric renal tumor. It has an annual incidence of 7.6 cases per million children under 15 years of age in the US. The mean age of diagnosis is 46.9 months for females and 41.5 months for males. Treatment involves nephrectomy followed by chemotherapy and possibly radiation therapy depending on stage. Staging is based on tumor size, involvement of surrounding structures, and presence of metastases. Prognosis depends on stage and histology, with 5-year survival rates over 90% for favorable histology stage I-III disease. Intensive multimodal therapy has resulted in significantly improved survival outcomes over the past decades.
This document summarizes the current state of neoadjuvant treatment options for esophageal and gastric cancer. It finds that neoadjuvant therapy prior to surgery should be considered for all patients with greater than T1 or node-positive disease. For esophageal cancer, most patients should receive neoadjuvant chemoradiation. For gastric cancer, there is strong support for adjuvant chemotherapy following surgery. Future areas of research include immunotherapy, targeted therapies, and combination approaches.
Lung cancer is the leading cause of cancer death in Ireland, causing 20% of all cancer deaths. Incidence in Irish women is increasing rapidly and is more than double the EU average. Lung cancer services in Ireland are currently disorganized and fragmented, with low rates of tissue diagnosis and accurate staging. Improved organization of lung cancer care through early diagnosis, rapid access to diagnostic services, and coordinated multidisciplinary treatment can improve outcomes. These guidelines aim to assist in providing all lung cancer patients with rapid access to high-quality multidisciplinary care.
This document discusses neuroblastoma, a common childhood cancer. Some key points:
- Neuroblastoma arises from neural crest cells and can occur in adrenal glands or sympathetic nervous system. Half of children present with metastatic disease.
- It is the most common cancer in infancy and accounts for 8-10% of childhood cancers. The median age of diagnosis is 19 months.
- Familial cases have an autosomal dominant pattern of inheritance and a younger median age of diagnosis. Amplification of the N-MYC oncogene and deletion of chromosome 1p are common genetic factors.
- Treatment involves surgery to remove the tumor if possible, chemotherapy, and sometimes radiation therapy to control local
Brain cancer, or tumors, refers to the abnormal growth of cells in the brain. There are two main types - benign tumors, which are non-cancerous and grow slowly, and malignant tumors, which are cancerous and grow rapidly, invading other brain tissue. Common symptoms include headaches, nausea, vision or balance problems, and changes in thinking or memory. Diagnosis involves scans, biopsies, and other tests to determine the type and location of the tumor, which help guide treatment options like surgery, chemotherapy, radiation, and medication.
Wilms tumor, or nephroblastoma, is a malignant kidney tumor that typically occurs in young children under 5 years old. It is the fifth most common pediatric cancer and is highly responsive to treatment, with a 90% survival rate. While the exact cause is unknown, genetic factors and abnormalities in genes like WT1 and WT2 may play a role in tumor development. Treatment involves surgery to remove the tumor, radiation therapy, and chemotherapy depending on the stage. Early detection and complete surgical removal of localized tumors results in high survival rates.
This document discusses the management of non-small cell lung cancer. It outlines the various treatment options depending on the stage of cancer, including surgery for early stages, radiation therapy, chemotherapy, and stereotactic body radiotherapy. It provides details on surgical procedures, radiation techniques, outcomes of stereotactic body radiotherapy, and the use of concurrent chemotherapy and radiation for locally advanced stages.
Ovarian cancer forms from abnormal cell growth in one or both ovaries. Most cases are epithelial cell tumors. Symptoms include abdominal bloating and pain. Risk factors include age, family history, and never being pregnant. It is often diagnosed late since symptoms are vague, but earlier detection improves prognosis. Treatment typically involves surgery to remove the ovaries and chemotherapy. Nursing care focuses on managing pain, preventing infections and blood clots, and providing education and support.
This document discusses kidney cancer, including its causes, diagnosis, staging, and treatment. Kidney cancer occurs when old or damaged kidney cells continue to divide uncontrollably. It is most treatable if caught early, but can spread to other organs if left untreated. Diagnosis involves medical history, exams, urine and blood tests, and imaging tests. Treatment may include surgery to remove part or all of the affected kidney, radiation, targeted therapy, immunotherapy, or chemotherapy depending on cancer stage. The most common type is renal cell carcinoma.
This document summarizes information about seminoma, a type of testicular cancer. It discusses the anatomy and epidemiology of testicular tumors. It describes risk factors, pathology, pathways of spread, clinical features, diagnostic workup and staging of seminoma. It provides details about management including surgery, radiation therapy and chemotherapy for different stages. It discusses follow-up protocols and results of therapy.
Hepatoblastoma is a rare liver tumor that affects children under 3 years old. It typically presents as a golf ball sized tumor in the right lobe of the liver. While the cause is unknown, genetic disorders like Beckwith-Wiedemann syndrome can increase the risk. Treatment depends on the stage, ranging from surgery alone for early stages to chemotherapy and surgery for advanced cases. Without treatment, hepatoblastoma has a 100% fatality rate.
General Basic knowledge of Brain tumour explained in brief of classification, pathogenesis, clinical features, CT, MRI, management, Radiotherapy. Best for MBBS and PG preparation student.
1. Bladder cancer is a type of cancer that forms in the bladder. It is more common in older males and risk factors include smoking, exposure to industrial chemicals, chronic bladder infections or irritation, and pelvic radiation.
2. Symptoms include blood in the urine, pain with urination, and low back pain. Diagnosis involves tests to detect cancer cells in urine or tissue samples.
3. Treatment depends on cancer stage and grade and may include surgery, chemotherapy, radiation therapy, immunotherapy, and intravesical therapies directly into the bladder. Ongoing monitoring is important due to the risk of recurrence.
Renal cell carcinoma (RCC) is the most common type of kidney cancer in adults, originating from the lining of the proximal convoluted tubule in the kidney. Risk factors include tobacco use, genetic factors, cystic kidney diseases, and exposure to certain chemicals. RCC is typically diagnosed through imaging tests and biopsy. Surgical removal of the kidney is the main treatment for localized RCC, while advanced or metastatic RCC may be treated with targeted drugs or immunotherapy. Prognosis depends on the stage, with localized RCC having high survival rates while advanced metastatic RCC has poorer outcomes.
The document provides information about brain metastasis including:
- Brain metastasis are cancer cells that have spread to the brain from primary tumors elsewhere in the body. Lung cancer, breast cancer, melanoma, and renal cancer are common sources.
- Symptoms depend on the location of metastases and can include headaches, nausea, focal weakness, seizures, and alterations in consciousness. Diagnosis is typically made through MRI or CT imaging.
- Treatment involves steroids, anticonvulsants, surgery to remove solitary metastases, stereotactic radiosurgery for a small number of lesions, whole brain radiation, and occasionally chemotherapy. The prognosis is generally poor with a median survival of 4-5 months.
The document discusses the anatomy and diagnostic evaluation of prostate cancer. It describes the prostate as a walnut-sized gland located below the bladder and surrounding the urethra. The primary function is to produce seminal fluid. Diagnostic workup involves PSA levels, digital rectal exam, prostate biopsy and various imaging modalities like CT, MRI, bone scan and PSMA PET/CT to stage disease extent and metastasis. Gleason scoring is used to grade prostate cancer based on architectural patterns seen on biopsy.
1. The patient presented with hypercalcemia due to metastatic lung cancer. Symptoms included confusion, dehydration, and signs of renal impairment.
2. Initial management involved IV rehydration with normal saline to improve kidney function and increase calcium excretion. Bisphosphonate therapy was given to reduce calcium levels.
3. Further imaging found a mass in the right hilum and new liver metastasis, consistent with progression of the original lung cancer.
The anal canal is approximately 4 cm in length extending from the anorectal junction to the anal verge. Anal cancers are rare and mostly squamous cell carcinomas arising from the anal transitional zone. Risk factors include HPV infection and immunosuppression. Combined chemoradiotherapy is the standard first-line treatment and results in high response rates and organ preservation compared to radiation alone. Salvage surgery may be considered for select cases after failed nonsurgical treatment or as primary treatment for those who cannot tolerate chemoradiotherapy. Prognosis depends on tumor stage, with 5-year survival rates ranging from 45-86% depending on depth of invasion and nodal involvement.
This document discusses the anatomy, embryology, classification, clinical features, diagnosis, and management of esophageal atresia with tracheo-esophageal fistula (TEF). Key points include:
1) TEF results from incomplete separation of the foregut from the laryngotracheal groove during embryological development.
2) There are various classifications of TEF including the Vogt and Gross system. Type C, with upper pouch atresia and lower pouch fistula, accounts for 85% of cases.
3) Clinical features include frothing at the mouth, choking, and cyanosis with feeding. Diagnosis is made with chest x-rays and es
This document presents the case of a 58-year-old female who presented with rectal bleeding and altered bowel habits for 5 months. Examination revealed pallor and a rectal mass. Investigations confirmed moderately differentiated adenocarcinoma of the rectum. Imaging showed the primary tumor in the rectosigmoid junction and suspicious lymph nodes. The patient underwent a laparoscopic low anterior resection with diverting ileostomy.
Abdominal trauma: diagnosis and managementvinayakas4
1) Abdominal trauma is a major cause of death globally, especially in young adults, due to injuries from motor vehicle accidents. The abdomen has no bony protection and is vulnerable to hemorrhage from solid organs or sepsis from hollow viscus injuries.
2) Evaluation of abdominal trauma involves history, physical exam, focused assessment with sonography for trauma (FAST), and CT scan if stable. Unstable patients may require diagnostic peritoneal lavage or immediate exploratory laparotomy.
3) Management depends on injury type and hemodynamic stability. Nonoperative management is preferred for solid organ injuries while laparotomy is often needed for penetrating injuries or hemodynamically unstable patients to control bleeding.
Wilms' tumor is the most common pediatric renal tumor. It has an annual incidence of 7.6 cases per million children under 15 years of age in the US. The mean age of diagnosis is 46.9 months for females and 41.5 months for males. Treatment involves nephrectomy followed by chemotherapy and possibly radiation therapy depending on stage. Staging is based on tumor size, involvement of surrounding structures, and presence of metastases. Prognosis depends on stage and histology, with 5-year survival rates over 90% for favorable histology stage I-III disease. Intensive multimodal therapy has resulted in significantly improved survival outcomes over the past decades.
This document summarizes the current state of neoadjuvant treatment options for esophageal and gastric cancer. It finds that neoadjuvant therapy prior to surgery should be considered for all patients with greater than T1 or node-positive disease. For esophageal cancer, most patients should receive neoadjuvant chemoradiation. For gastric cancer, there is strong support for adjuvant chemotherapy following surgery. Future areas of research include immunotherapy, targeted therapies, and combination approaches.
Lung cancer is the leading cause of cancer death in Ireland, causing 20% of all cancer deaths. Incidence in Irish women is increasing rapidly and is more than double the EU average. Lung cancer services in Ireland are currently disorganized and fragmented, with low rates of tissue diagnosis and accurate staging. Improved organization of lung cancer care through early diagnosis, rapid access to diagnostic services, and coordinated multidisciplinary treatment can improve outcomes. These guidelines aim to assist in providing all lung cancer patients with rapid access to high-quality multidisciplinary care.
This document discusses neuroblastoma, a common childhood cancer. Some key points:
- Neuroblastoma arises from neural crest cells and can occur in adrenal glands or sympathetic nervous system. Half of children present with metastatic disease.
- It is the most common cancer in infancy and accounts for 8-10% of childhood cancers. The median age of diagnosis is 19 months.
- Familial cases have an autosomal dominant pattern of inheritance and a younger median age of diagnosis. Amplification of the N-MYC oncogene and deletion of chromosome 1p are common genetic factors.
- Treatment involves surgery to remove the tumor if possible, chemotherapy, and sometimes radiation therapy to control local
Brain cancer, or tumors, refers to the abnormal growth of cells in the brain. There are two main types - benign tumors, which are non-cancerous and grow slowly, and malignant tumors, which are cancerous and grow rapidly, invading other brain tissue. Common symptoms include headaches, nausea, vision or balance problems, and changes in thinking or memory. Diagnosis involves scans, biopsies, and other tests to determine the type and location of the tumor, which help guide treatment options like surgery, chemotherapy, radiation, and medication.
Wilms tumor, or nephroblastoma, is a malignant kidney tumor that typically occurs in young children under 5 years old. It is the fifth most common pediatric cancer and is highly responsive to treatment, with a 90% survival rate. While the exact cause is unknown, genetic factors and abnormalities in genes like WT1 and WT2 may play a role in tumor development. Treatment involves surgery to remove the tumor, radiation therapy, and chemotherapy depending on the stage. Early detection and complete surgical removal of localized tumors results in high survival rates.
This document discusses the management of non-small cell lung cancer. It outlines the various treatment options depending on the stage of cancer, including surgery for early stages, radiation therapy, chemotherapy, and stereotactic body radiotherapy. It provides details on surgical procedures, radiation techniques, outcomes of stereotactic body radiotherapy, and the use of concurrent chemotherapy and radiation for locally advanced stages.
Ovarian cancer forms from abnormal cell growth in one or both ovaries. Most cases are epithelial cell tumors. Symptoms include abdominal bloating and pain. Risk factors include age, family history, and never being pregnant. It is often diagnosed late since symptoms are vague, but earlier detection improves prognosis. Treatment typically involves surgery to remove the ovaries and chemotherapy. Nursing care focuses on managing pain, preventing infections and blood clots, and providing education and support.
This document discusses kidney cancer, including its causes, diagnosis, staging, and treatment. Kidney cancer occurs when old or damaged kidney cells continue to divide uncontrollably. It is most treatable if caught early, but can spread to other organs if left untreated. Diagnosis involves medical history, exams, urine and blood tests, and imaging tests. Treatment may include surgery to remove part or all of the affected kidney, radiation, targeted therapy, immunotherapy, or chemotherapy depending on cancer stage. The most common type is renal cell carcinoma.
This document summarizes information about seminoma, a type of testicular cancer. It discusses the anatomy and epidemiology of testicular tumors. It describes risk factors, pathology, pathways of spread, clinical features, diagnostic workup and staging of seminoma. It provides details about management including surgery, radiation therapy and chemotherapy for different stages. It discusses follow-up protocols and results of therapy.
Hepatoblastoma is a rare liver tumor that affects children under 3 years old. It typically presents as a golf ball sized tumor in the right lobe of the liver. While the cause is unknown, genetic disorders like Beckwith-Wiedemann syndrome can increase the risk. Treatment depends on the stage, ranging from surgery alone for early stages to chemotherapy and surgery for advanced cases. Without treatment, hepatoblastoma has a 100% fatality rate.
General Basic knowledge of Brain tumour explained in brief of classification, pathogenesis, clinical features, CT, MRI, management, Radiotherapy. Best for MBBS and PG preparation student.
1. Bladder cancer is a type of cancer that forms in the bladder. It is more common in older males and risk factors include smoking, exposure to industrial chemicals, chronic bladder infections or irritation, and pelvic radiation.
2. Symptoms include blood in the urine, pain with urination, and low back pain. Diagnosis involves tests to detect cancer cells in urine or tissue samples.
3. Treatment depends on cancer stage and grade and may include surgery, chemotherapy, radiation therapy, immunotherapy, and intravesical therapies directly into the bladder. Ongoing monitoring is important due to the risk of recurrence.
Renal cell carcinoma (RCC) is the most common type of kidney cancer in adults, originating from the lining of the proximal convoluted tubule in the kidney. Risk factors include tobacco use, genetic factors, cystic kidney diseases, and exposure to certain chemicals. RCC is typically diagnosed through imaging tests and biopsy. Surgical removal of the kidney is the main treatment for localized RCC, while advanced or metastatic RCC may be treated with targeted drugs or immunotherapy. Prognosis depends on the stage, with localized RCC having high survival rates while advanced metastatic RCC has poorer outcomes.
The document provides information about brain metastasis including:
- Brain metastasis are cancer cells that have spread to the brain from primary tumors elsewhere in the body. Lung cancer, breast cancer, melanoma, and renal cancer are common sources.
- Symptoms depend on the location of metastases and can include headaches, nausea, focal weakness, seizures, and alterations in consciousness. Diagnosis is typically made through MRI or CT imaging.
- Treatment involves steroids, anticonvulsants, surgery to remove solitary metastases, stereotactic radiosurgery for a small number of lesions, whole brain radiation, and occasionally chemotherapy. The prognosis is generally poor with a median survival of 4-5 months.
The document discusses the anatomy and diagnostic evaluation of prostate cancer. It describes the prostate as a walnut-sized gland located below the bladder and surrounding the urethra. The primary function is to produce seminal fluid. Diagnostic workup involves PSA levels, digital rectal exam, prostate biopsy and various imaging modalities like CT, MRI, bone scan and PSMA PET/CT to stage disease extent and metastasis. Gleason scoring is used to grade prostate cancer based on architectural patterns seen on biopsy.
1. The patient presented with hypercalcemia due to metastatic lung cancer. Symptoms included confusion, dehydration, and signs of renal impairment.
2. Initial management involved IV rehydration with normal saline to improve kidney function and increase calcium excretion. Bisphosphonate therapy was given to reduce calcium levels.
3. Further imaging found a mass in the right hilum and new liver metastasis, consistent with progression of the original lung cancer.
The anal canal is approximately 4 cm in length extending from the anorectal junction to the anal verge. Anal cancers are rare and mostly squamous cell carcinomas arising from the anal transitional zone. Risk factors include HPV infection and immunosuppression. Combined chemoradiotherapy is the standard first-line treatment and results in high response rates and organ preservation compared to radiation alone. Salvage surgery may be considered for select cases after failed nonsurgical treatment or as primary treatment for those who cannot tolerate chemoradiotherapy. Prognosis depends on tumor stage, with 5-year survival rates ranging from 45-86% depending on depth of invasion and nodal involvement.
This document discusses the anatomy, embryology, classification, clinical features, diagnosis, and management of esophageal atresia with tracheo-esophageal fistula (TEF). Key points include:
1) TEF results from incomplete separation of the foregut from the laryngotracheal groove during embryological development.
2) There are various classifications of TEF including the Vogt and Gross system. Type C, with upper pouch atresia and lower pouch fistula, accounts for 85% of cases.
3) Clinical features include frothing at the mouth, choking, and cyanosis with feeding. Diagnosis is made with chest x-rays and es
This document presents the case of a 58-year-old female who presented with rectal bleeding and altered bowel habits for 5 months. Examination revealed pallor and a rectal mass. Investigations confirmed moderately differentiated adenocarcinoma of the rectum. Imaging showed the primary tumor in the rectosigmoid junction and suspicious lymph nodes. The patient underwent a laparoscopic low anterior resection with diverting ileostomy.
Abdominal trauma: diagnosis and managementvinayakas4
1) Abdominal trauma is a major cause of death globally, especially in young adults, due to injuries from motor vehicle accidents. The abdomen has no bony protection and is vulnerable to hemorrhage from solid organs or sepsis from hollow viscus injuries.
2) Evaluation of abdominal trauma involves history, physical exam, focused assessment with sonography for trauma (FAST), and CT scan if stable. Unstable patients may require diagnostic peritoneal lavage or immediate exploratory laparotomy.
3) Management depends on injury type and hemodynamic stability. Nonoperative management is preferred for solid organ injuries while laparotomy is often needed for penetrating injuries or hemodynamically unstable patients to control bleeding.
This document describes a case of a 31-year-old male patient who presented with chronic abdominal pain and pain in both lower limbs for 6 months. Investigations revealed complete occlusion of the infrarenal aorta and celiac and superior mesenteric arteries. The patient underwent an open surgical bypass grafting procedure involving an aorto-mesenteric graft to restore blood flow to the celiac and superior mesenteric arteries. The procedure was technically successful and the patient was discharged after an uneventful post-operative recovery. Chronic mesenteric ischemia can be treated through open surgical or endovascular methods, with endovascular interventions demonstrating better long-term outcomes in many cases.
Drs. Penzler, Ricker, and Ahmad’s CMC Abdominal Imaging Mastery Project: Octo...Sean M. Fox
Dr. Morgan Penzler is an Emergency Medicine Resident and Drs. Raza Ahmad and Ansley Ricker are Surgery Residents at Carolinas Medical Center in Charlotte, NC. They are interested in medical education. With the guidance of Drs. Kyle Cunningham and Michael Gibbs, they aim to help augment our understanding of emergent abdominal imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides. This month’s cases include:
- Traumatic Abdominal Hernia
- Hemorrhagic Ovarian Cysts
- Small Bowel Obstruction
- Aortic Thrombus
Drs. Penzler, Ricker, and Ahmad’s CMC Abdominal Imaging Mastery Project: Augu...Sean M. Fox
Dr. Morgan Penzler is an Emergency Medicine Resident and Drs. Raza Ahmad and Ansley Ricker are Surgery Residents at Carolinas Medical Center in Charlotte, NC. They are interested in medical education. With the guidance of Drs. Kyle Cunningham and Michael Gibbs, they aim to help augment our understanding of emergent abdominal imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides. This month’s cases include:
- Nephrolithiasis
- Infected Iliac Aneurysm
- Pancreatic Masses
The document provides information about renal biopsies, including their definition, history, indications, contraindications, preparation, procedure, post-procedure care, complications, and discharge/follow-up. A renal biopsy is a procedure that obtains kidney tissue, typically using a needle, to help diagnose kidney diseases. It has become safer since the 1950s with the development of needle biopsies and imaging guidance. Key indications include unexplained kidney issues like proteinuria or injuries. Risks include bleeding, but most complications are minor and self-limiting. Patients are monitored after the procedure and advised on follow-up care.
The spleen is responsible for filtering blood and mounting immune responses. Indications for splenectomy include trauma, idiopathic thrombocytopenic purpura refractory to steroids, and hematological conditions causing abnormal red blood cell morphology. Splenectomy may be performed open or laparoscopically and indications include trauma, hematological diseases, neoplasms, and spontaneous rupture. Complications include infection, bleeding, and thrombocytosis.
An intravenous pyelogram (IVP) uses iodinated contrast injected intravenously and x-ray imaging to evaluate the kidneys, ureters, and bladder. It is used to detect abnormalities, tumors, stones, or other issues. Patients fast before the procedure and are monitored after for side effects from the contrast such as nausea. Nursing care focuses on hydration, monitoring the IV site, and reporting any issues.
1) A 60-year-old male presented with severe abdominal pain and was found to have complicated diverticulitis of the sigmoid colon with contained perforation.
2) He underwent a laparoscopic low anterior resection to remove the diseased portion of colon.
3) Key steps of the laparoscopic low anterior resection included mobilization of the descending colon and sigmoid mesocolon, ligation of the inferior mesenteric artery, dissection of the rectum, division of the rectum, creation of an end-to-end anastomosis, and possible creation of a temporary ileostomy.
This document presents a case report of a rare gastric teratoma in a 3-month old male infant. The infant presented with abdominal distension and a palpable abdominal mass. Imaging showed a large soft tissue mass with calcifications. The mass was surgically excised and pathology confirmed an immature gastric teratoma. Teratomas are rare tumors containing tissues from all three germ layers. Complete surgical excision is the treatment of choice and prognosis is generally excellent.
A 18-year-old male presented with blunt abdominal trauma from an RTA. On examination, he was tachycardic and hypotensive with abdominal tenderness. Imaging showed free fluid and injuries. He underwent an exploratory laparotomy where splenic injury and gastric perforation were found and repaired. Post-operatively, he was intubated but became more stable over subsequent days.
ANAESTHESIA AND ANALGESIA IN CLASSIC BLADDER EXSTROPHY REPAIR.pptxDrVANDANA17
This document presents a case report of anaesthetic implications in classic bladder exstrophy repair in a 4-month-old male pediatric patient. Key considerations included long operating times of 5-7 hours, unpredictable bleeding and fluid shifts requiring close monitoring, and providing adequate postoperative pain management. An epidural catheter was carefully placed and intermittent doses of bupivacaine with fentanyl were administered intraoperatively and postoperatively for 3 days to provide excellent pain control while minimizing sedation. The 8-hour surgery was successful and the patient recovered well with normal follow-ups. Epidural analgesia provides safe and effective pain management for such complex pediatric bladder exstrophy repairs when administered carefully.
This case report describes a 52-year-old male farmer who presented with abdominal pain and bleeding for several months. Imaging revealed multiple liver abscesses and a mass arising from the second part of the duodenum. Biopsy of the mass during endoscopy indicated adenocarcinoma. The patient underwent a Whipple procedure where a 6x5cm mass was removed. Post-operative biopsy found it to be a malignant gastrointestinal stromal tumor (GIST). The patient was referred for chemotherapy. GISTs of the duodenum are rare but often diagnosed via endoscopy with biopsy. Surgical resection is the main treatment but imatinib may help downstage tumors for less invasive surgery or as adjuvant therapy.
Mr. NBR, age 42, was admitted with symptoms of jaundice, abdominal pain, dark urine, and clay-colored stools. Investigations revealed multiple stones in the common bile duct. He underwent open cholecystectomy with exploration of the common bile duct and intraoperative cholangiography. Multiple impacted stones were found and removed from the common bile duct and intrahepatic ducts. The patient's postoperative recovery was uncomplicated and he was discharged on the 11th postoperative day after drain removal and suture removal.
- 32 year old female diagnosed with triple negative breast cancer and admitted for MRM surgery.
- She previously underwent lumpectomy which showed invasive ductal carcinoma.
- She received 4 cycles of neoadjuvant chemotherapy and was scheduled for MRM.
- Physical exam and tests showed no signs of metastasis.
- She underwent MRM surgery which included removal of breast tissue and axillary lymph nodes.
- 32 year old female diagnosed with triple negative breast cancer, admitted for MRM surgery
- Previously underwent lumpectomy 10 months ago which revealed invasive ductal carcinoma
- Physical exam and tests showed no signs of metastasis
- Planned for MRM surgery under general anesthesia, involving removal of right breast tissue and lymph nodes of axilla
- 32 year old female diagnosed with triple negative breast cancer, admitted for MRM surgery
- Previously underwent lumpectomy 10 months ago which revealed invasive ductal carcinoma
- Physical exam and tests showed no signs of metastasis
- Planned for MRM surgery under general anesthesia, involving removal of right breast tissue and lymph nodes of axilla
This patient presented with symptoms of difficulty breathing, lower limb swelling, decreased urine output, and pallor. Her labs showed kidney dysfunction with elevated creatinine and liver enzymes. Her history of abruptio placenta and recent pregnancy termination suggested HELLP syndrome. A kidney biopsy was considered but the patient refused. Her kidney function and labs gradually improved with aggressive fluid management and medications.
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1. Define an electrocardiogram (ECG) and electrocardiography
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3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
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Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
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4. HOPI
• Presented in some private hospital in Sialkot
• Vomiting for 2 days Half a cup of gastric contents,
3-4 episodes per day, associated with oral intake, not
relieved with medications
• Abdominal pain for 1month Left hemi abdomen,
dull, moderate, no migration/radiation, partially
relieved by medication, no aggravating factor
5. • Attendants did not notice any mass
• But attending physician noticed a mass in left flank
on examining the child
• At Sialkot initial management done and on workup
pt. diagnosed as a case of left renal mass and
referred to CHL.
6. Systemic Inquiry
No H/O constipation/ diarrhea, hematuria, dysuria,
facial flushing, cough ,fever or lower limb swelling
7. Birth & Family History
• Born of non consanguineous marriage
• S.V.D at term
• 3rd among 4 siblings.
• No other siblings have any significant medical or
surgical history.
11. GPE
• Healthy looking playful child with average built sitting
comfortably in mothers lap.
• Weight 12 kg
• Normal looking except for loss of hairs on head
• No Pallor, jaundice, cyanosis, lymphadenopathy
• Vitals
• Pulse: 110/min
• Temp: 98 F
• BP: 95/70 mmHg
• RR: 30 breaths/min
12. Systemic Examination
● Abdominal Examination
Abdomen soft, distended on left side with 7x7 cm firm
to hard mass in left lumbar area, bimanually palpable
and ballotable. No visceromegaly or other mass.
13. • Respiratory System
• B/L Non vesicular breathing, no added sound
• CVS
• No murmur appreciated on auscultation, apex beat normal
• CNS and Motor/Sensory
• Grossly intact, No weakness in any limbs, intact sensation
14. Management at CHL
● Pt was received in Oncology department
● Baselines and Radiological investigations performed
● Biopsy of mass performed
● Chemotherapy commenced as 8 cycles
doxyrubicin, vincristine and dactinomycin
17. Ultrasonography
● A solid hyperechoic lesion measuring
12.8x9.8x8.6cm is noted arising from lower pole
of left kidney
● Right kidney and rest of organs appeared normal
with no significant findings
26. MDT
● Plan made to involve cardiac surgery and go for left
nephrectomy with extraction of thrombus.
● Cardiac surgery team to perform extraction of intra
cardiac and thoracic part of IVC thrombus
● Peadiatric Surgery to perform Nephrectomy and
thrombolectomy from intra abdominal part of IVC.
27. SURGICAL PLAN
Sternotomy for atrial thrombus removal under Cardiac Bypass
plus Trans-abdominal left sided Radical Nephrectomy, venous
thrombus removal and lymph node biopsy
28. Pre Op Preparation
● Shifted to Surgery ward
● Detail explanation of procedure to parents
● Informed consent obtained
● Optimization of patient for surgery
● ICU bed availability with ventilator
● Fresh labs & arrangement blood and components
● Detailed discussion with cardiac surgery for plan of action
29. Cardiothoracic Surgery
● Median sternotomy
● Cardio pulmonary bypass machine
● Evacuation of thrombus from RA thoracic part of
IVC
32. Nephrectomy + Thrombectomy
● Left supra umbilical transverse incision
● A 15*7 cm mass with enlarged precaval, para-
aortic and mesenteric lymph nodes, along
with thrombosed renal vein and thrombus
extending to IVC
● Nephrectomy with lymph node dissection
33.
34. ● Partial control of IVC was taken with Satinsky clamp
to prevent decreased pre load
● Thrombectomy performed
● IVC repaired
● Drains placed in pelvis and renal bed
37. Post Operative Management
● Pt shifted to cardiac ICU on elective mechanical
ventilation
● Extubated on 2nd post op day
● Started oral liquids on and shifted to SICU on 3rd pod
● Urinary catheter out on 4th pod
● Drains out on 6 th pod and shifted to ward
● Patient discharged after establishing oral diet on 9th pod
38. Post op Echo
● No residual mass in IVC
● No residual mass in RA & RV
● Good biventricular function
39. Histopathology Report
● 13x8.5x7cm mixed type triphasic Wilm’s Tumor.
● RA and IVC Thrombus involved by tumor
● Para-aortic lymphnodes involved
● Mesenteric lymphnode not involved
41. GROSS EXAMINATION
Case No. 1320-26/2022
1462) Received a left radical nephrectomy measuring 15 x 7 x 6cm.
Ureter measuring 10 x 0.4cm. The specimen was bivalved. There was a
tan white firm tumour measuring 13 x 8.5 x 7cm (80% viable and 20%
necrotic), capsule is 0.1cm away from tumour. Normal kidney
measuring 2 x 0.5cm. Small cysts identified grossly. Renal sinus fat and
hilum was not identified grossly. Representative sections were taken as:
A = Ureter resection margin B = Hilum
C = Perinephric fat D = Hilar blood vessels
E = Tumour with capsule F = Tumour with normal kidney
G = Normal kidney H-U = Sections from tumour
42. 1321) Received two pieces of tissue, larger measuring 2.5 x 2 x 0.2cm
and smaller measuring 1.5 x 1 x 0.5cm, representative sections were
taken in two blocks.
1322) Received a single piece of tissue, measuring 2 x 1 x 0.2cm,
passed entirely in one block.
1323) Received a single piece of tissue, measuring 5 x 2 x 1.5cm,
hemorrhagic areas seen grosly, representative sections were taken in four
blocks.
1324) Received a single piece of tissue, measuring 1.5 x 1 x 0.4cm,
bisected and passed entirely in one block.
1325) Received a single piece of tissue, measuring 1.5 x 1.5 x 1cm,
bisected and passed entirely in one block.
1326) Received a single piece of tissue, measuring 2 x 1 x 0.4cm,
bisected and passed entirely in one block.
49. OPINION
• 1321) Thrombus from renal vein, biopsy. Involved by Tumour.
• 1322) Wall of renal vein, biopsy. Free of Tumour.
• 1323) Thrombus from IVC, biopsy. Involved by Tumour.
• 1324) Hilar lymph node, biopsy. Reactive Lymph
Node.
• 1325) Para aortic lymph node, biopsy. Involved by Tumour.
• 1326) Mesenteric lymph node, biopsy. Reactive Lymph
Node.
50. Follow up
● Follow up was done on 15th post op day
● No active issues
● Wounds were healthy, stitches were removed.
● Currently patient is on H/oncology followup
52. RENAL TUMORS
●6.3% of childhood cancers
●Include
○Wilms Tumour
○Renal Cell Carcinoma
○Clear Cell Sarcoma of Kidney
○Rhabdoid Tumour of the Kidney
○Congenital Mesoblastic Nephroma
○Renal Cystic Tumour
○Angiomyolipoma
53. WILMS TUMOUR
● Nephroblastoma or Renal Embryoma
● 91% of paediatric renal tumors
● 6% of all paediatric tumors
● Named after Carl Max Wilhelm Wilms, a German
pathologist and Surgeon
54. EPIDEMIOLOGY
●2nd most common malignant abdominal tumor after
neuroblastoma.
●Risk in general population is 1:10,000.
●Mean age at diagnosis is 36 months
●Most children present between 12 to 48 months of
age.
●Unilateral or bilateral
58. ● Fever, Anorexia, Weight loss (10%)
● Left varicocele ( due to extension of tumour into renal vein)
● Cardiac malfunction (extension into atrium)
● Acute Abdomen (rare, due to tumour rupture and
haemorrhage)
⮚ Generally, children with WT are healthy toddlers with
palpable abdominal mass
60. DIAGNOSIS
● ULTASONOGRAPHY
○ Site of origin and extension
○ Sensitive for intravascular extension
● CT SCAN
○ Confirms renal origin of mass
○ Rules out bilateral Wilms Tumour
○ Confirms presence of metastasis if any
61. ● MRI
○ Avoids radiation exposure
○ Distinguish nephrogenic rests from WT
○ Follow up children with bilateral WT after resection
● Echocardiography
62. SCREENING
● Children at high risk for developing WT (syndromics )
● Scan every 3 to 4 months.
● Confirmation with CT or MRI needed
63. PATHOLOGY
● Embryonal tumours with all components seen in normal
developing kidneys, including:
○ Blastemal
○ Stromal
○ Epithelial tubules
● Class WT is triphasic, containing all
● Biphasic and Monophasic lesions also occur.
64. ● Monophasic can be very invasive and difficult to
distinguish
● Histologically 2 groups:
○ Favourable Histology almost 90%
○ Unfavourable Histology anaplastic, clear cell sarcoma of
kidney and rhabdoid tumours
65. Favorable Histology
• Triphasic pattern of
blastema, epithelial and
stromal tissue
• Small uniform nuclei
• Good response to treatment
Unfavorable Histology
• Higher degree of anaplasia
• Hyperchromatic, pleomorphic
nuclei larger than 3 times of
adjacent cells
• Abnormal mitotic figures
• Poor response to treatment
66. PRETREATED TUMOURS AND
PATHOLOGY
● Pre-treated tumours differ in histology from non
treated tumours.
● Chemotherapy may either produce necrosis of
tumour or differentiation of tumour.
● Without neoadjuvant chemotherapy:
○ Triphasic mixed histology (45%)
○ Blastemal (39%)
○ Epithelial dominant (15%)
68. STAGING
● Local Staging: refers to abdominal disease.
● Disease Stage: considers both local and distant
hematogenous metastatic disease.
● Described by:
○ COG (children oncology group)
○ SIOP (Societe Internationale D'oncologie Pediatrique)
69.
70.
71. TREATMENT
● Based on studies by COG and SIOP.
● According to COG protocols:
○ Nephrectomy
○ Chemotherapy
○ Radiotherapy
72. ● According to SIOP protocols:
○ Neo-adjuvant chemotherapy
○ Nephrectomy
○ Chemotherapy
○ Radiotherapy
73.
74.
75.
76. SURGERY
● Mainstay of either treatment regimen.
● Fundamental Tasks include:
i. Safe resection of tumour
ii. Accurate staging of tumour
iii. Avoidance of complications that will upstage tumour
iv. Correct documentation of intraoperative findings
and details of procedure
77. ● Factors that negatively affect patient survival include:
i. Tumour spills
ii. Failure to biopsy lymph nodes
iii. Complete tumour removal
iv. Failure to assess for extra-renal tumour extension
v. Surgical complications
78. TECHNICAL CONCERNS IN
UNILATERAL TUMOURS
● Wide abdominal exposure using transverse
transabdominal or thoracoabdominal incision
● Complete removal of Gerota fat and fascia.
● Complete mobilization of tumour.
● Ligation of renal artery first when ligating renal
pedicle.
● Renal vein should be palpated first for any
intravascular extension and then ligated.
79. ● Adrenalectomy if mass arises in upper pole of kidney.
● Ligation and division of ureters as low as possible.
● Sampling of lymph nodes: hilar, pericaval and para-aortic
nodes.
● In case of invasion into surrounding structures, en bloc
resection should be avoided
● Liver metastasis should be treated with adjuvant
chemotherapy and resection should be avoided.
80. UPSTAGING OF TUMOUR
● SPILL: refers to break in tumour capsule;
transaction of ureter or renal vein while these
structures are containing tumour.
● RUPTURE: traumatic or spontaneous rupture of
tumour pre-operatively; incisional biopsy; tumour
invading capsule with open neoplastic tissue surface
being in contact with peritoneal cavity.
⮚All these events makes child stage 3; so such
events must be documented carefully.
81. MANAGEMNT OF
EXTENSION IN RENAL
VEIN, IVC & ATRIUM
● Detected pre-operatively
by USG/CT/MRI
● Neo-adjuvant
chemotherapy if tumour
thrombus extends into
IVC at the level of liver
or higher.
82. ● Palpation of renal vein before tumour mobilization
of kidney.
● If tumour extends into renal vein or IVC below level
of liver it should be removed en bloc with kidney by
taking control of renal vessels above and below the
kidney.
• If tumour thrombus still persists above level of liver
it should be removed by putting patient on
cardiopulmonary bypass.
84. Drawbacks of IVC & Cardiac
Extension
• Extended course has no additional benefits
• Sugical morbidity
• Prlonged surgery time
• Increased blood loss
• Prolonged hospital stay
• Complications
85. CHEMOTHERAPY
● Dactinomycin remains the mainstay of treatment
regimen today.
● FAVORABLE HISTOLOGY TUMOURS:
○ WITHOUT LOH:
○ Stage I&II: 18 weeks of vincristine &
dactinomycin; OS 98.4% and 98.7%
○ Stage III&IV: 24 weeks of vincristine,
dactinomycin and doxorubicin
86. ● Bone marrow transplant has been performed with
EFS rates of 36% to 60% in these small series.
87. Take Home Message
● The surgical resection of Wilms tumor with
intravascular extension remains a formidable
challenge.
● This complicated task is achieved by
multidisciplinary approach