Benign or Malignant?

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Benign or Malignant? by Mind Map: Benign or Malignant?

1. Benign

1.1. Nomenclature / Classification

1.1.1. ___oma benign epithelial neoplasms squamous = papilloma transitional = transitional/urothelial papilloma glandular = adenoma benign connective tissue neoplasms lipoma (fat) neuroma (neural tissue) chondroma (cartilage)

1.2. Features

1.2.1. well circumscribed

1.2.2. encapsulated

1.2.3. slow growth may spread locally into adjacent tissues

1.2.4. well differentiated (resembles tissue of origin)

1.2.5. cannot metastasise, but can become malignant over time colon adenoma --> carcinoma (loss of p53 tumour suppressor)

1.3. Clinical Presentation

1.3.1. bleeding haematemesis (vomiting blood), haemoptysis( coughing up blood), malaena (dark stool) upper GI bleeding (oesophagus, stomach, small intestine)

1.3.2. lump

1.3.3. mass effect cerebral stroke GIT obstruction may present with diarrhoea as stool must be made more fluid to get past obstruction --> excessive peristalsis

1.3.4. pain

1.4. Treatment & Prognosis

1.4.1. surgery is generally curative unless growth is in an inoperable site

1.4.2. may cause death if associated with severe blood loss

2. Borderline

3. Neoplasm

3.1. Uncontrolled cell proliferation leading to a mass or nodule

3.1.1. autonomous, uncontrolled, purposeless, progressive, parasitic

3.2. A tumour is any type of lump/mass from any cause

4. Diagnosis

4.1. History

4.2. Clinical Examination

4.3. Special Tests

4.3.1. referral to radiology to check for metastasis -- CT, MRI, PET (uncommon as expensive)

4.3.2. pathology fine needle aspirate Bx aspirate resection

5. Malignant

5.1. Nomenclature / Classification

5.1.1. carcinoma (epithelium) in-situ no invasion beyond collagen basement membrane --> unable to metastasise invasive squamous cell carcinoma resemblance + keratin production skin, mouth, oesophagus, cervix adenocarcinoma resemblance +/- mucin or glandular production GIT, breast, thyroid, uterus small cell carcinoma most lethal, commonly in the lung associated with hormonal and paraneoplastic effects high grade neuroendocrine carcinoma transitional cell carcinoma basal cell carcinoma anaplastic carcinoma undifferentiated --> classify by tumour markers (immunohistochemistry)

5.1.2. sarcoma

5.1.3. lymphoma nodal or extranodal hodgkin's lymphoma RS cells not present excellent prognosis non-hodgkin's lymphoma reed-sternberg cells

5.1.4. leukaemia malignancy of bone marrow cells malignancy of bone marrow cells

5.2. Features

5.2.1. macroscopic haemorrhage and necrosis leaky vessels formed by neoplasm-induced angiogenesis --> haemorrhagic + necrotic due to ischaemia and resulting hypoxia metastasis (capable of spreading)

5.2.2. microscopic hyperchromasia (dark nuclei) increased mitotic activity increased nucleus:cytoplasm ratio normally around 1:4 --> nears 1:1 in malignant cell pleomorphism (variation in nuclear shape + cell size)

5.3. Clinical Presentation

5.3.1. effect of primary lump obstruction bleeding loss of function

5.3.2. effect of metastasis (see above)

5.3.3. effect of hormone secretion examples ACTH release from small cell carcinoma -- Cushing's syndrome oestrogen from testicular tumour -- gynaecomastia

5.3.4. paraneoplastic effects peripheral neuropathy motor or sensory, often associated w/ lung carcinoma dermatomyositis

5.3.5. general effects of malignancy weight loss fatigue anorexia lassitude