Tumour,Cysts Sinus and Fistula

8/11/2019 Tumour,Cysts Sinus and Fistula

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TUMOUR

New growth of cells

Independent growth

Atypically arranged

No function


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TUMOUR

BENIGN

lipoma

fibroma

neuroma

papilloma MALIGNANT


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PAPILLOMA

SKIN PAPILLOMA

-Squamous papilloma..soft papilloma

..squamous papilloma

-Basal cell papilloma(seborrhoeic keratosis)


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ARISING FROM MUCUOUS

MEMBRANE OF VISCERQAL ORGANS

-Transitional cell papilloma of bladder

-columnar cell papilloma of rectum

-Cuboidal cell papilloma of GB

-Sq papilloma of the larynx

-Papilloma of the breast


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FIBROMA

Soft fibroma

Hard fibroma

-Neurofibroma

-Fibrolipoma

-Myofibroma-Angiofibroma


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LIPOMA

Benign tumor fm fat cells of adult type

Types

-Single subcut lipoma

-Multiple lipomatosis

-Uncapsulated lipoma Histological types

Anatomical types


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ANATOMICAL VARIETY OF

LIPOMA Subcutaneous

Subfascial

Intermuscular

Subsynovial and intra-

articular

parosteal

Submucuous

Subserosal

Extradural

Interglandular


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COMPLICATIONS OF

LIPOMA Liposarcoma

-swelling grows rapidly

-painfulnerve infiltration

-red colour with dilated veins

-warm surface

-skin fungation or fixation-mobility restricted


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COMPLICATIONS OF

LIPOMA(cont) Calcification

Myxomatous degeneration

Intussusception


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NEUROMA

TRUE NEUROMA

ganglioneuromasympathetic chain

neuroblastomachildren

myelinic neuromaspinal cord

FALSE NEUROMAEnd..cut end of nerve

Lateral.partial injury


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NEUROFIBROMA

ARISING FROM CONNECTIVE TISSUE

OF NERVE SHEATH


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TYPES OF NEUROFIBROMA

Single subcutaneous neurofibroma

Generalized neurofibromatosis (Von

Recklinghausen disease)

Plexiform neurofibromatosis(Trigeminal)

Elephantiasis neuromatosa

Pachydermatocele


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Single subcutaneous

neurofibroma Tingling and numbness,paraesthesia

Round to oval swelling in the direction of

the nerve

Smooth surface, round border

Consistency firm

Skin can be lifted


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Generalized neurofibromatosis

(Von Recklinghausen disease) Autosomal dominant

Coffee-au-lait spots

Soft and non-tender


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NEURILEMMOMA

Arising from Schwann cells

Single or multiple

Fusiform shape

Soft,lobulated,well encapsulated tumours


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MALIGNANT TUMORS

CARCINOMA

-ectodermal

-endodermal

-mesodermal

SARCOMA-mesoblast

-mesenchymal


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MALIGNANT TUMORS

AETIOLOGY DIET

CHEMICALS

-benzanthrenes

-benzopyrenes

-B-naphthylamine

-nitrosamines andamides

IONIZING RADIATION

ULTRAVIOLET

RADIATION

VIRAL FACTORS

DNAHPV,EB

RNAHTLV-1

HABITS-Smoking

-Alcohol


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CYSTIC SWELLINGS

IT IS A SWELLING LINED BY

EPITHELIUM OR ENDOTHELIUM

CONTAINING SEROUS FLUID,MUCOID MATERIAL, PUS,

BLOOD,LYMPH OR PULTACEOUS

MATERIAL.


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CLASSIFICATION OFCYSTIC

SWELLINGS CONGENITAL

ACQUIRED

PARASITIC


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CLASSIFICATION

CONGENITAL

-Sequestration

dermoid cyst-Branchial cyst

-Thyroglossal cyst

-Lymphangioma-Embryonic remnant

cyst

ACQUIRED

-Retension

-Exudation-Distension

-Cystic tumors

-Traumatic

PARASITIC-Hydatid


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CLINICAL FEATURES

LOCATION

SHAPE

SURFACE

CONSISTENCY

FLUCTUATION

TRANSILLUMINATION

MOBILITY

PLANE OF SWELLING

COMPRESSIBILITY

(Sign of refilling) PULSATION

-expansile

-transmitted

PRESSURE EFFECT-bone

-nerve


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Compressible swelling

Haemangioma

Lymphangioma

Meningocoele


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Salient features of aneurysm

Expansile pulsation

Proximal compression.size decrease

Distal compression.size increases

Thrill and Bruit

Distal pulses weak


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COMPLICATION OF CYSTS

Infection

Calcification

Pressure effects

Malignant transformation


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DERMOID CYST

Cyst containing desquamated cells lined by

squamous epithelium whose contents arethick and viscid , appearing like toothpaste

which is a mixture of sweat, sebum,

desquamated cells and sometimes even hair.


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CLASSIFICATION

Congenital/Sequestration Dermoid

Implantation Dermoid

Teratomatous Dermoid

Tubulo-embryonic dermoid


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CONGENITAL

/SEQUESTRATION DERMOID

CYST

Occurs in the line of embryonic fusion

As the cyst grows it indents the mesoderm

(future bone)..explains the defect in the

bony structure

Occur any where in the midline of the body


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CONGENITAL

/SEQUESTRATION DERMOID

CYST(cont) Manifest chilhood or adolescene

Painless ,slow growing swelling

Location of the cyst typically at the line of

fusion

Soft, cystic and fluctuant with negative

transillumination

Underlying bony defect


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SEBACEOUS CYST

Also called as epidermoid cyst

Occurs due to blockage of the sebaceous

duct


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SEBACEOUS CYST(cont)

Slow growing , early childhood

Does not occur in palm and sole

Punctumkeratin filled duct Sign of moulding

Sign of indentation

Smooth surface, soft, non-tender,putty consistency Pressure effect in the scalp loss of hair


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COMPLICATIONS OF

SEBACEOUS CYST(cont) Infection

Sebaceous hornslow drying of contents

after squeezing Cocks peculiar tumorrefers to infected,

ulcerated cyst of the scalp with poutinggranulation tissue with everted edges

Calcification

BCC


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GANGLION

Tensely cystic swelling due to myxomatous

degenerationof the synovial sheathllining

the joint /tendon sheath containinggelatinous fluid

Location - scapholunate articulation

- flexor aspect of finger


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GANGLION(cont)

Round to oval swelling, smooth surface well

defined borders

Tensely cystic, fluctuation and transilluminationnegative

Mobility restricted when tendon put in contraction

Not connected to joint space

Becomes smallerdissapears between bones


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GANGLION(cont)

Best left alone if asymptomatic

Aspiration and inj of sclerosant

Surgical excision but recurrance rate is high


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GLOMUS TUMOUR

Glomangioma

Abundant AV anastomosis surrounded by

clear cells.glomus cellsandnon/medullated nerve fibresbetween the

cells


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GLOMUS TUMOUR(cont)

Benign

Most painful either at rest ormovement.compression of nerve by dilated

blood vessels

5thdecade

Locationnail bed of hands and feet

Single, purple-red in colour,


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BURSA

Sac or sac like cavity lined by endotheliumcontaining fluid

Function to reduce friction bet tendons &bone

Inflammation.bursitis

Causes -constant pressure-constant irritation

-minor trauma


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EXAMPLES OF BURSITIS

Prepatellar bursa

Infrapatellar bursa

Olecranon bursa Under insertion of

gracilis,sartorius,

semitendinosus

-housemaids knee

-clergymans knee

-students elbow-Bursitis anserina


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CLINICAL FEATURES OF

BURSITIS A cystic swelling in an anatomical site of a

bursa is a chronic bursitis unless proven

otherwise Soft,cystic circumscribed or oval swelling,

fluctuation positive but most often negative

due to inflammatory exudate Signs of inflammation


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SEMIMEMBRANOUS BURSA

VS BAKERS CYSTSM BURSA BAKERS CYST

AETIO Friction/pressure Rh/osteoarthritis

AGE Young Middle age


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SEMIMEMBRANOUS BURSA

VS BAKERS CYSTLOCATION Higher&med Below&lat

FLEX KNEE Disappears Increases

EXT KNEE Appears Decreases

PATELLAR

TAP

_ +

COMPRESS. _ + (partially)

KNEE MOV Normal Restricted


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TRANSILLUMINANT

SWELLING IN THE BODY Ranula

Lymphangioma

Meningocele

Epididymal cyst

Hydrocele


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RULES OF

TRANILLUMINATION TEST

DONE IN DARK SURROUNDING

AVOID SURFACE

TRANSILLUMINATION

MAYBE NEG.INFECTION,

HAEMORRHAGE/SCLEROTHERAPHY


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FISTULA

An abnormal communication bet lumen of

one viscus and lumen of another (internal)

or communication of one hollow viscus and

with the exterior (body surface)


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CLASSIFICATION OF

FISTULAINTERNAL

Tracheo-oesophagealfistula

Colovesical fistula

EXTERNAL

Thyroglossal fistula Branchial fistula

Orocut fistula


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SINUS

Blind track leading from the surface down

into the tissue lined by granulation tissue


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PERSISTANCE OF SINUS

AND FISTULA Foreign body

Infection

Epitheliasation of tract

Distal obstruction

Non-dependant drainage

Malignancy

Absence of rest


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EXAMINATION OF SINUS

AND FISTULA LOCATION

NUMBER

OPENING

-Sprouting granulation tissue

-Flush with skin

DISCHARGE

SURROUNDING SKIN

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Tumour,Cysts Sinus and Fistula