TUMOUR

New growth of cells

Independent growth
Atypically arranged
No function
TUMOUR
BENIGN
lipoma
fibroma
neuroma
papilloma
MALIGNANT
PAPILLOMA
SKIN PAPILLOMA
-Squamous papilloma..soft papilloma
..squamous papilloma

-Basal cell papilloma(seborrhoeic keratosis)

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
FIBROMA
Soft fibroma
Hard fibroma
-Neurofibroma
-Fibrolipoma
-Myofibroma
-Angiofibroma
LIPOMA
Benign tumor fm fat cells of adult type
Types
-Single subcut lipoma
-Multiple lipomatosis
-Uncapsulated lipoma
Histological types
Anatomical types



ANATOMICAL VARIETY OF
LIPOMA
Subcutaneous
Subfascial
Intermuscular
Subsynovial and intra-
articular
parosteal
Submucuous
Subserosal
Extradural
Interglandular
LIPOMA
Usually single
Painless
Slow growing

Soft
Cystic
Pseudofluctuation
Lobular surf
Slipping sign
Freely mobile
COMPLICATIONS OF
LIPOMA
Liposarcoma
-swelling grows rapidly
-painfulnerve infiltration
-red colour with dilated veins
-warm surface
-skin fungation or fixation
-mobility restricted

COMPLICATIONS OF
LIPOMA(cont)
Calcification
Myxomatous degeneration
Intussusception
NEUROMA
TRUE NEUROMA
ganglioneuromasympathetic chain
neuroblastomachildren
myelinic neuromaspinal cord
FALSE NEUROMA
End..cut end of nerve
Lateral.partial injury
NEUROFIBROMA
ARISING FROM CONNECTIVE TISSUE

OF NERVE SHEATH

TYPES OF NEUROFIBROMA
Single subcutaneous neurofibroma
Generalized neurofibromatosis (Von
Recklinghausen disease)
Plexiform neurofibromatosis(Trigeminal)
Elephantiasis neuromatosa
Pachydermatocele
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
Generalized neurofibromatosis
(Von Recklinghausen disease)
Autosomal dominant
Coffee-au-lait spots
Soft and non-tender
NEURILEMMOMA
Arising from Schwann cells
Single or multiple
Fusiform shape
Soft,lobulated,well encapsulated tumours
MALIGNANT TUMORS
CARCINOMA
-ectodermal
-endodermal
-mesodermal
SARCOMA
-mesoblast
-mesenchymal
MALIGNANT TUMORS
AETIOLOGY
DIET
CHEMICALS
-benzanthrenes
-benzopyrenes
-B-naphthylamine
-nitrosamines and
amides
IONIZING RADIATION
ULTRAVIOLET
RADIATION
VIRAL FACTORS
DNAHPV,EB
RNAHTLV-1
HABITS
-Smoking
-Alcohol
CYSTIC SWELLINGS
IT IS A SWELLING LINED BY
EPITHELIUM OR ENDOTHELIUM
CONTAINING SEROUS FLUID,
MUCOID MATERIAL, PUS,
BLOOD,LYMPH OR PULTACEOUS
MATERIAL.
CLASSIFICATION OFCYSTIC
SWELLINGS
CONGENITAL
ACQUIRED
PARASITIC
CLASSIFICATION
CONGENITAL
-Sequestration
dermoid cyst
-Branchial cyst
-Thyroglossal cyst
-Lymphangioma
-Embryonic remnant
cyst
ACQUIRED
-Retension
-Exudation
-Distension
-Cystic tumors
-Traumatic
PARASITIC
-Hydatid



CLINICAL FEATURES
LOCATION
SHAPE
SURFACE
CONSISTENCY
FLUCTUATION
TRANSILLUMINATI
ON
MOBILITY

PLANE OF SWELLING
COMPRESSIBILITY
(Sign of refilling)
PULSATION
-expansile
-transmitted
PRESSURE EFFECT
-bone
-nerve


Compressible swelling
Haemangioma

Lymphangioma

Meningocoele
Salient features of aneurysm
Expansile pulsation
Proximal compression.size decrease
Distal compression.size increases
Thrill and Bruit
Distal pulses weak
COMPLICATION OF CYSTS
Infection
Calcification
Pressure effects
Malignant transformation
DERMOID CYST

Cyst containing desquamated cells lined by
squamous epithelium whose contents are
thick and viscid , appearing like toothpaste
which is a mixture of sweat, sebum,
desquamated cells and sometimes even hair.
CLASSIFICATION

Congenital/Sequestration Dermoid
Implantation Dermoid
Teratomatous Dermoid
Tubulo-embryonic dermoid

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
CONGENITAL
/SEQUESTRATION DERMOID
CYST(cont)

External and internal angular dermoid
Median nasal dermoid
Sublingual dermoid
Suprasternal space of Burns
Pre/Post auricular dermoid
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
SEBACEOUS CYST


Also called as epidermoid cyst

Occurs due to blockage of the sebaceous
duct

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


COMPLICATIONS OF
SEBACEOUS CYST(cont)
Infection
Sebaceous hornslow drying of contents
after squeezing
Cocks peculiar tumorrefers to infected,
ulcerated cyst of the scalp with pouting
granulation tissue with everted edges
Calcification
BCC

GANGLION
Tensely cystic swelling due to myxomatous
degenerationof the synovial sheathllining
the joint /tendon sheath containing
gelatinous fluid
Location - scapholunate articulation
- flexor aspect of finger
GANGLION(cont)
Round to oval swelling, smooth surface well
defined borders
Tensely cystic, fluctuation and transillumination
negative
Mobility restricted when tendon put in contraction
Not connected to joint space
Becomes smallerdissapears between bones

GANGLION(cont)
Best left alone if asymptomatic
Aspiration and inj of sclerosant
Surgical excision but recurrance rate is high
GLOMUS TUMOUR
Glomangioma
Abundant AV anastomosis surrounded by
clear cells.glomus cellsand
non/medullated nerve fibresbetween the
cells
GLOMUS TUMOUR(cont)
Benign
Most painful either at rest or
movement.compression of nerve by dilated
blood vessels
5
th
decade
Location nail bed of hands and feet
Single, purple-red in colour, <1cm
D/D subungual haematoma
Surgical excision



BURSA
Sac or sac like cavity lined by endothelium
containing fluid
Function to reduce friction bet tendons &
bone
Inflammation.bursitis
Causes -constant pressure
-constant irritation
-minor trauma
EXAMPLES OF BURSITIS
Prepatellar bursa
Infrapatellar bursa
Olecranon bursa
Under insertion of
gracilis,sartorius,
semitendinosus
-housemaids knee
-clergymans knee
-students elbow
-Bursitis anserina

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
SEMIMEMBRANOUS BURSA
VS BAKERS CYST
SM BURSA BAKERS CYST
AETIO Friction/pressure Rh/osteoarthritis
AGE Young Middle age
SEMIMEMBRANOUS BURSA
VS BAKERS CYST
LOCATION Higher&med Below&lat
FLEX KNEE Disappears Increases
EXT KNEE Appears Decreases
PATELLAR
TAP
_ +
COMPRESS. _ + (partially)
KNEE MOV Normal Restricted
TRANSILLUMINANT
SWELLING IN THE BODY
Ranula
Lymphangioma
Meningocele
Epididymal cyst
Hydrocele

RULES OF
TRANILLUMINATION TEST

DONE IN DARK SURROUNDING
AVOID SURFACE
TRANSILLUMINATION
MAYBE NEG.INFECTION,
HAEMORRHAGE/SCLEROTHERAPHY
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)
CLASSIFICATION OF
FISTULA
INTERNAL

Tracheo-oesophageal
fistula
Colovesical fistula
EXTERNAL

Thyroglossal fistula
Branchial fistula
Orocut fistula
SINUS


Blind track leading from the surface down
into the tissue lined by granulation tissue
CLASSIFICATION OF SINUS
CONGENITAL

Preauricular sinus
ACQUIRED

Median mental sinus
Tubercular sinus
Osteomylitis
Pilonidal sinus
PERSISTANCE OF SINUS
AND FISTULA
Foreign body
Infection
Epitheliasation of tract
Distal obstruction
Non-dependant drainage
Malignancy
Absence of rest
EXAMINATION OF SINUS
AND FISTULA
LOCATION
NUMBER
OPENING
-Sprouting granulation tissue
-Flush with skin
DISCHARGE
SURROUNDING SKIN