Hello everyone, a very very good morning to all of you. Am I audible? Am I visible?
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So I welcome you all for today's session. A very very good morning to all of you. I am Dr. Priyanka Sajdev here. And today I am here to continue my crash course of pathology. Especially for second prof amoeba students who are going to write their university exam.
this year so we have completed most of the portions in pathology we have completed systemic pathology we have completed hematology we have started general pathology yesterday but we couldn't finish it so today i'm continuing with general pathology today in general pathology i take two sessions this is the first session in this session i will continue with neoplasia and in the next session i will continue with hemodynamics so this is the session for neoplasia everyone give me a thumbs up shall i start okay i guess i must start give me a minute Okay, so let me start with Neoplasia. Neoplasia is a very very important topic for the university exams as well as many MCQs come from this topic. So Neoplasia, the first thing I would like to tell the definition of the Neoplasia, how you will define Neoplasia. So Neoplasia means new growth. The term Neo and Klasia.
Neo means Neo, Klasia means growth. So it is a new growth anywhere in the body. The new growth which is formed is known as Neoplasm or it is also known as Tumor. it can be of two type benign or malignant so tumor can be of two type or neoplasm can be of two type right and the branch of the science which deals with neoplasia or tumors is known as oncology right so uh for defining neoplasia or neoplasm i would like to show you a diagram can you see this is a cell of course you can see this is a normal cell i have written normal cell here so on the surface of the normal cell there is a growth receptor can you see this is a growth receptor whenever growth factor is coming which is known as stimulus that is whenever stimulus is coming can you see this is stimulus this is the growth factor so whenever stimulus is coming binding with the growth receptor growth factor coming binding with the growth receptor only that time this cell will divide and into uh two cells are formed and mitosis occurs that is for normal cell mitosis is under control of stimulus whenever stimulus is coming only that time mitosis is occurring otherwise mitosis is not occurring this is true for normal cell in human body for all cells in human body this is true so in our human body normally when any cell wants to divide this is the phenomenon the stimulus or growth factor will come bind with the growth factor receptor and then only mitosis takes place this is normal but what is neopla neoplastic cell or cancer cell so this is the definition from robbins but it looks complicated right so split the definition into multiple parts to simplify it i will split it let me show you a diagram can you see now this is a neoplastic cell this cell is not normal cell this is neoplastic can you tell me what is the difference in this in this diagram and the diagram i have shown you previously for normal cell can anyone of you tell me what is the difference have a look on the diagram you yourself will understand this is also a cell on the cell surface you can also see a growth receptor here also like normal cell only but this cell is showing mitosis even in absence of growth factor or stimulus so the growth the mitosis is not under control the mitosis is uncontrolled so this cell will divide divide divide divide divide even in absence of stimulus even in absence of growth factor and from one cell two will form from two four will form from four to eight eight to sixteen sixteen to thirty two ultimately a bunch of cells are formed which is known as neoplasm so this is neoplasm so you got my point neoplastic cell differs from normal cell how it differs so this is the definition you got my point so this is the definition yes actually absolutely right this is the definition of neoplasm it is an abnormal mass of the tissue in which a bunch of cells are there the growth of which is exceeded and uncoordinated so the growth of that cell is exceeded and uncoordinated and growth continues even after cessation of stimuli this is the biggest line you have to write growth continues even after cessation of the stimuli absence of the stimuli stimuli is absent growth factor is absent even that cell go on dividing dividing dividing dividing so growth is uncoordinated and it is uncontrolled it is exceeded this cell is known as neoplastic cell and because of this cell the mass of tissue which is formed is known as neoplasm this is the definition given in robins now give me a thumbs up so you can combine the multiple lines and write the definition like this everyone give me a thumbs up you have to write this definition in your exam from robins so don't learn it don't mug it understand the meaning behind it and draw this diagram so neoplastic cell even in absence of growth factor the cell is dividing so show it is uncoordinated it is uncontrolled and it is accessible so because of which a mass of cells is formed it is known as neoplasm Neoplasm can occur in any part of human body from head to toe.
Starting from brain to toe, it can occur in any part of the body. Most common it occurs in oral cancers are very common. So it can occur in genital tract. It can occur anywhere, right? So basically we can say neoplastic cells are the cell which lost control and regulation of the replication.
So replication control is lost. Control and regulation of replication is lost. Such a cell is not a normal cell. It is a neoplastic cell, right?
Now, coming on the components of the neoplasia. In the neoplasia, we are having basically two components. The parenchyma component and the supportive stroma. Can you see? The cells are known as parenchyma.
Can you see these cells? Okay, let me show you the cells. Can you see these cells?
The cells, the cells, these cells. Actually, tumor cell is known as parenchyma. Parenchyma is the tumor cell itself. And the background, the background which contains fat. blood vessels fibrosis the background is known as stroma so in any tumor we have two two things can you see this is a diagram of a breast tumor right so in the breast cancer you can see these are the clusters of the cells small clusters so having many cells inside it they are arranged in glandular pattern right all these cells are the parenchyma and can you appreciate the background let me show you the background please appreciate the background i'm talking about the background background not the clusters of the cell the background is the stroma which contain fibrosis so give me a thumbs up you got my point so what are the what is parenchymal component and what is stromal component the two types of component are there background is stroma right so now sometimes in the background there is excessive fibrosis in the background can you see in the background fibrosis is there but sometimes in some tumors there is excessive fibrosis in the background and that term is known as desmoplasia desmoplasia come for two months what is desmoplasia so desmoplasia is the stromal component in some cancers in some tumors the tumor cells made the background have excessive fibrosis or excessive collagen you can say excessive collagenous trauma such tumors are you know they are more aggressive and these are known as desmoplastic see this diagram can you appreciate the background appreciate the background the background is excessive fibrosis this is known as desmoplastic tumor anyway coming on the classification of the tumor till now what we have done we have done two things we have done the definition we have done the components now coming on the classification as we all know there are two types of tumors benign and malignant let me tell you the nomenclature all benign tumors have oma in the suffix o-m-a oma in the suffix let me show you so all benign have oma oma in the suffix oma oma let me show you some examples so can you see adenoma oma papilloma oma so let me show you this is this is papilloma any tumor having papillary projections is known as papilloma any tumor having glandular appearance can you appreciate the glands is known as adenoma the term eddy eddy means glands the term peppy peppy means fingers it is finger like projections can you see the shape so the suffix is oma oma oma is the benign tumor adenoma papilloma oma is benign you got my point okay let me show you a few more see all these are benign tumors all these are benign tumors just a second all these are benign tumors see papilloma papilloma adenoma adenoma you can see more diagrams lipoma fibroma myxoma chondroma osteoma synovioma leomyoma rhabdomyoma hemangioma so please appreciate the oma i want to show you this oma in the suffix so see the oma in the suffix lymphangioma right so neurofibroma pseudolymphoma ganglioneuroma right anything oma in the suffix is benign please fit this thing into your mind exceptions are five you have to learn five exceptions so the five exceptions are in front of you these five tumors have oma in the suffix but these are not benign these are malignant so accept these five All the tumors who have oma in the suffix are benign.
So what are the exceptions? Melanoma have a oma in the suffix, but it is malignant. It is not benign. Seminoma is a testicular tumor. It is a tumor of testes in male.
And in female, it is not known as seminoma. It is given some other name. So seminoma is also having oma in the suffix, but it is malignant. Hippatoma, again, it is malignant.
Mesothelioma, it is malignant. And lymphoma, it is malignant. So these are the exceptions. for the rule otherwise anything having oma anything having oma in the suffixes benign you got my point you got my point coming on the nomenclature of the malignant humor so malignant tumor how we define how we nomenclature of the malignant tumor so we know in human body there are two types of cells mesenchymal cells that is muscle bone and the epithelial cell epithelium is of two types squamous and columnar it can be squamous and it can be columnar so any tumor any malignant tumor which arises from epithelial cells squamous or columnar the suffix is carcinoma so you add the suffix as carcinoma not only oma it is complete carcinoma and if any tumor arising from the mesen kind you add the suffix as sarcoma so malignant tumors may either carcinoma or sarcoma so what is the summary let me show you the examples first you can see this is sarcoma and this is carcinoma the two type of the carcinoma squamous cell carcinoma and adenocarcinoma don't learn the diagrams but yeah You see this malignant tumor.
See on the malignant tumor side, you have a look on the suffix. So can you see it is squamous cell carcinoma, transitional cell carcinoma, adenocarcinoma, basal cell carcinoma. Melanoma is an exception. it is having oma but it is exception i've told you hepatoma is also an exception coreo carcinoma otherwise suffixes carcinoma because these are all are arising from the epithelial origin now see liposarcoma fibrosarcoma myxosarcoma chondrosarcoma osteosarcoma synovial sarcoma leomyosarcoma rhabdomyosarcoma mesothelioma is an exception i told you the exception right angiosarcoma so these all sarcomas are malignant so in malignant either in the suffix is carcinoma or in the suffix is tarcoma so two types of suffix is there so what is the summary the tumors are of two type whether they are benign or they are malignant right summary is that for nomenclature all benign tumors have oma in the suffix except five you know the exceptions right all malignant tumors have either carcinoma in the suffix if they are arising from epithelial origin or they have sarcoma in the suffix if they arise from the mesenchymal tissue so this is the summary everyone give me a thumbs up so nomenclature is done so till now we have done three things what three things we have done the definition of neoplasia along with the diagram we have done the components of the neoplasia with definition you have to write the components parenchymal and meson parenchymal and stromal stroma is the background and we have done the nomenclature of the benign and malignant tumor with examples so as many as examples you can write lipoma liposarcoma fibroma fibrosarcoma angioma angiosarcoma likewise you can show this is benign this is malignant for benign five exceptions are there till now we have understood these three things right now there is a special tumor known as teratoma it's been two or three mark cushion out there now your pattern is changed right in mpmsu uh yesterday the pattern is declared the new pattern right so you have three mark cushion you have five mark question you have 20 mark question right if i'm right right so you can be having teratoma as five mark also and three mark also right so what is teratoma you know human body embryo embryo embryology have you read embryo embryology in your first year you may have read so in embryology you may have read there are three germ cell layers there are three germ cell layers the actoderm endoderm and mesoderm some organs are formed from acto like the skin nervous tissue you may have read it andoderm like the blood vessels mesoderm like the muscles bone so i don't know the exact distribution but yeah each organ is formed from one one of the germ cell layer right so whenever tumor arise in that organ just suppose skin tumor skin is actodermal so that tumor will be actodermal just suppose blood vessel tumor so blood vessel is mesodermal so that tumor will be mesodermal so any tumor have one of the germ cell line normally any tumor whether it is benign or malignant the tumors have one germ cell one germ cell line right but some tumors have all three germ cell line because they are arising from totipotent cell you know what are totipotent cells totipotent cells are the cells which can differentiate into any of the germ cell so that the tumors which arise from the totipotent cell are known as teratoma that's why they have three germ cell layers the actoderm mesoderm andoderm acto also meso also and also and these are known as teratoma so whenever teratoma coming in your exam you write one thing the teratoma or the tumors which arise from totipotent cell write the word totipotent they arise from totipotent cell that's why they have three germ cell layers in them acto meso ando so this is the diagram of the teratoma in the teratoma the gross you can see the hairs yeah teratoma usually occurs in gonads it occurs in ovaries in females and it occurs in testes in males right so inside the ovary or testy you can find the hairs oh my god the hairs inside the ovaries and testes yes you can find the tit you can find the tit you can find the cartilage you can find the bone you can find anything because it is acto also meso also and also so the three jump cell layers are there you got my point so these are the two retomas you always you find most of the time you find here's so looking at the gross only you can identify to the teratoma right the next two terms which comes for three marks in your exam is hamartum and choreostoma they come for three mark what is hamartum what is choreostoma listen in short I will tell you what is hamartum these both are not tumors so both have suffix as oma They look like tumour but they are not real tumours.
They look like tumour. What is hematoma? Hematoma is abnormal.
it is abnormal tissue the tissue is abnormal abnormal tissue but the site is normal at normal site the site is normal right and what is choriostoma what is choriostoma it is normal tissue the tissue is normal but the site is abnormal here the site is abnormal at abnormal atopic site what do you mean by that what do you mean by the two terms this is the basic definition of the two i can tell you listen now let me tell you each one by one so the same definition is given so normal tissue the tissue is normal but the site is abnormal the site is atopical abnormal it is scoriostoma but the tissue is abnormal and the site is normal it is known as hamartoma what do you mean by that tissue side tissue site normal abnormal let me explain you let me start with hamartoma let me start with hamartoma okay can you see this is spleen this is normal spleen please appreciate the normal spleen in the normal spleen we have two pulp the red pulp and the white pulp you may be knowing that red pulp is the sinusoids sometimes the sinusoids they get they get you know that cells are mature but they are haphazardly arranged they just proliferate and haphazardly arranged so tissue become abnormal but the site is normal it is red pulp only this is red pulp of the spleen only and red pulp is the normal component of the spleen so the site is normal here what can i say the site is normal it is red pulp only and it is not malignant it is not dysplastic the cells are mature only the thing they are haphazardly arranged they become disorganized so disorganized haphazardly arranged proliferative tissue so tissue become abnormal so site is normal but tissue is abnormal this is known as hematoma give me a thumbs up this is a hematoma of spring give me a thumbs up so what is hematoma you can say it is a focal developmental malformation in which the tissue becomes disorganized but it is mature mature means it is not this plastic it is not malignant only thing it is disorganized it is haphazardly arranged it is developmental malformation but the site of the tissue is normal So they present at the indigenous site. Where they are present, they are present there. Red pulp is inside the spleen.
It has not gone anywhere else. It is native to that site. So the site is normal. Tissue is abnormal but site is normal. Give me a thumbs up.
That is hematoma. Coming on choriostoma. See the choriostoma. Can you see in this diagram what it is? It is tongue.
You can see yes it is tongue. But what is this? This is thyroid.
You can say how thyroid can come in the tongue? Yes it can happen. We have thyroid in the neck. But sometimes thyroid come in the tongue. right so here if you cut it and make a slide it is absolutely normal you will feel like it is absolutely same thyroid as it occurs in neck so the tissue is absolutely normal the tissue is absolutely normal it is not it is not mild development it is not focal mild development no but the site is abnormal what is the abnormality in the site the site is ectopic it is ectopic site you got my point sometimes what happen inside the stomach you find pancreas this is the stomach and you find incidental finding you are a surgeon doing a surgery you will find a focal mass here and if you cut you will find pancreas so pancreas can occur inside the stomach inside the intestine if you cut it these are normal tissue normal pancreas but they are the site is abnormal give me a thumbs up so these are known as choreostoma these are choreostoma choreostoma are the atopic islands of the normal tissue the tissue is normal that's why known as heterotopia give me a thumbs up now you got the two definition you tell me what is choreostoma in choreostoma learn what is abnormal Here abnormal is the site.
The abnormal thing is the site. That is ectopic. But tissue is normal.
Right. In hamartoma abnormal is the tissue. So what is abnormal?
Learn that. In hamartoma abnormal tissue hai. Site normal hai.
Aur koreostoma abnormal site hai. Lekin tissue normal hai. Everyone give me a thumbs up.
So students always get confused in the two terms. And it comes for three marks or five marks in your exam. So koreostoma and hamartoma.
We have covered it. The two with definitions and examples. We have covered it.
Now. coming to the next heading differentiate benign and malignant tumor we have done the definition of neoplasia we have done the components of neoplasia we have done the nomenclature of neoplasia after that i taught you few special terminologies teratoma short note i taught you hamartoma short note i taught you choreostoma short note i taught you if they come they will come separately for three mark or five mark right so leave this you have understood it right definition done components done nomenclature of benign and malignant nut now the next topic differentiate benign and malignant tuber the biggest question it comes for five marks also and if you are lucky it can come for 20 marks also it can be a long question also right so differentiate not based on which how many marks it is coming you have to describe in that manner if it is coming for three mark or five marks just draw the table differentiating table benign malignant it is coming for 20 marks that is long question whatever is long question pattern in your university long question means you have to write eight to ten pages right so after you have to make the table but in each point of the table you have to explain in detail so that you will be able to fill five five to ten pages you got my point so let me differentiate benign and malignant tumor so on these five criteria i will differentiate benign and malignant humor based on their rate of growth so you tell me benign tumors are slow growing and malignant tumors are fast growing right so whenever any patient come to you you are a doctor you after getting your degrees your certificates you practice as a doctor so patients will come to you complaining doctor i am having lump hindi medicine gathan so patient i'm patient say i am having lump here here there wherever so any lump is a tumor that is the excessive growth so there is a lump there is a lump it can be painful it can be painless right there is a lump so the first question you should ask the patient what is the rate of its growth so how you will ask the rate of the is its growth so ask the patient doubling time ask the patient the question doubling time in how much time it doubles so whenever you notice it may be 0.5 centimeter or one centimeter so from one centimeter to two centimeter how much time it take so benign tumors mean doubling time is very high it takes years to double but malignant tumors mean doubling time is very less within few months or within few weeks or days it just doubled it grows grows grows very fast so you have to ask the patient doubling time so here comes the role of the doubling time you got my point the the time taken by the tumor to double its size from one centimeter to two from two to four likewise give me a thumbs up so that is the rate of the growth so you can have a guess that whether the tube no it is not 100% true if the patient is saying doubling time is six months or five months it is not necessary it is always benign it can be malignant or if the patient is saying mug mug the doubling time is one month so it is not always malignant it can be benign so exceptions are there but based on this criteria you can have a broad broad overview whether the lump is benign or malignant so whenever any patient coming to your doctor I'm having a lump here here here anywhere first question is that you want to differentiate whether it is benign or malignant right you are a doctor and you because the treatment of the two differs you now you should ask me a question why it is necessary for a doctor to differentiate benign and malignant tumor listen why it is necessary any tumor treatment is surgery there is no medicine in the world which can dissolve the tumor right no there is no medicine so treatment is only surgery whether it is a benign tumor surgery has to be done whether it is a malignant tumor surgery has to be done if you are a surgeon you will ask me ma'am i am a surgeon whether benign or malignant if lump is there i have to operate so why don't directly operate the patient right to differentiate benign and malignant before starting the surgery yes it is necessary because for benign tumor only treatment is surgery and it will never occur again it don't have metastasis it don't have local invasion it will never occur there is no recurrence so surgery is the only treatment you ask the patient to go home and follow-up is not really required it is benign but in malignant tumor after surgery you have to provide chemotherapy radiotherapy targeted therapy hormonal therapy multiple therapies are available not only surgery because malignant tumors show metastasis they show local invasion and recurrence is common so you do not want the patient to come in recurrence recurrence is stage four i will tell you the staging of the tumors also so being a surgeon being a good clinician you must differentiate benign and malignant tumor before operate if it is benign consult the patient it is a benign tumor no need to fear do surgery and it will never reoccur don't worry don't panic but if it is a malignant tumor you have to come for regular follow-ups every three month every six months it can reoccur anytime to prevent the recurrence we will give you chemotherapy radiotherapy hormonal therapy please complete the course and even after the complete therapy it can occur any time of your life so that is why we have to differentiate whether it is a benign tumor or a malignant tumor so how you differentiate you are a doctor now the first question you will based on the rate of growth you will have a broad overview whether the tumor is benign or malignant so benign tumors grow slowly it takes years to double and malignant tumors grows very fast number one number two based on the clinical feature ask the patient what are the clinical features benign tumors don't have any clinical features they are just lump they are painless and they just grow they don't have they just compress the surrounding tissue and don't produce much symptoms but malignant tumors sometimes produce symptoms so they invade they show metastasis they produce ulcers so benign tumors are usually asymptomatic usually and malignant tumors are usually symptomatic i'm using the word usually exceptions are always there now man in geoma see the suffix man in Goma it is a tumor of the managers in the brain manage you ma is it benign or malignant I told you OMA is benign so man in Goma OMA it is benign so you will see my man in Goma should be asymptomatic but depending on the site in the brain very tuckering it can be symptomatic sometimes seizures occurs and manage you ma so it is not always necessary that benign or asymptomatic and malignant or symptomatic it is a broad judgment but final final diagnosis will be based on microscopy only right so that is the second differentiating feature between between benign and malignant give me a thumbs up so based on the rate of growth you will decide whether the tumor is benign or malignant benign tumors are slow growing malignant tumors are fast growing doubling time in benign is more doubling time in malignant is less after that clinical features benign tumors are usually asymptomatic exceptions are there like meningioma malignant tumors are usually symptomatic but again exceptions are there like breast cancer patient female patients don't come to the doctor they come at very late stage because usually it is a painless lump so the female have only lump in the breast nothing else no other complaint it is not painful so in usually it is the tendency of the patient a layman that unless until the disease is causing symptoms or trouble to you don't go to the doctor it is a painless lump not causing any harm so don't go to the doctor but they don't know that malignancies also present painless like asymptomatic and they all and when they present now it is already stage four so whenever any patient having any lump in the body it should be diagnosed early diagnosis is the key right so that is the thing coming on the gross the third differentiated i will give you the description of all just understand first now you are a surgeon you have done the surgery you have done the surgery so after that you have taken the tumor out the tumor is that is in the tray right so in the tray based on the external appearance of the tumor you will again have a judgment that whether it is benign or malignant benign tumors are well capsulated they are circular spherical well encapsulated that is benign tumor but malignant tumor are asymmetrical they are they can be any shape right and they are invasive and they are non-capsulated So based on Ross appearance also being a surgeon, you can have a only guess. But finally, you will send that specimen to the laboratory and a histopathologist will make a slide of it. And based on the microscopic, I will tell you 10 microscopic features here.
Based on that 10 microscopic features, the histopathologist will decide finally that the tumor is benign or malignant. So being a clinician, being a surgeon, you can always have a guess whether the tumor is benign or malignant based on these three points. But finally whether the tumor is benign or malignant can be said only on a slide only on a slide that is histopathology slide on hne slide so take the biopsy take the tumor out make a slide and see under microscope in the microscope look for the tan features these tan features are known as anaplasia anaplasia tumors show anaplasia so i will tell you the definition of anaplasia these 10 features if any tumor showing these 10 features it is malignant not showing these 10 features so you have to learn these 10 features here based on these 10 features we will decide whether the tumor is benign or malignant give me a thumbs up and the last point i will teach you the spread of the tumors there are two type of spread right uh there is a tumor now the tumor just suppose the tumor is in the stomach from the stomach it can grow to the adjacent organs listen uh just understand the two type of spread then i will give you the description of all very fast i will give the description you can see this is stomach this is lever this is pancreas this is spleen multiple organs are present around it right now just suppose this is the tumor can you see in the stomach this is the tumor now the tumor is this right now tumor can grow grow grow grow and by locally it can involve the in continuity it can involve the other organs in continuity it is involving in continuity it is involving the tumor the primary tumor is continuous growing everywhere it is known as local invasion the what it is known as local invasion so in continuity it is involving other organs apart from the main organ that is local invasion now see this is the blood vessel of this patient right now the tumor cells are going in the blood vessel these are the blood vessel and from the blood vessel these tumor cells reach to the brain reach to the bone reach to the other distant organs and they are producing tumors there also the secondary tumors these producing tumor in the brain in the bones in the lungs right so these tumors are discontinuous from the primary one discontinuity is there via blood it is reaching right so these one this is known as metastasis so this is the difference between metastasis this is the difference between local invasion and metastasis in local invasion the other organs are involved in continuity right in metastasis other organs are discontinuous and they spread via blood give me a thumbs up so the two type of the spreads are local invasion and metastasis you understand the difference so this is the main tumor primary tumor which is in the stomach this is primary tumor now primary tumor can involve other organs in continuity also and it can involve other organs which are distant now brain and stomach they are far away stomach cannot directly involve the brain but via going in the blood and coming in the brain again it can involve so metastasis can happen give me a thumbs up now both these properties the next most important point both these properties listen local invasion as well as metastasis occurs in malignant tumor Malignant tumour shows both property and both are absent and benign. Benign tumours neither show local invasion nor show metastasis so benign tumor are concise to that organ only in whatever organ they are arising they will concise to that organ only benign tumor do not involve other organs because they don't show local invasion as well as they don't show metastasis you got my point so these are the differences these are the five differences based on which we can differentiate benign as well as malignant now i will give you a description of all these points the most important are the last two the last two the first three are okay so but not very important so rate of growth you tell me what is the rate of growth malignant tumors grow very fast they have increased mitotic rate that's why less doubling time but benign tumors have decreased mitotic rate and more doubling time you got my point so based on the rate of growth you can decide the benign tumor and malignant tumor benign tumor grows slowly malignant tumors grow fast so say mitosis in each of them here mitosis is less here mitosis is more say the doubling time here doubling time is more here doubling time is less give me a thumbs up so based on that you can write the three differences based on the first feature we are done with the first feature coming on the second feature clinical features as i have told you benign tumors are slow growing that's why they are asymptomatic but it is a general rule exceptions can be there like manangioma manangioma may produce scissors it is a benign tumor but it presents it presents right so and malignant tumors they grow rapidly and they can ulcerate they can locally invade they can go to the distant side showing metastasis patient have weight loss anorexia so they are usually symptomatic so based on we we have done based on two features based on rate of growth benign malignant so these are slow growing these are fast growing right here mitosis is more here mitosis is less here doubling time is less here doubling time is more this is the first feature based on chemical feature benign tumors are asymptomatic and malignant tumors are symptomatic give me a thumbs up till now is it okay coming on the third feature based on gross we will decide based on the gross benign and malignant then i will show you the final table the complete table everyone give me a thumbs up based on the gross benign tumors are spherical circular they are well capsulated and freely mobile right and okay and malignant tumors are irregular they don't have fixed shape and they are non-capsulated non-succumscribed non-capsulated give me a thumbs up give me a thumbs up so see this is the tumor of the breast here you can see a well-circumscribed circular tumor this is fibroadenoma this is a benign tumor of the breast and here you can see i cannot find the margin of the tumor it is invading everywhere this is so it is irregular in shape and invading now understand the two terms compression and invasion you got my point compression and invasion i would like to draw two breasts two breast tumors in front of you this is first breast this is second breast so in the first breast this is the tumor right and in the second breast this is the tumor here right listen this is a benign tumor i have drawn this is the malignant tumor based on the shape you can make it out this is well circumscribed this is circular and it is capsulated also and freely mobile this one is irregular haphazard right and it is non-capsulated non-circumscribed capsulated circumscribed non-capsulated non-circumscribed circular oval irregular so based on the shape and capsule you can make it out but the biggest difference is that listen now This benign tumour, it grows, grows, grows.
So it will compress the surrounding tissue. You know, normal tissue will get compressed. Compress means in Hindi, dhakel na. Compress.
So it will compress the surrounding tissue. But it will not enter inside the surrounding tissue. You got my point? It will compress. Usko dhakel, dhakel ke badega.
It will grow in size. It will grow in size. So benign tumour also grow.
They grow slowly although. But they grow. They grow.
So they will grow. They will grow. So while growing, the surrounding tissue is compressed. The word to be taken here is compressed.
Right? but what about malignant tumor the malignant tumor invade inside the surrounding tissue let me draw the surrounding tissue here this is all surrounding normal tissue this is all surrounding normal tissue of the breast so malignant tumors what they are doing they are entering even they are entering inside the inside the malignant uh this tissue uh normal tissue They are invading. The word here to be taken is invade. You got my point.
They are not compressing. The word invade means to enter inside. So this one is compressing the surrounding tissue.
This one invades the surrounding tissue. You got my point. Everyone give me a thumbs up. This is the biggest difference.
So benign tumor compresses the surrounding tissue. Malignant tumor. invade the surrounding tissue have you got the meaning of that give me a thumbs up if you got the meaning give me a thumbs up have you got the meaning so till now the things are very clear here also you can see these are benign tumors they are well circumscribed i can make the boundary they are circular they are oval but they are multiple they are benign but here where is the boundary this is the malignant tumor can you make out this one this is the malignant tumor it is invading if you can appreciate it is going in the surrounding tissue the yellow colored breast it is invading inside that and this one is compressing the surrounding tissue right so that is the thing so till now what we have learned we have learned benign tumors malignant tumors the two type of tumors based on rate of growth these one benign malignant these one are slow growing these are fast growing so more less mitosis more mitosis more doubling time less doubling time we have done three differences based on that based on clinical features these are asymptomatic usually these are symptomatic usually but exceptions are there in both i told you the exception based on the growth These are circular. These are irregular.
These are encapsulated. These are non-capsulated. These are circumscribed.
These are non-circumscribed. Non-encapsulated, non-circumscribed. These compress. The word here is compress. The surrounding tissue.
These invade the surrounding tissue. Give me a thumbs up. How much difference is there? Count it. Count it out.
So, coming on the biggest difference now. Now, you are a surgeon. So, you will... open the patient in OT.
You will take the tumor out. Wherever it is in the body, you are taking the tumor out. The tumor is in the tray, right?
Now, looking at that, you are guessing the tumor is circular, it is circumscribed, it is capsulated. So, looking at that, it looks benign or it is irregular, haphazard, it is malignant. But you are not sure.
So, you will send it to the laboratory. It is a rule that if you are a surgeon and you take any part of human body out of the body, any part, even a small or large, whatever is the size, it has to be histologically proven. so you cannot directly throw it in the dustbin no it has to be proven on histology so send it to the laboratory keep it in a container the fill the container with formalin pack the container and ask the relatives or any health care provider to submit it to the laboratory right in the laboratory histopathologist will make a slide of it on the slide there are 10 features which differentiate benign and malignant these 10 features are known as anaplasia in benign anaplasia is absent in malignant anaplasia is present So now I'm going to define the microscopic features that is anaplasia, the 10 features of anaplasia, which are seen by the pathologist on a slide. Give me a thumbs up.
So these 10 features will basically differentiate the benign and the malignant tumor. Everyone give me a thumbs up. So I'm coming on microscopic features. So presence of anaplasia defines malignancy, anaplasia. So what is anaplasia?
Let me show you anaplasia. So these 10 features are basically known as anaplasia. I will show you all in the diagram. i will show you all 10 features don't worry i will explain all these all 10 are absent in benign and these all 10 are present in malignant if these 10 features are present the tumor is definitely malignant it is not benign these are the 10 features of so if anaplasia coming for three mark or five mark write these 10 features and draw them in the diagram this is a diagram showing anaplasia everyone give me a thumbs up everyone till now you got it everyone now the features are a little bit difficult but i will try to explain them in the diagram so see the first feature it is loss of polarity the first feature is the loss of polarity what do you mean by loss of polarity see the cells here this is normal normal tissue see the cells can you see the cells yes you all can see the cells this is the basement membrane this is the basement membrane this is the basement membrane this is where is the nucleus so nucleus is not at the center the nucleus is towards the basement membrane nucleus is towards the niche you know basement membrane so nucleus is towards the basement membrane this is known as basal polarity so basal polarity is present basal polarity is present normally also in benign tumors also it is present basal polarity is maintained all the nucleus are towards the base base means one of the pole north pole south pole basis south pole right it is towards the base basal polarity that is the meaning it is maintained but see malignant tumor this one tumor is malignant can you see the cells yes this is a cell where is the nucleus inside each cell it is present anywhere it is not basically towards the base it is haphazardly arranged it is anywhere so basal polarity is lost here loss of basal polarity is a feature of anaplasia give me a thumbs up so the first thing you should be able to write also and you should be able to draw also so this is the first feature please appreciate basal polarity is maintained in benign tumor and it is lost in malignant tumor give me a thumbs up basal polarity is lost loss of basal polarity is malignancy give me a thumbs up everyone and maintenance is normal give me a thumbs up so describe like this normally the nucleus are oriented towards the basement membrane this is known as basal polarity but tumor cells have a tendency to lose basal polarity that is their nucleus lie away from the basement membrane not towards the basement membrane they are lie away so that is loss of basal polarity opposite basal polarity that is the first feature give me a thumbs up the second feature i would like to show you here is the pleomorphism pleomorphism what do you mean by pleomorphism see all the cells here see the shape and size all the cells have same shape same size that is there is no pleomorphism the term pleomorphism is Joker's Joker Joker Joker means different shapes different size Joker so multiple shape and size right multiple appearance basically so that is so here there is no pleomorphism all are same looking like these are like schoolboys all are in the same uniform same color same size so these are not like jokers see the cells here some are small some are large some are medium so here pleomorphism is present so absence of pleomorphism is normal and presence of pleomorphism is malignancy give me a thumbs up it is opposite of basal polarity i said loss of basal polarity is malignancy and i am saying presence of pleomorphism is malignancy see the plus and minus give me a thumbs up everyone give me a thumbs up so this is pleomorphism described like this so variation in shape and size is known as pleomorphism and it is the hallmark of the malignancy everyone give me a thumbs up that is the second thing you have to describe we are done with the two things we are done with basal polarity and we are done with pleomorphism so basically in malignancy basal polarity is absent pleomorphism is present we have seen that coming on the third property nc ratio nucleus cytoplasm ratio so take a scale measure the nucleus here and measure the cytoplasm here in all the cells so nucleus the size of the nucleus write down in numerator and the size of the cytoplasm write down in the denominator the same thing do here also do here also measure the size of the nucleus write down in the numerator and measure the size of the cytoplasm write down in the denominator so what you are finding what you are finding here in malignancy the nucleus are bigger as compared to that so the numerator increases and cytoplasm is less as compared to that so denominator is decreasing so overall numerator is increasing denominator is decreasing and c ratio increases in malignancy in malignancy nc ratio increases this is a rule so increase in nc ratio is a hallmark of malignancy so you can see here here nc ratio is low and here nc ratio is high that is the meaning and it should be visible in the diagram so if lichnes and yoga the yahaap in nucleus when you draw on a draw small small nucleus and large cytoplasm whenever you are drawing here now draw big big nucleus and less cytoplasm you have to show the difference so here nc ratio is less here answer ratio is more see the numerator see the denominator give me a thumbs up give me a thumbs up so describe like that you can see like like the answer ratio is shown right you can see like ansi ratio so nucleus are enlarged numerator is more which is disproportion to the cell size that is cytoplasm so that nc ratio is more normal nc ratio is one is to four that is point point uh two five yes point two five right normal but in malignancy it is one is to one that is complete one so point two five is becoming one so if you want to learn the figures otherwise learn and see ratio is increasing the next property i'm showing you here see here the next property is an isocytosis the fourth and isocytosis no split the term split the term kya hota hi hai an isocytosis students ko spelling hi nahi aati padhne hi nahi aata it is n iso cytosis split it and then read it and I saw cytosis now understand the meaning of it and means no and means no no iso means is equal to in pathology iso means is equal to and cytosis means cell size cell size give me a thumbs up no equal cell size No, so cell size are not equal. This is a property of benign or malignant.
You tell me. All the cell size are not equal. This is a property of benign or malignant.
It is a property of malignancy. In malignancy, all the cell size are different. Some are small, some are medium, some are large. So all the cells are not iso.
They are different. They are N. N means no equal size. So anisocytosis is present in malignancy. It is a feature of malignancy.
Normally, there is no anisocytosis. So N isocytosis is absent normally. all the cells are same shape same size and see here all the cells are different size right so anisocytosis is present here give me a thumbs up so describe anisocytosis like this actually not the complete cell anisocytosis and it's a nucleosus and iso nucleosus means nucleus size complete cell casais to preomorphism now sit nucleus all the nucleus are same shape same size here the nucleus some are small some are medium some are large so an iso nucleus is normally absent and here in malignancy it is present so nucleus show variation in shape and size that is anisocytosis give me a thumbs up the next property is hyperchromatism don't learn hyper chroma the word chroma chroma what is the meaning of chroma chroma means color chroma the word chroma means color the word chroma chroma means color color so hyper hyper chromatism is the term so nucleus is dark color in malignancy now compare the color of the nucleus here it is lighter and here it is darker because the chromatin is packed in malignancy the chromatin in the nucleus become packed it become compact so it becomes dark color so hyper chromatism is a feature of malignancy normally chromatin is normal it is not hyper it is normal and here it becomes hyper give me a thumbs up everyone give me a thumbs up the next point inside the nucleus there is a nucleoli can you appreciate the nucleoli inside the nucleus we have these dots so this is a cell inside the cell we have a nucleus inside the nucleus there is a nucleoli so in malignancy you can see inside all the cells most of the cells there are multiple nuclei can you appreciate the nuclei the nuclei its presence in malignancy normally there are no nuclei here inside the so here nuclei are normal or they are absent here nuclei become prominent more prominent that is the seventh feature sixth feature give me a thumbs up the next feature you can see this is the mitosis normally inside the nucleus no mitosis but see here this cell can you appreciate this cell see the spindles is it visible to you see the spindles in the cell the spindles in the cell that is the cell is dividing so this is showing frequent mitosis frequent mitosis are present in malignancy normally there are no mitoses so mitoses are normal here here abnormal mitotic figures are present the next is the giant cell normally i can't find any giant cell here but here if you see i am finding this giant cell giant cell means multiple nucleus inside one cell appreciate the giant cell So giant cell, mitosis, nucleoli, all are features of malignancy.
They are not features of benign. They are not features of normal. Give me a thumbs up. The next is the cytoplasm.
see the cytoplasm color here all the cytoplasm is pinkish normal see the cytoplasm here it is less pinkish because inside the cytoplasm mucin is present inside the cytoplasm mucin is present mucin is present now in these properties if you have trouble in learning learn like this is a property of nucleus you be new nucleus these five properties of the nucleus nucleus Nucleus has mitosis and multiple nucleus. Nucleus number. You can say multiple nucleus giant cell number.
So, size of nucleus, color of nucleus, number of nucleus, mitosis of nucleus and nuclei. These 5 features are of nucleus. This one feature of cytoplasm.
One feature. So, 5 plus 1 is 6. And apart from that these are the general features. So, learn like that.
It will be easy for you to remember in the exam. Give me a thumbs up. give me a thumbs up after that last is if you do the molecular uh method here you will find here that all chromosomes are showing diploidy in humans we have deployed cells now the 46 chromosomes all the cells are deployed they are normal but in malignancy there is aneuploidy there can be aneuploidy there can be no it is not necessary it is deployed it can be haploid it can be triploid you know so aneuploidy is there give me a thumbs up and you ploidies are common here give me a thumbs up so what are the 10 features so describe each of them the description is written in front of you so if it is coming for a long question describe each of them give me a thumbs up now you can see in this diagram this is the uterus of a female she is having multiple tumors in the uterus so see the shape size she see she is uh whether it is encapsulated non-encaps this one and here also the patient is having a tumor in the uterus see the shape size invasion so based on the gross first decide whether it is benign or malignant no based on the gloss these one are circular these are encapsulated this one is irregular this is non-encapsulated so i feel like this is benign this is malignant but i am not sure so i will make a slide so this is the slide of this and this is the slide of this now compare those 10 features what i have taught you compare in this slide can you see a giant cell yes giant cell is present can you see this cell is showing mitosis please appreciate the spindles on the cell spindle in this cell in this cell also spindle this is also a giant cell so by your choice you can draw multiple joint cells multiple mitosis in each of them see the nucleus it is of different size different shape see the nc ratio see all those 10 features so all the 10 features are present see the color color of the nucleus here is hyperchromatic there it is normal so final based on those 10 features my answer is that this is a benign tumor this is a malignant tumor so to this lady i will just operate and send to the home there is no further treatment requirement right and for this lady after my after operating i will offer chemotherapy radiotherapy also and i will explain the patient if you don't take chemo and radio it will reoccur so that is malignant and chances of recurrence are there always prognosis is poor here prognosis is very good it is always 100 curable give me a thumbs up so that is the thing this is leo myoma this is leo myo sarcoma see the suffix also this is oma this is sarcoma give me a thumbs up so many things are proved here so this is like you like this. Whenever patient comes to you, patient don't tell you I'm having a benign or malignant tumor.
Patient will say I am having a lump. That is the lump. Now being a doctor, it's your job to see the lump is benign or malignant based on whatever feature, based on draws, based on clinical feature. And ultimately, it is the job of the histopathologist to decide whether the tumor is benign or malignant in the report.
if i write benign surgeon will do like that in my report if i write it is malignant surgeon will consult the patient like that so it is the report of the histopathology basically which decides the treatment as well as prognosis of the patient so the surgeons or the clinicians how they counsel the patient how they treat the patient what is the prognosis of the patient what is the therapy for that patient that is depending on histopathology report basically the 10 features of anapasia whether they are present or absent everyone give me a thumbs up everyone means everyone so can you define so in these figures also can you make out this is a mitotic cell can make out a beautiful mitosis the spindle formation is shown here and this is the giant cell i guess and you can see the pleomorphism some cells are small big large you can see the anisocytosis some nucleus are small big large variation in shape and size of the cell is known as pleomorphism variation in shape and size of the nucleus is known as an iso nucleosis both properties are present here so basically it is a malignant tumor right looking at the slide only i can see at the first look it is a malignant tumor i will see all 10 properties but yeah it is malignant right so it is malignant here also i can find a big giant cell right it is also malignant tumor right let me move ahead okay you can see the various mitosis this cell is my tosses this cell is showing mitosis appreciate the spindle appreciate the spindles right so these are the abnormal mitosis right so you have to look for all 10 properties it is a giant cell it is looking here right so you have to look for the giant cell mitosis i am done with the microscopic feature so based on these features still now what you have learned what you have learned tell me the summary what is there in the benign what is there in the malignant who will tell me based on the rate of growth based on the rate of growth you tell me based on the clinical features you tell me based on the gross you tell me based on the microscopic features you tell me can you tell me can you tell me rate of growth is very easy they are slow they are fast right clinical features are very easy they are asymptomatic they are symptomatic right gross is also very easy they are circular opioid uh they are encapsulated and circumscribed they are they are irregular shape non-set non-circumscribed non-encapsulated right based on microscopy you have to tell me the 10 features what is there and what is there that is the biggest difference then i will come on the last the spread one give me a thumbs up everyone give me a thumbs up okay just a second i would like to enumerate the 10 features in the diagram can you can you enumerate the 10 features in the diagram anyone of you so this is benign this is malignant who will tell me the 10 features in benign basal polarity is present it is maintained in malignant the basal polarity is lost that is the first feature you should be able to draw also right also right benign the pleomorphism is absent in malignant the pleomorphism is present in benign the NC ratio is low it is low in malignant the NC ratio is high that is the third thing in benign an isonucleosis absent new and here an isonucleosis is present in malignant right in benign the color of the chromatin is normal here the color of the chromatin is hyper the color of the nucleus is dark color right here nuclei are absent Their nuclei are absent inside the nucleus. Here, nuclei are present inside the nucleus. Give me a thumbs up. Here, mitotic figures are absent.
Giant cells are absent. Here, mitosis is present. Giant cells are present.
Give me a thumbs up. Here, cytoplasm is normal. Here, in the cytoplasm, mucin is present.
Here, chromosomes are deployed. Here, chromosomes are aneuploid. Everyone, give me a thumbs up. These 10 features define anaplasia.
Jitne audience, utne thumbs up. You got my point? So, if you got it, let me move ahead to the difference ka table. then i will come on the fifth and the last property the fifth and the last property that is spread of tumors that is the two type of the spreads i will come on the fifth property so i will explain you so you can see this table benign and malignant who will explain me the same features are written very easy it is benign it is malignant first tell me first you tell me based on clinical features and based on the gross first tell me the boundary of benign and malignant they are encapsulated and well circumscribed but the malignant one are poorly circumscribed and they are irregular in shape they are not circular they are irregular tell me the surrounding tissue they compress the surrounding tissue but they invade i have explained you the terms compress compress or invade you got my point if you understand hindi so they compress the surrounding tissue and they invade the surrounding tissue coming on the size the benign are usually smaller the malignant are usually larger Secondary changes means clinical features. Here they are absent, here they are present.
So based on clinical features and draws. I will talk about 10 features of Microscopy later. Look at the growth rate of both. So growth rate, these are slow and these are rapid.
Yes or no? Yes or no? The two spread, what are the two types of spread? The local spread and metastasis.
Local spread is in continuity and metastasis is discontinuous. So stomach tumour entering in adjacent organ that is spleen, pancreas, liver. it is local but stomach tumor going to the brain going to the bone going to the cervix going to any organ lungs it is metastasis via blood so both these features that is local invasion and metastasis are absent here and both these features are present here give me a thumbs up give me i will explain you this property prognosis here it is good here it is poor death usually occurs by metastasis so prognosis now coming on the 10 features who will describe the 10 features anyone among you describe the 10 features describe basal polarity pleomorphism and c ratio an isonucleosis hyperchromatism mitosis giant cell chromosomal abnormality so all these features i have already explained you in the diagram don't only write here draw in the diagram also basal polarity is maintained here here it is lost pleomorphism is absent here it is present here and c ratio is normal here or low here it is increased here right and isonucleosis hyperchromatism mitosis all are absent here here they all are present Give me a thumbs up.
Giant cells are maybe present but without ATP or absent here. And they are present. So like this you have to describe.
Everyone give me a thumbs up. Everyone. So this is the difference ka table.
So if it is coming for 3 mark or 5 mark, draw this table only. Nothing else. If it is coming for 3 mark, I advise you to just make this table.
Nothing else. If it is coming for 5 mark, along with this table, I expect to draw the diagram also. 5 mark mein. And if it is coming for 20 mark, draw this table. Draw the diagram and explain each feature in description.
So this is how you are to judge according to the marks of the question. Everyone give me a thumbs up. Jitne audience ho, jitne thumbs up do.
Samajh mein aaya kya? Shall I proceed ahead? So that is the same difference written in front of you. The main are the 10 microscopic features.
Itke number milenge. Ye to easy hai, easy hai, easy. Everyone knows.
The most important is this one. The one student who knows the 10 differences. Anaplasia between benign and malignant. That will get the marks.
So give me a thumbs up. Coming on the last feature, the spread of the tumor. Two types of spread I have already explained you.
There are two types of spread. Local means in continuation. And metastasis means distant. That is discontinuous.
Both these features that is local invasiveness and metastasis. They are absent in benign and they are present in malignant. Both these features.
Students usually have confusion. They think local invasion is in benign and metastasis is in malignant. Maybe you also think so. But it is not so.
Both these features are absent in benign. Benign tumors neither show local invasion. nor they show distant spread that is metastasis malignant tumor shows both malignant tumors go to the adjacent organ also distant organ also benign tumor concise to the organ in which they are so if they are in stomach then they will not go to the liver pancreas and other organs they will remain in that organ only they neither show local invasion nor they show distant invasion but malignant shows both so this is the biggest difference you must understand now here i would like to explain you the metastasis where 5 mark or 20 mark question can also come metastasis steps you so i'm directly coming on the metastasis so till now it is okay and you can see in the diagram this one is the main tumor can you see the tumor the red is the tumor and purple is the normal tissue just suppose the purple is the breast normal breast of a female and inside which red is the tumor right so local invasion can you see the tumor is going in the adjacent organs from the breast it can go to the pectoralis major it can go to the ribs it can go to the heart lungs that is the adjacent organ of the breast breast ki asapas jo bhi organs hai so that is local invasion it is going locally locally locally but after that it is coming in the blood See, it is coming. The tumor cells are coming. This is a blood vessel.
It is coming in the blood and tumor cells are traveling in the blood. Can you see? The tumor cells are traveling in the blood.
They are traveling, traveling, traveling and after that they are coming at some other organ. After coming out in some other organ, this is some other organ. They are growing there. So, this is metastasis. They are growing in some other organ.
This is metastasis. So, they can grow anywhere in the body. They start from one point and they spread in all the organs.
This is stage 4 tumor metastasis means spread it all over. Once the tumor cells come in the blood, it is stage four there is no treatment of it you cannot operate complete body no you cannot take the operation of the brain also bones also lung also liver also the tumor is in every organ and if you operate it once it will occur again it will occur again it is present in the blood basically so tumor in the blood is metastasis that is stage four that is incurable so we prevent you should treat the patient before coming stage four at stage one stage two stage three it is curable but at stage four it is incurable here only we can extend the life but we cannot cure it all the organs are involved and one by one the patient deteriorate ultimately the patient die so stage four is bad right that is metastasis right you got my point so that is the thing local invasion there is no need to understand you already got what is local invasion so this is tumor cells in the primary organ and they are invading in continuity the word here is continuity in the adjacent organ here it is continuous that is local invasion benign tumors coming on metastasis the most important is metastasis you get a 5 mark or a 20 mark question on metastasis if it is coming for 5 mark write only roots if it is coming for 20 marks write the steps also i will tell you eight steps of metastasis exactly give me a thumbs up so write the definition of metastasis what is metastasis who will tell me what is metastasis metastasis is discontinuous secondary formation which is discontinuous with the primary discontinuous secondary tumors or mass are formed at the site of lodgement which is away from the primary now primary tumor is in stomach and the secondary is formed in the brain in the liver in the lungs which are discontinuous from the primary organ via blood give me a thumbs up shall i draw the diagram or you already know it so primary tumor can be anywhere i'm drawing stomach it can be in the breast it can be anywhere and this is the blood vessel of the person and these are other organs this is brain this is bone these are lungs this is liver these are the other organs right now here is the primary tumor this is the primary tumor some of the tumor cells will come in the blood some not all and they will travel in the blood via blood they will involve other organs which are discontinuous with the primary organ this is the definition of metastasis these all tumors are known as secondaries and this is the main primary tumor from which all the secondaries are formed give me a thumbs up this is stage four that is metastasis so what is the definition of metastasis by the way it is discontinuous secondary tumor or masses formation at the site of the lodgement which is away which away from the primary tumor it is not in continuity it is not in continuity that is the definition it is also known as distant spread if you understood the definition you'll learn one thing benign tumors do not show metastasis and all malignant tumor shows metastasis except two there are two exceptions multiple time mcq there are two exceptions glioma is a tumor it is a malignant tumor but it didn't never metastasize and basal cell glial of the brain right of the cns and basal cell carcinoma of the skin skin ka basal cell carcinoma yaha bhe hota hai at the site of the tears right ye nasal fold me hota hai right you know it it is known as rodent ulcer right it never metastasize so these are two malignant tumors they never metastasize unless until apart from these two all malignant tumor shows have a tendency to show metastasis if you don't treat it timely If the patient is not taking timely chemotherapy, radiotherapy and surgery, it will show metastasis. All malignant tumors.
And benign tumors never show metastasis. Even if you don't operate for the whole life, it's okay. If it is not producing any symptom, it's okay.
You don't have any fear that it will spread to other organs. Locally also, distant also. It will never spread.
Give me a thumbs up. So that is the thing. Learn these two exceptions.
Glyoma and basal cell carcinoma. You got my point. so you got what is the definition after definition you got one point benign tumor do not metastasize and malignant tumor do but except two malignant tumors you know the exception after that coming on the roots how the the primary tumor spread to other sides okay again the same diagram just suppose this is the primary tumor right and these are the secondaries multiple organs in the human body right it can be any organ liver lung bone right and how this is the primary tumor how it can reach there what are the roots the most common root is blood i've already taught you blood right so this is a blood vessel via blood vessel they can go to all the second is the lymphatics via lymphatics also they can go to all and third is this transceleomic transceleomic transceleomic is the cavity okay let me show you the three roots This is a blood vessel, this is a lymphatic vessel. Right, lymphatic vessel and blood vessel are same.
Both of them are lined by endothelial cells. Right, lymphatic vessel and blood vessel both are same. They are lined by endothelial cells. Only difference in lymphatic vessel, we have lymph nodes in between. These lymph nodes will come in between.
They are not continuously smooth. like a pipe they have lymph nodes in between and blood vessels are continuous give me a thumbs up give me a thumbs up now these tumor cells can leave the primary site and some of them can come in the blood and after coming in the blood they will deposit in various organs that is hematogenous root the blood root or else they come in the lymphatic vessel they come here in the lymphatic vessel and from the lymphatic vessel they are depositing in various organs that is lymphatic root so hematogenous root is the first root lymphatic root is the second root and number third number third tumor cells that they are neither coming in blood nor coming in lymphatic they are shedding in the cavity the abdominal cavity the peritoneal cavity and they are floating here and there by floating here and there they can go to the various organs and get deposited this route is known as transpelomic transcelemic is through cavity they are shed in the cavity the free cavity we have thoracic cavity abdominal cavity peritoneal cavity pelvic cavity so in the cavity they are they are free and they will float here and there and they will deposit to some other organ which is distant from the primary organ the word to be catch is distant give me a thumbs up give me a thumbs up so what are the three roots hematogenous lymphatic and transceleomic transceleomic is rare not very common but i will explain you all three right uh blood and hematogenous and lymphatic are more common give me a thumbs up everyone give me a thumbs up now which tumor spread by which root who will decide so there is a rule that sarcomas spread by hematogenous root and carcinomas spread by lymphatic root it is a rule give me a thumbs up the two types of tumors the two types of malignant tumors are sarcomas carcinomas i already explained you at the beginning give me a thumbs up so if you know these general you can describe in your own words so what are the three roots you tell me the first root is the lymphatic so uh carcinoma spread by this root the second root is the hematogenous that is blood sarcoma spread by this root and third is transcelemic transcelemic i will explain you but mostly it is through cavities body cavities give me a thumbs up so i will explain you the three roots one by one you can see all three roots here you can see the three roots here can you see this is the main tumor in this diagram also the same diagram this is the main tumor so main tumor cells are coming via blood via lymphatic and the third will be via cavity and they are spreading in the complete body so that is the three roots so i have already taught you carcinomas spread by lymphatic root sarcomas spread by blood root hematogenous root learn this is a rule it is a golden rule it is a give me a thumbs up Everyone give me a thumbs up if you got till now. So you got the three roots. I will give you a small small description of the three roots.
Write some points about lymphatics here. 1, 2, 3, 4, 5. Some important points about hematogenesis. And some important points about transelomate.
After that. So this is general for metastasis. You should know the definition. You should know the three roots.
And small small description about the three roots. If it is coming for 20 marks. Write the steps of the hematogenesis root. It has 8 steps. I will tell you that steps also.
I will not tell you the steps here and here, they are not important. But hematogenous root you should know the exact steps. First let me give the description of these three, then I will come on the steps later on.
We will see the description little by little. Starting with lymphatic root. Lymphatic root I have already taught you, carcinoma spread by lymphatic root.
Give me a thumbs up, give me a thumbs up. Now from lymphatic root you can see this is the main tumor. This is the main tumor, the main tumor. This is the second organ. It can be brain, lung and these are the lymphatics.
in between these are the lymphatics so tumor cells can go from the lumen of the lymphatic the lumen or they can form a line over the border of the lymphatic okay i will draw it a better diagram so these are the lymphatics right this is a lymphatic this is a lymphatic tumor cells are traveling inside it so they have two options either they travel from the lumen or they travel through the wall you got my point from the primary to secondary from primary to secondary these are the two ways so what are these two ways one is lymphatic permeation one is lymphatic emboli if they are gummy coming from the lumen it is lymphatic emboli if they are moving through the wall it is lymphatic permission not very important but you should know it the two types it is shown in the diagram so pattern of lymph nodes so in between all the lymph nodes will be involved see this is the primary tumor this is the primary tumor everyone have a look here this is the primary tumor and these are the lymphatics of the organ if the primary tumor is coming through this route this is the first lymph node coming in route right if the primary tumor coming through this route This is the first lymph node coming in route. Right. First lymph node is known as sentinel lymph node. The first lymph node which is involved after that the others will also involved in sequence. All the lymph nodes in the way.
They will involved one by one. In the step. Right. From primary to secondary. In between all the lymph nodes will be positive.
So not only blood. The tumor will spread to the secondary organ. Okay.
Whatever the secondary organ is. Brain, liver, lungs. Whatever. Whatever.
That will be involved. In between. between all the lymph nodes they are also involved they also become positive the first lymph node is known as sentinel give me a thumbs up so all the natural roots say all the lymphatics are there they all will be involved and the first lymph node is sentinel lymph node give me a thumbs up so looking at that if you do the biopsy of this lymph node you will come to know whether lymphatic spread has already occurred or not occurred so that is the thing give me a thumbs up give me a thumbs up so that is the thing important here you can see here this is the primary tumor here in the salivary gland right and it is coming into the lymphatics right so this this can be sentinel this can be sentinel the same thing right okay okay you can leave all this you can leave all this so this is how lymph nodes are involved right you can see the lymph nodes can be involved lymphatic spread you write down the sentinel lymph node what is sentinel lymph node right that's it that is only important point here for you at mbbs level coming on hematogenous root hematogenous root so sarcoma spread by hematogenous root i already taught you what the sarcoma it's spread by now in hematogenous we have arteries also veins also tumor is a artery or vein and why you should know the reason also why now see this is the primary tumor and primary tumors say this is artery arising from the primary tumor and this is vein arising from the primary tumor tumor cells prefer to go in artery or vein to go in other organs i'm asking you i'm asking you can you give me the answer what is the answer here the answer is the vein because veins have thinner wall so tumor cells are there in the primary tumor they prefer to go in the vein because penetration is easy in artery the walls is thick so penetration is difficult so tumor prefer to go in veins as compared to arteries this is a rule give me a thumbs up for for hematogenous spread so veins are more commonly involved because of the thinner wall as compared to arteries which have thicker wall so that is a give me a thumbs up now in hematogenous root two organs are most commonly secondarily involved so wherever the tumor the primary tumor in the body either secondarily it will go to the liver or in the lung why why i'm asking you why tell me the reason for both tell me the reason for liver and lung you know what is the git this is git this is stomach this is spleen pancreas small intestine large intestine complete git drained in portal vein you know this is the portal vein coming out of the git so if tumor is occurring in the stomach imagine there is a person having tumor in the stomach imagine a person having tumor anywhere in the GIT spleen pancreas intestine stomach esophagus anywhere tumor in the GIT where the tumor will go hematogenous spread where it will go it will go in artery or vein it will go in vein I have already explained you why because it is having thinner wall what is the vein of GIT which way it will go name the vein of the git the vein of the git is the portal vein so all the tumor cells are going in the portal vein they are reaching in the portal vein from portal vein they will reach the liver and they will form a secondary here that's why tumor occurring anywhere in the git via portal vein it will reach the liver and this is a secondary in the liver so all the tumors in git they present a secondary in the liver this is the first secondary they are occurring and after that it can go anywhere in the body but the first it is occurring in liver so liver is most common involved organ as a secondary organ in case of git tumors if the primary tumor is in the git anywhere in the git it can be esophagus stomach intestine anywhere so it is the portal drainage portal vein drainage which cause liver as secondarily most commonly involved give me a thumbs up so that is the portal drainage because of which liver is most commonly involved give me a thumbs up now tumor in the git is like this a tumor anywhere else in the body not in git anywhere else in the body so you know this diagram tumor is here anywhere else in the body in some organ any organ it is not git organ it can be bone it can be muscle it can be gonads it can be ovary it can be testes it can be breast it can be brain anywhere anywhere not git so where the tumor will go i'm talking about hematogenous root so in hematogenous root it will go in artery or vein all organs have artery all organs have vein so of course as i have told you it will go in vein right so it will go in vein of that organ but all the veins go where all the veins go in svc ibc and via svc ivc all the ways go in right side of the heart so tumor cells are reaching right side of the heart so all organ tumor cells they will go in their vein respective vein so brain will go to the brain vein ovary will go to the ovarian vein likewise so all the veins go in svc ivc and tumor cells finally reach in right auricle from right auricle they will go to the right ventricle from right ventricle they will go to the pulmonary artery and they will form a secondary in the lung that's why tumor anywhere else in the body they form a secondary in the lung tumor in the git they form a secondary in the liver and tumor anywhere else they form a secondary in the lung so these are the two so lung is the cowl super svc ivc uh superior and inferior vena cava cava is cowell blood because of that lung is most commonly involved give me a thumbs up everyone give me a thumbs up so liver and lung are the most two common organs which are involved in secondary so secondary organ is most commonly 90 percent of the patient either liver or lung if git is the primary tumor organ is liver if anyone else um is the primary tumor not git so lung is most commonly involved that is the first organ involved in secondary after these all other organs are also involved the patient can have tumor in all organs of the body the secondary tumor but these are the first secondaries you got my point give me a thumbs up if you got my point if you have any doubt i'll ask it so that is about that is about so most common organ involved in secondary via hematogenous root is lever followed by lung liver or lung maybe lever is number one lever followed by lung so lever followed by lung this is the sequence so that is you can see the liver multiple secondaries are there so some tumor in the git so it can be in the esophagus stomach small intestine large intestine pancreas it can be in spleen so via portal vein it is coming in the liver and forming multiple secondaries in the liver what you will do in the treatment there is no treatment you have to take complete liver out and liver transplant but not only liver is the one organ involved now all organs are involved you cannot replace all organ the ultimate is the death you can extend the life but it is not curable give me a thumbs up so that is metastasis stage four right so that is the thing now you can see all organs are there can you see liver multiple secondaries lung multiple secondaries brain multiple bone make it nearly so patient is stage four like this they have secondaries in all the organs virtually in all organs right because tumor is already present in the blood and blood is going everywhere so tumor can go any organ and it can form secondary in any organ right this is stage four most common liver involved second most common lung involved but after that all other organs can be involved this is metastasis give me a thumbs up give me a thumbs up so only two two tumors are malignant but they don't show metastasis you know the exception glioma of the brain and basal cell carcinoma rodent ulcer of the skin these two are malignant tumors but they don't show metastasis so in lymphatic spread i learned one term sentinel lymph node if you write sentinel lymph node i will give you one mark right sentinel lymph node is the first lymph node coming in the way of the lymphatic in hematogenous i learned that veins are more commonly involved than arteries the first rule i have learned and two organs i have learned i have learned if the tumor is in git liver is the most common secondary organ if the tumor is anywhere else in the body lung is the most common organ and liver followed by lung these are the three things i have learned now i have written here in short compact form but if you give the description it will be one page description why liver is the most common organ in git why lung is the most common secondary organ in other tumors apart from git you should give a valid description along with the diagram as i have given in my notes so this is how you have to describe hematogenous root you describe lymphatic root you describe hematogenous root coming on the third row transcelomic root in transcelomic root there are three things one i have already taught you via cavities via cavities i will explain you all three via cavities uh you got my point via cavity see this is a tumor the tumor is in the stomach she is a female she is a female and she is having a tumor in the stomach tumor cells are not going in the blood they are not going in the lymphatic the tumor cells are shared in the cavity they are just shared in the abdominal cavity stomach is abdominal organ so they are shared in the cavity so shedding they are floating here and there from the abdominal cavity they are going to the pelvic cavity and the secondaries are formed in ovary not in one ovary in both ovaries in both ovaries so this is a triple tumor one the primary in the stomach and two secondaries in the ovary this is a syndrome it is known as crookenberg syndrome crookenberg krukenberg syndrome in krukenberg syndrome patients have three some three tumors one in the stomach and two in the ovary you just do a ct scan you just do a usg you just do any imaging triple tumor there is a triple tumor looking at the triple tumor it should be clear to your mind the primary rivers cannot happen the ovarian tumor cannot come to the stomach but yeah this happens very frequently the stomach tumors can come to the bilateral ovary so this female have bilateral ovary see the one ovary see the other ovary in center this is uterus both ovaries are enlarged drastically drastically and this is the stomach showing the tumor so it is a triple tumor give me a thumbs up it is known as crook and bug again can you see this is uterus in the center and appreciate the size of the two ovaries the two ovaries are drastically enlarged along with the stomach this is crook and bug this is crook and bug so this is typical crook and bug is the best example so carcinoma of the stomach seeding in the both ovaries it is an example of trans thalamic thus tumor is spreading via cavity so that stomach tumor is shed in the abdominal cavity from abdominal they are going to the pelvic and from pelvic they are involving both ovaries and triple tumor patient comes to you and very poor prognosis very poor patient dies within you know six months and one year you know very poor prognosis crook and bug so if you if you do the biopsy of the ovary you will get stomach tumor inside the ovary so that is the meaning of the metastasis in ovary there is no ovarian tumor in ovary you are getting stomach tumor means this is the secondary so this is a rule how to find out the secondary now in this sometimes we have confusion what is primary what is secondary patient is coming to us with multiple tumors so we will do the biopsy of the organ and see what is the primary what is the primary secondaries have same morphology as that of primary right so that is the thing so that is the first thing in transcelomic the transcelomic second thing first is cavity second is csf you know csf anywhere tumor occurring in the brain for example this is the primary tumor in the brain the tumor cells can be shed in the csf and via csf they are traveling here and there and they are forming secondary somewhere else which is distant from the primary So primary tumor is this, secondary is this.
They are not in continuation. They are distant. If they are distant, who is doing the spread? The spread is done by the CSF.
So this route is not hematogenous. It is not blood. It is not lymphatic. It is not lymphatic. But it is CSF.
The CSF is coming in trans-cellulomic route. So that is the second example. Give me a thumbs up.
Tumor anywhere in the CNS forming a secondary at other side in the CNS only. But the two things are discontinuous. If they are discontinuous, the definition is fitting in metastasis.
It is not local invasion. The two primary and secondary, they are discontinuous. So the spreader.
who's spreading csf so csf is the second example and third it is very very rare of the rarest but yeah it is implantation uh there is a surgeon who is operating two patients this is the first patient having a tumor the patient is having a tumor somewhere in the body and the surgeon is using scalpel needles in this patient and are without sterilizing the same surgeon the same instruments are used in the second patient so here the tumor cells are sticking here on this instrument and they can be transmitted to other so very rarely these cases have reported so spread of some cancers by implantation of the surgeon's scalpel needle sutures not from one patient to another but in the same patient also i'm sorry not from one to other it will not occur from one to other but in the same patient if this is the tumor if this is the tumor primary tumor and surgeon is operating it and surgeon is using scalpel here so the tumor cells are there on the scalpel and same scalpel surgeon is doing some other surgery in the same patient so he has implanted the tumor cells from here to there so transfer this may kia surgeon scalpel so this is trans celomic root give me a thumbs up everyone give me a thumbs up so trans celomic root there are three roots of trans celomic number one cavity number two csf one number two csf and number three implantation these three things are coming give one one example of each of them so these are the three roots so till now what we have learned if the question is coming in your exam three mark or five mark metastasis what you will write you tell me what you will write you will write the definition what is the definition definition is formation of secondary tumor from the primary tumor which is distant from secondary there is no continuity so that is the definition uh tell me the golden rule the golden rule is that benign tumor do not show metastasis all malignant tumors show metastasis exceptions are two there are two exceptions glioma of cns and basal cell carcinoma of the skin tell the golden rule. So, after definition, tell the golden rule. After the golden rule, tell me the three roots and give the description of the three roots. What are the three roots? The first root is lymphatic, the second is hematogenous and third is transcelemic.
You know what to write in these. Transcelemic again having three things, right? Number one is cavity, the best example is Krukenberg.
The second is the surgeon's scalpel. right implantation and the third is the csf right and you give here the description of the sentinel lymph node here you can write veins are more commonly involved than arteries why you should give the reason and liver and lung are the two most common organs involved why you should give the reason so this is all description it should be sufficient for five mark i'm am i right and if it is coming for 20 mark write the steps of the hematogenous route write the steps of only now i'm going to teach you eight steps of hematogenous route i will not teach you all three routes coming on the steps coming on the steps of hematogenous route give me a thumbs up so mechanism and the steps these are the eight steps so this is a diagram from hush moon i will show you the same diagram in robbins also whatever you find comfortable you can draw that diagram near exam the information is same the information the labeling should be correct right okay so these are the eight steps okay just a second these are the eight steps one by one first let me show you all eight steps in this diagram in one diagram only uh see this is a primary tumor everyone appreciate i will use blue color for the primary this is a primary tumor can you see this is a primary tumor inside the primary tumor these are the tumor cells these are the individual tumor cells right and you can see this is a blood vessel i'm showing you hematogenous root now so this is a blood vessel the blood vessel is lined by the endothelial cells so these are the endothelial cells lining the blood vessel this is the lumen of the blood vessel containing blood now between the primary tumor and the blood vessel there is a yellow colored tissue can you appreciate the yellow colored tissue this yellow color tissue is ecm that is extracellular matrix extracellular matrix so tumor cell in the primary organ it can be any organ and this is the blood vessel to that organ this is a vein basically because tumor cells prefer to go in the vein not in artery so this is the vein for that organ give me a thumbs up and it is always ecm is present the yellow color ecm between the tumor and the vein between the blood vessel and the vein give me a thumbs up everyone give me a thumbs up now the first rule is that uh some of the cell of this primary tumor they will become aggressive they will become aggressive in which a sub clone a sub clone is formed maybe two three cells a cluster of two three cells they will become aggressive inside which some mutations take place they are going to show metastasis so not all cell will enter few cells a cluster of few cells will enter inside the blood vessel that is aggressive clone is formed aggressive clone is formed inside the main tumor that is the first thing give me a I will give you the description of all 8 steps But first understand the meaning Everyone give me a thumbs up So that is the first step After that These cells These 3 cells 2 cells Whatever They will lose from other cells So they have to lose now Because they have to leave and enter here now So they have to lose Lose from the main cell So who is the glue? Glue means gum Who sticks it and keeps all the cells? There is a gene or a protein Known as E-caterine E-caterine is like a gum Like a glue who do the sticking of the cell now these three cells four cells who's who are aggressive they will lose a catarine so they will lose the glue so they will show the loosening so the second step is loosening of the tumor cell by lossing a catarine a catarine protein on their surface all tumor cells have a catarine on their surface which stick them together like a like a bundle give me a thumbs up so these will lose a catarine everyone give me a thumbs up so loss of a loss of a catarine so that they will become loose the second step after that These tumor cells, these 3-4 tumor cells, can you see this one, this one, this one, they are coming and interacting with ECM. They are interacting, please allow us to come inside you, the yellow color ECM, extracellular matrix, right?
So that is tumor cell ECM interaction. Tumor cell ECM interaction take place. They are interacting that we want to come inside you, that is interaction. After that, ECM is saying no. i will not allow you to come inside me no i will not allow you so what tumors are doing tumors are secreting some enzyme ecm is made up of collagen so they are they are secreting collagenase ecm is made up of elastin they are they are secreting elastinase right so they are secreting the enzymes which degrade the acm you see First they will ask permission from ECM that can I come inside you? I want to go inside the blood vessel so I have to penetrate you for going inside the blood vessel.
ECM will not allow, it is rigid, no you cannot enter. So they are secreting the enzyme which degrades the enzyme and will break it and go ahead. You got my point? So first they interact with the ECM and then they degrade the ECM. Give me a thumbs up.
First they interact with the receptors, I will tell you the name of the receptors with the ECM. And after that they secrete enzyme, collagenase, elastase, multiple enzyme, metalloproteinase, right? and they will degrade the ecm and go inside the ecm give me a thumbs up so step three and four interaction with ecm degradation of ecm step one was aggressive clone formation step two was loosening of the tumor cells from the main main clone by loss of e-caterin step three is interaction with ecm with the help of receptors step four is degradation of ecm by secreting enzyme now step five step five is entry inside the blood vessels see they are entering inside the blood vessel can you appreciate they are entering inside the blood vessel can you appreciate their entering so it is the entry of tumor cell in the lumen of the blood vessel the most important step but but blood vessel contains wbc now it contains it contains rbc also wbc also and plated also anything foreign coming in the blood is killed by the wbc so tumor cells are foreign wc should kill them you should ask me ma'am why wc are not killing them two muscles are foreign for the blood now as soon as they enter wbc should kill them tumor cells are very smart so what they do basically they will form a clone these are the tumor cells they will form a clone and they will cover themselves with rbc and platelet that is known as thrombus they will they will cover themselves from rbc and platelets so that wc cannot identify them so tumor cell will form a clone and they will cover themselves from self RBC and self platelet and they will travel from here and there so that WBC attack cannot happen right so that is known as thrombus formation so tumor cells are basically forming a thrombus if you can appreciate these are the tumor cells and if you can beautifully appreciate in this diagram these are the RBCs and platelet covering the thrombus so that WBC cannot attack it give me a thumbs up and they are traveling from here there everywhere in the human body at some distant organ of their choice whatever is the distant organ they are again coming out so this is the seventh step extravasation extravasation means again they come out can you see they are coming out see the arrow they are coming out of the lumen of the lumen of the blood vessel in some tissue extravasation and after coming out they will grow in that organ and they will form a secondary so the last step is formation of metastasis they will grow there angiogenesis will happen and they will form a secondary tell me the eight steps who will tell me the eight step tejaswini ashwini anmol kalma pratyaksha anyone what are the eight steps who will tell me the eight steps so close your eyes and just imagine what is happening if you know the basic diagram you can tell me the eight steps so the first step okay i will show you description also first step is the what is the first step the first step is aggressive clone formation it is the aggressive the clone proliferation and tumor heterogeneity will occur from the cluster of tumor few cells will separate they will show aggressiveness so tumor become heterogeneous now some are normal but some are aggressive so tumor heterogeneity is the term here you have to write right so this these two three cells become heterogeneous so tumor heterogeneity and these cells are becoming more aggressive second they will lose they will lose from the surrounding cells by loss of e cadherin you have to use the word e cadherin in the description right so e cadherin is the glue which is sticking which is sticking the multiple cells with each other they are losing the glue so that they become loose so first and second step is done now they will interact with ecm and degrade the ecm for interacting they require receptors so they will interact via laminin fibronectin vitro nactin collagen these are the these are the risk there are receptors on the surface of the tumor cells via which they will they will interact with these components of the ECM this is the composition of the ECM extracellular matrix have all these so by our receptors it is interacting with all kya humko andar aane do na so these all are not allowing so what next they will do they will just degrade it first they will ask the permission or nahi mili permission so they will just secrete the enzyme and degrade everything so they will secrete the enzyme and degrade it so which enzyme they will secrete protease they will secrete metalloproteinase uh they will secrete collagenase and multiple gelatinase collagenase multiple enzymes that will degrade the ecm that will degrade the ecm and after that they will enter inside the ecm so they will enter inside the ecm the four steps are done what is the fifth step entry of tumor cell inside the blood vessel can you see so the fifth step is the entry of tumor cell inside the blood vessel for which a factor is required which is known as autochrome mortality factor and they are entering inside after entering inside to prevent the attack of wbc they are covering themselves with rbc and platelet this is known as thrombus formation right so they the tumor cells are now covered with the with the circulating blood that is rbc platelet and they form a thrombus so thrombus hai 2 fayada hai ek to thrombus protect them from the immune attack of WBC and second thrombus provide them nourishment so double fayada right so double advantage thrombus formation after that they will move here and there and at some other side they will do extravasation so the next step is extravasation tumor cells attached to the vascular endothelium and they come out coming out is known as extravasate they just extravasate at some other side and whatever is the site they will grow there with the help of roe factor they will form a secondary mass metastasis there these are the eight steps the diagram was from hushmo and this diagram is from robbins giving the same information see this is the primary tumor see the cells of the primary tumor and see this is a blood vessel this is a longitudinal diagram this is the blood vessel see the endothelial cell and see the extracellular matrix between the two can you appreciate now these three cells they are becoming see the steps first clonal expansion and aggressiveness then the loosening is not written here they will lose a metastatic subclone is formed and they will lose they will lose right after losing they will interact with ecm and degrade the ecm right and intra position they will enter inside the blood vessel inside the blood vessel they will interact with the lymphoid cell that's why they form a embolus or a thrombus right they will form a thrombus after that they will move here and there and here they are doing extra position can you see so they are doing extra position and they are forming a metastatic deposit at some other point so same eight steps are there you can see these are losing after that they are interacting the ecm they are degrading the ecm they are entering the blood vessel see beautifully they are forming the thrombus this is the thrombus or emboli after that they are going to other side doing extra position and forming a secondary mass whatever diagram if you like this draw this write the eight steps if you like this draw this write the eight steps everyone give me a thumbs up everyone everyone i am done i am done with the benign and malignant uh differences so ultimately we have learned based on rate of growth benign and malignant tumors so these are slow these are fast based on clinical features these are asymptomatic these are symptomatic based on gross these are circular capsulated these are non-circular irregular and encapsulated based on microscopy the 10 features of anaplasia all of them is absent here all of them are present here you already know the 10 features hyperchromatism giant cell mitosis nc ratio and isonucleosis basal polarity you know everything you know everything so all the 10 features Based on spread of tumor, two spread, local invasion and metastasis.
Both are absent here, both are present here. Not only this, metastasis's three roots and the eight steps, you already know. Everyone give me a thumbs up.
So, I am done with benign and malignant tumor. I am done. Everyone give me a thumbs up.
So, these were the important points in neoplasia. I want to tell you, apart from this, some other important points are also there in the neoplasia. Genes are not really important for your university exam.
Some important genes are there, but not frequently they are asked. three more things here are important which are left number one carcinogenesis you cannot skip carcinogenesis it will be a 20 mark question carcinogenesis has to be done the three type of carcinogenesis physical chemical and biological right carcinogenesis one is paraneoplastic syndrome it will come three or five marks only paraneoplastic syndrome and one is tumor marker so three more questions are important from the chapter neoplasia but the time is over so i have to stop now so you can read it by yourself if you still find difficulty i can launch another lecture for the neoplasia i'm having a next lecture right now just after 15 minutes in which i'm going to take complete hemodynamics so i will teach you five things in that lecture in that lecture i will start with edema then i will move on congestion then i will move on hyperemia and congestion to hogia the second is thrombosis third is thrombosis then embolism and then shock so five topics all are 20 mark question it can become any of the five can come for 20 mark only congestion is five mark rest of them are long cushion the rest four edema can come for long cushion thrombus can come ambulance can come and shock can come so please don't miss my next lecture hemodynamics i will try to cover all five if time allows i will be fast and that is my next lecture uh just a second so just after 15 minutes with a break of 15 minutes the time was 10 but i'm already late so i will start at 10 15. after taking a break of 15 minutes i will start at 10 15 a.m sharp my next lecture uh you can find it on youtube only where you are attending right now on the same youtube channel that is unacademy live you will find me live at 10 15 sharp so i want everyone i want everyone to come back right we will discuss complete hemodynamics in a ultra fast manner starting with edema congestion thrombosis embolism shock five topics i will give 15 15 minutes to each topic so maybe one and half hour we will complete entire hemodynamics and one of the 20 mark question is fixed from this topic so don't dare to miss it so thank you very much for being with me for this lecture i hope you you learned it no it is not on the app mad mix it is on youtube only right so i hope you have learned new pleasure and don't forget to click on the like button of this lecture if you like it and please share the link on your badge group so that your friends colleagues everyone should get benefit of this free lecture if you like it and if you think it is useful so just a second there are few announcements for you for the students from the team give me a minute so thank you very much for being with me what is happening okay it is not responding just a second okay okay so yeah if you take an academy plus subscription plus our iconic subscription till 19th of may the 12 midnight you will get extra 20 off so this is the offer for limited period today is 18 till tomorrow night 12 pm uh you will get this offer so prize hike is coming soon after that the prices of the uh plus and iconic all the subscription will be hyped so this is an announcement from the team those students who want to grab this opportunity they can grab so an academy it is a light is already out in which you will get the test series only test series not the video recordings only test series for the from the team if you want you can take it these are the latest new batches which are launched by the team and you can take the benefit of all these if you take the subscription these are the various plants available with the team so we have plus plan these are the uh uh various subscriptions these are the plants in iconic these are the plants in light subscription these are the plan first probably you will get only three subject anatomy biochemistry and physio physiology for university exam and next these are the plants whatever plan suitable to you according to your choice according to your wish according to your requirement you can go with that plan if you apply my code sachdev10 s-a-c-h-d-e-v such dev is my surname without paste 10 on any of these plants such they can if you apply before payment you will get 20 off instead of 10 instead of 10 you will get 20 off if you take any of the offer before 19th may that is tomorrow thank you very much bye bye study hard all the best thank you for giving your precious time to me i would like to see you all after 15 minutes at 10 15 for hemodynamics bye i'm ending