Nonepithelial tumors actuality of the topic icon

Nonepithelial tumors actuality of the topic




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NONEPITHELIAL TUMORS

Actuality of the topic. The nonnepithelial tumors often take place, the immature tumors of this group are characterized by a complicated development and can cause death. The immature nonepithelial tumors often have the distinct cellular peculiarities that they lose the signs of tissue, they originated from, so there is a need to use histochemical, immunohistochemical and ultramicroscopic methods for establishing the correct diagnosis. It is necessary to be able to distinguish these tumors on the microscopic base, have the idea about the peculiarities of their hystogenesis, clinical development, complications, meaning for an organism. These knowledge and skills, gained at the lessons, are necessary for the doctors of every specialization, they also help at mastering the appropriate sections at the departments of radial diagnostics, therapy, surgery, oncology.

Aim: to be able to distinguish morphological peculiarities of mature and immature nonepithelial tumors.

Concrete aims Aims of the primary level

To be able to

1. Classify the nonepithelial tumors according to the origin of tissue.

1. Know the embryonic sources of development of nonepithelial tissues in the ontogenesis and their morphological peculiarities (normal anatomy and histology department).

2. Classify tumors of the connective tissue according to the degree of maturity and histogenesis, state their development and prognosis.

2. Distinguish the normal structure of connective, lipid, bony, cartilaginous tissues and types of cells in their composition (histology department).

3. Classify tumors of muscular tissue according to the degree of maturity and histogenesis, state development and prognosis.

3. Distinguish the normal structure of smooth and cross-striped musculature, localization of these tissues in the organs ( department of normal anatomy and histology).

4. Classify vascular tumors according the to degree of maturity and histogenesis, state development and prognosis.

4. Distinguish the normal structure of capillaries, arterial and vein vessels (normal anatomy and histology department).

5. Classify tumors of the nerve system according to the degree of maturity and histogenesis, state their development and prognosis.

5. Distinguish the normal structure of different sections of CNS, PNS, VNS, brain membranes, ependyma of ventricle and ventricle vascular plexus (normal anatomy and histology department).


6. Classify tumors of melanin-forming tissue, know the pretumor states, their development, prognosis.

6. Know the localization of melanocytes in organs and tissues (normal anatomy and histology department)


For you to know whether your primary level of knowledge corresponds to the necessary one, propose to complete several tasks.

Tasks for the self-control of primary level of skills-knowledge

Task № 1. During studying a skin tumor was stated that it has nonepithelial genesis, consists of prolonged cells fascicles, expressed desmins. Chose the possible source of its development:

  1. cuticle;

  2. sweat glands;

  3. sebaceous glands;

  4. hair follicle;

  5. muscle rising a hair.

Task № 2. During an operation a surgeon removed a tumor growing like a node. During the microscopic examination it was stated that its origin came from smooth tissue cells. In which of enumerated organs this node could localize?

  1. brain;

  2. heart;

  3. uterus;

  4. liver;

  5. kidney.

Task № 3. In the region of talocrural joint at a child was removed a node of dense, semitransparent, shining on the section surface homogeneous tissue. Which tissue this node can come from?

  1. bony;

  2. fibrillar connective;

  3. cartilaginous;

  4. lipid;

  5. smooth muscular.

Task № 4. Removed enlarged mesenteric lymphatic ganglia had the foci of black color, there was diagnosed the metastatic tumor from melanin forming cells during the histological examination. Point out an organ in which there are melanin producing cells as the most possible source of a tumor.

  1. kidneys;

  2. adrenal gland;

  3. pancreas;

  4. spleen;

  5. blind gut.

The keys for right answers for the self-control of the primary level of skills-knowledge: 1-5; 2-3; 3-3; 4-2.

The information necessary for completing of skills-knowledge can be found in the following literary sources:

  1. Привес М. Г., Лисенко Н. И., Бушкович В. И. Анатомия человека/М., «Гиппократ», 2001.- с.37-104, 153-231, 376-473, 479-636.

  2. Афанасьев Ю. И., Юрина Н. А. Гистология, цитология и эмбриология/М., Медицина.-1999.-с.93-137, 199-252, 253-267, 268-301.

The main theoretical questions on the base of which the aiming tasks are possible to complete:

  1. the definition of the nonepithelial tumors, classification.

  2. connective tumors: classification, localization, structure, development, prognosis.

  3. muscular tumors: classification, localization, structure, prognosis.

  4. vascular tissues: classification, localization, structure, development, prognosis.

  5. central, peripheral, vegetative nervous system tumors: classification, localization, structure, development, prognosis.

  6. melanin forming tissue tumors: classification, localization, structure, prognosis, pretumor states.

Literature for mastering skills-knowledge:

  1. Струков А. І., Сєров В. В. Патологічна анатомія/ Харків, «Факт».-1999.

  2. Лекции кафедры на тему: «Неэпителиальные опухоли»

  3. Граф логической структуры (приложение № 1)

Additional literature

  1. Шлопов В. Г. Основи патологічної анатомії людини/ Київ.-1999.-с.216-225.

  2. Серов В. В., Ярыгин Н. Е., Пауков В. С. Патологическая анатомия. Атлас./М., Медицина.-1986.

After studying the previous tasks for mastering skills-knowledge, the following aiming tasks are proposed to complete:

Task № 1. At a man, aged 45, there was removed a tumor of the front lobe of the brain. During the histological examination there was stated that a tumor is metastatic, consisting of polymorphic spindle-shaped cells. For stating the histogenesis there was made immonuhistochemical examination according medial filaments. There was found only vimentin in the tumor cells. What tumor metastasized in the brain?

  1. carcinoma;

  2. fibro sarcoma;

  3. leiomyosarcoma;

  4. rhabdosarcoma;

  5. melanoma.

Task № 2. At a woman, aged 53, there was found a tumor in the hip muscle, growing like a nod. The tumor was removed, during the operation it was stated to be connected with aponeurosis. During the microscopic examination it was stated that the tumor consists of moderate polymorphic fibroblastic cells with big nuclei and collagenic fibers, the cells and fibers fascicles are of different thickness and go in different directions. There are a great quantity of mitosises, pathological at the same time. Your diagnosis:

  1. fibroma;

  2. fibrosarcoma;

  3. leiomysarcoma;

  4. desmoid;

  5. leiomyoma.

Task № 3. At a woman, aged 50, during USE of uterus there were found two ganglia, situated subserously, about 6 sm in diameter each. The tumors were removed, during the microscopic examination there was diagnosed a fibromyoma of the uterus. What complication could develop at such localization of the tumor?

1. uterine bleeding;

2. parametritis;

3. pyelonephritis;

4. peritonitis;

5. metrovesical fistula.

Task № 4. During the post-mortal examination of a woman, aged 65, a pathologist discovered a neoplasm looking like a sharply separated ganglia of purple-blue color in the liver. The tissue resembles a sponge on the incision. During the microscopic examination it was stated that a tumor consists of thin-walled cavities of different sizes and shapes, filled with blood; the cavities are covered with one layer of mature endothelial cells. Your prognosis:

  1. capillary hemangioma;

  2. cavernous hemangioma;

  3. arterial hemangioma;

  4. vein hemangioma;

  5. glomusangioma.

Task № 5. There was found a tumor, 5 sm in diameter, at a man, aged 35 in the retroperitoneal space. The tumor was growing like a nod of dense consistency, sharply separated from surrounded tissues, of lobe structure on the incision. During the microscopic examination it was stated that the tumor is made of different in size groups of large, gigantic, round, processed cells with large light nucleus, great amount of cytoplasm, situated among the fascicles of podgy fibrillar connective tissue and neurotic fibers. Your diagnosis:

  1. neurinoma (schwannoma);

  2. neurofibromatosis;

  3. neuroblastoma;

  4. ganglioneuroma;

  5. glioblastoma.

Task № 6. During the post-mortal examination of a man, aged 52, a pathologist discovered a neoplasm on the skin of the back 3 sm in diameter, brown-black in color. Microscopic the tumor consists of polymorphic cells with large hyperchromic nuclei, there is a large quantity of mytosises, often – pathological. There are a lot of granules of brown pigment in the cytoplasm. There is a dense lymphocytic infiltrate on the tumor border. Your diagnosis:

  1. pigmental nevus;

  2. capillary hemangioma;

  3. cavernous hemangioma;

  4. melanoma;

  5. hemangioendothelioma.

Methodical instructions for students’ work at the practical lesson on the topic: “Nonepithelial tumors”

At the beginning you should check the correct answers of home assignment according to the keys. Your preparation for the lesson will be checked by the means of test-control. You must study the macro- and micropreparations, solve the situational tasks by yourself. The macroscopic forms of nonepithelial tumors are studied on the preparations “Fibromyoma of uterus”, “Melanoma metastasis into liver”, using the standard of the macroscopic diagnosis. On the microphoto- and micropreparations the morphology of “Fibromyoma of uterus” “Cavernous hemangioma of liver”, “Melanoblastoma of an eye”, “Ganglioneuroma” are studied and described, with the help of the standard of microscopic diagnosis of the tumors.

^ Technological scheme of the lesson

lesson

Stages

Time/min

Handouts

Equipment

Place

1.

Checking and correction of the primary level.

5

Tests tasks




Classroom

2.

Self-work. Description of the macro- and micro preparations.

60

Key of logical structure (addition № 1), algorithm of morphological tumor diagnostics. Algorithm of studying the macro- micro preparations.

Microscope, macro- micro preparations, micro photogramms




3.

Self-control and correction in mastering of the material.

30

Aiming tasks







4.

Final test-control

15

Collection of tests







5.

Summing up

10












Addition № 1

Key of logical structure on the topic: “Nonepithelial tumors”


Nonepithelial tumors




Tumors of connective tissue



Of fibrillar connective tissue Of lipid tissue Of cartilaginous tissue

↓ ↓ ↓ ↓ ↓ ↓ ↓

Mature Immature Mature Mature Immature Mature Immature

↓ ↓ ↓ ↓ ↓ ↓ ↓

Fibroma Fibrosarcoma Lipoma Hypernoma Liposarcoma Chondroma Chondrosarcoma


Of bony tissue

↓ ↓

Mature Immature

↓ ↓

Osteoma Osteosarcoma


Tumors of muscular tissue


Of smooth musculature Of skeletal musculature

Mature → leiomyoma Mature→ rhabdomyoma

Immature→ leiomysarcoma Immature→ rhabdomyosarcoma


Vascular tumors


Of bloody vessels Of lymphatic vessels

Mature Immature Mature Immature

↓ ↓ ↓ ↓

Hemangioma Hemangioendothelioma Lymphogioma Lymphogioendothelioma

Arterial

Venous

Capillary

Cavernous

Tumors of melanoforming tissue


Nevus ← tumoral state Immature → Melanoma


Addition № 1(continuation)

Key of logical structure on the topic: “Nonepithelial tumors”

Nonepithelial tumors




Tumors of neurotic system




Tumors of central neurotic system





Neuroectodermal tumors




Meningovascular tumors

Mature - Meningioma

Glial tumors

of vascular plexus of ventricle Immature- Malignant

plexus ependyma meningioma

↓ ↓ ↓

Mature- Medulloblastoma Mature Immature Mature- Ependimoma

Glioblastoma ↓ ↓ Immature- Ependimoblastoma

Astroblastoma choroidpapilloma choroidcarcinoma

Immature- Astrocytoma

Oligodendroglioma


Tumors of peripheral neurotic system

Mature Immature

↓ ↓

Neurofibroma Malignant neurinoma

Neurinoma



Tumors of vegetative neurotic system


Mature- Ganglioneuroma Immature- Ganglioneuroblastoma

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