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ЗмістThe specific goals: Purposes of the initial level
The flow chart of the occupation
Chronic By histogenesisis By histogenesisis
The appendix №1(Continuation)
Tumors of the hemopoietic tissue
Urgency of the theme: The diseases of the hemopoietic organs are widespread, are encountered in people of all age categories. Emergency on Chernobyl' AES led to an increase in the level of radioactive radiation in the territory of the Ukraine, which led to a sharp increase in the morbidity by leucoses and by lymphomas. The knowledge of essences and morphological manifestations of the tumors of hemopoietic cloth they are necessary for the successful instruction in the therapeutic departments, in particular, hematology, oncology, and also for the practical work of the doctor of any profile with differential diagnostics of different diseases and, correspondingly, of timely and correct designation of therapy purpose (associating): to understand the essence of the tumors of the hemopoietic organs, on the macro- and microscopic manifestations to determine the system and regional tumors of the hemopoietic organs, to treat their complications and value for the organism.
To know how:
so that you could explain, the initial level of your knowledge- skills does answer necessary, we propose to carry out number of problems.
in woman conducted the laboratory investigation of the blood. It is established that in it is anemia, thrombocytopenia, leukocytosis. Indicate a normal quantity of leukocytes in the blood.
in the man of 42 years revealed an increase in the lymphatic is main neck and an increase in the spleen. With an histological study the structure of lymph node is preserved, lymphatic follicles are increased, with the clearly expressed bright centers. Name the cells, which are appeared most numerous in the bright centers of lymphoid follicles?
3. plasma cells
4. dendritic cells
in the dead person of 46 years with the dissection bone marrow of the diaphysis of tubular bones is juicy, pink color. What color bone marrow of the diaphysis of tubular bones within the standard?
1. The red
The correctness of solution of problems proved, after comparing them with the standards of answers.
Standards of answers for the solution of problems for self-verification and self-control of the initial level of the knowledge- skills: the 1st; 2-5; 3-4.
The information, necessary for completing the necessary knowledge- skills can be found in the following literary sources:
1. increase in weight M.G., young fox N.I., Bushkovich V.I.// anatomy man- M., medicine, 200y.-S.ya""-ya"9.
2. Of afanas'ev YU.I., Yurina N.A. of //Gistologiya, cytology embryology- M., medicine, y999.-S.yashch2-ya"2.
The basic theoretical questions, on basis of which possibly the fulfillment of purposeful it is specific the activity:
1. classification of the tumors of the system of the blood. Essence of leucoses, their morphological characteristic. Classification of leucoses.
2. clinical-morphological special features of sharp and chronic leucoses.
3. myeloid and lymphoid leucoses: essence, morphology. Reasons of death of the patients with leucoses. 4. myeloma disease: form, localization, morphological manifestations in the bones, the kidneys.
5. classification of the regional tumors of hemopoietic tissue. Classification of nekhodzhkinskikh lymphomas according to the nature of increase, tsitogenezu, degree of maturity.
6. Hodgkin's Lymphoma: general characteristic, clinical-morphological of form. Histological versions of Hodgkin's lymphoma. Literature
Literature for mastering the knowledge- skills:
1. Strukov Of a.І., Sєrov EXPLOSIVES. Patology of anatomіya.-Kharkіv: "Fakt", y999.-S.29"-e22.
2. lecture of department for the theme: the "tumors of hemopoietic cloth".
3. graphs of the logical structure of theme (appendix №y)
4. algorithm of morphological diagnostics of the tumors of hemopoietic tissue (appendix №2)
the additional literature:
1. Shlopov V.G. Osnovi of patologіchnoїof anatomіїof lyudini.-Kiїv, y999.-S.и'-2yashch.
2. Serov EXPLOSIVES, Yarygin N.E., spiders V.S. pathologic anatomy. Atlas- M., Medicine, y98'.-S.и0-иshch.
After the study of the enumerated above literary sources for the self-verification of mastering material on this theme it is proposed to carry out the following purposeful tasks:
in woman with an histological study of the lymph node of mediastinum is revealed the diffuse growth of tumor cells of the type of lymphocytes. An additional study of bone marrow and spleen did not reveal changes. What tumor did develop in patient?
2. myeloid leucosis
3. lymphoid leucosis
4. myeloma disease
5. Of eritroleykoz.
in the child of 6 years on the skin appeared plural punctulate hemorrhages, in the cavity of mouth - ulcerous stomatitis. With a study of the peripheral blood are discovered anemia, leukocytosis (70 thousand on 1 l) with the presence of blast cells. With a study of the puncture specimen of bone marrow and lymphatic it is main - the massive growths of monomorphic cells with the rounded nucleus, the dense chromatin without the chromatospherite, the narrow rim of cytoplasm. What illness did develop in child?
1. plural myeloma;
2. sharp leucosis;
3. chronic leucosis;
4. generalizovannaya form (IV stage) of Hodgkin's lymphoma;
5. lymphoma Of berkitta.
With the dissection of the corpse of 23- summer woman it is revealed an increase in many groups of lymph nodes, spleen. Lymph nodes were the packets of solid consistency, in the section of whitish-grey color with the yellow- gray centers of necrosis. Spleen is increased, its pulp in the section red with the plural bel- yellow centers of necrosis and sclerosis, motley, "porphyritic" form. For what illness is characteristic this morphological picture?
1. myeloma disease
2. myeloid leucosis
3. Nekhodzhinskaya lymphoma
4. lymphoid leucosis
5. Hodgkin's lymphoma
with an histological study of bioptata from the knot in the vertebra anatomical pathologist revealed the growth of polymorphous cells with the eccentrically located nucleus and the amphophilic cytoplasm. In the surrounding bone cloth of the beam sharply of istoncheny (osteoporosis). What illness did develop in patient?
1. Hodgkin's lymphoma;
2. myeloma disease;
3. metastasis of cancer into the spine;
4. sharp lymphoid leucosis;
5. chronic myeloid leucosis.
in VIC- that infected of sick 37 years sharply increased neck lymph node to the right. Lymphoma is suspected. With a study of bioptata is advanced the diagnosis of high(ly)-malignant lymphoma. Which of enumerated lymphomas does have the worst forecast?
1. lymphoma Of berkitta;
2. smeshannokletochnyy version of Hodgkin's lymphoma;
3. nodulyarnaya lymphoma from the cells of follicular center;
4. small-celled lymphocytic lymphoma;
5. nodul4rno- sclerous form of Hodgkin's lymphoma.
in sick 19 years appeared subfebrile temperature, sweating, increased SOE, neck lymph nodes increased. With the microscopic examination of the biopsy of lymph node is noted the worn condition of figure due to the growth of the tumor tissue, which consists of a large quantity of cells of Berezovskogo- Sternberg and Hodgkin, generatrix large accumulations - symplasts, between which are located single small lymphocytes, plasma cells, eosinophils. Anatomical pathologist placed the diagnosis: Hodgkin's lymphoma. You will refine the histological version of disease in this patient?
1. nodular type of lymphoid predominance;
2. version with the predominance of lymphocytes;
3. nodul4rno- sclerous version;
4. smeshannokletochnyy version;
5. version with the suppression of the lymphoid cloth
The operating instructions for the work of students in the practical instruction: the "tumors of hemopoietic cloth"
In the beginning of occupation using the standards of answers the correctness of the solution of domestic task is checked. Then via test control will checked your preparation for the occupation. Independently you must study micro-preparations and, solve situation tasks by macro-. Macroscopic manifestations with the tumors of the system of the blood study in the preparations "bone marrow with the lymphoid leucosis", "bone marrow with the myeloid leucosis", "liver with myeloleukemia", "liver with lymphoid leukosis", "lymph nodes with the leucosis", "lymph nodes with Hodgkin's lymphoma", "spleen with Hodgkin's lymphoma". Use an "algorithm of differential diagnostics of the tumors of the system of the blood" (appendix №2). On the micro-preparations are studied the localization of tumor cells in the liver with the leucoses, cellular composition with the smeshannokletochnoy form of Hodgkin's lymphoma. In this case is used the "algorithm of differential diagnostics of the tumors of the system of the blood" (appendix №2) and the graph of logical structure "classification of the tumors of hemopoietic cloth" (appendix №y). With the aid of the microphotograms: "bone marrow with the leukemia", the "liver with the lymphoid leucosis", the "liver with myeloleukemia", "lymphoma of Hodgkin", "malignant lymphoma", and also tables on this theme it is necessary to obtain idea about the microscopic special features of different leucoses and regional tumors of the system of the blood. Occupation concludes with the analysis of the sums of the independent work of each student by checking the description of micro-preparations, test checking of the mastered knowledge.
the graph of the logical structure of the theme of the "tumors of hemopoietic tissue"
Системные опухоли кроветворной ткани
System tumours of
Classification on a picture of blood
Lymphatic knots are not increased 1.
1. All groups of lymphatic it is main are considerably increased, are formed the packets, soft, juicy, bel- pink color.
2. bone marrow is juicy, pink color.
3. spleen to 1 kg of red color.
1. Lymph nodes are insignificantly increased, sulfur- red color.
2. bone marrow is pioidnyy.
3. liver, spleen reach 6-8 kg 1
1.The lymph nodes of several groups are considerably increased, joined between themselves into the packets, grey-yellow color with the centers of caseous necrosis.
2. spleen is motley, "porphyritic.”
Lymph nodes of one of the groups are increased.
Increase in the lymph nodes of one localization or organ, the cloth of their bel- pink color
Localization in the upper or lower jaw, the ovaries, the kidneys, the adrenal glands in the children of 4-8 years, is more frequent of the African countries.
Hodgkin's lymphoma generalizovannaya
lymphoma of Hodgkin localized
lymphoma Of berkitta
Connective-tissue capsule, sines, lymphoid follicles in the crust, paracortical zone, cerebral zone.
1. Lymph nodes with the effaced structure, are diffuse infiltrated by the unripe cells of a lymphoid number. 2. leukemic infiltration of bone marrow, spleen, liver, myocardium, kidneys.
1. In bone marrow of flat and tubular bones diffuse infiltration by the unripe cells of a myeloid number
2. diffuse infiltration by the unripe cells of a myeloid number of the pulp of spleen, lymph nodes, liver.
In the lymph nodes, the spleen the diffuse proliferation of lymphocytes, histiocytes, giant cells of Hodgkin, Berezovskogo- Sternberg, the centers of caseous necrosis, sclerosis.
As with generalizovan- noy to form, only in one organ or lymph node.
The diffuse or nodulyarnoye growth of the unripe cells of a lymphoid number the tumor cells of average size,
Among them are scattered the large macrophages with the bright cytoplasm, which create the form of the "celestial sphere".
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