2009

MENTION :

a)

Squamous cell carcinoma More common in men Strong positive correlation with cigarette smoking Arise central in major bronchi and mestasize later Associated with hypercalcemia range from well differentiated with keratin pearls and intercellular bridges to poorly differentiated neoplasms

Adenocarcinoma Most common lung cancer in women Weakest association with smoking. All patients are non-smokers. Occurs as a peripheral mass especially in relation to lung scars Mucus secreting cell forming acini, papillae or solid mass

b) 1) HBV Infection. Chronic carrier state may confer a 200-fold increased risk for HCC. 2) HCV Infection 3) Liver cirrhosis 4) Aflatoxins

DISCUSS : a) Imbalance in gastro-duodonal mucosal defence mechanisms and damaging forces. Plus diagram in page 95 b) Injured hepatocytes and accumulated inflammatory cells release cytokines that stimulate ITO CELLS to form type 1 and type 3 collagen. By time, they transform to fibrous tissue that leads to destruction of the normal lobular architecture.

LIST : TABULATE DIFFERENCES : 1) Cholestrol Gallbladder stones More than 80% of gallstones Result from either increased cholesterol level or decreased bile salts in bile Pure : Usually solitary, oval in shape, pale yellow in color and may be translucent. Mixed : Formed of mixture of cholesterol, calcium carbonate, calcium phosphate and bilirubin. Multiple and faceted due to contact with eact other, and are radio opaque. Pigment Gallbladder Stones Less than 20% of gallstones Presence of excess unconjugated bilirubin in the biliary tree increases the likelihood of pigment stone formation Small, multiple, friable and black in colour. Stones are radio opaque.

Incidence Pathogenesis

Morphology

2) Centriacinar Proximal or central parts of the acini are affected while distal parts are not affected Associated with chronic bronchitis and in males, especially those who are heavy smokers Panacinar Affects the lower zones, the anterior margins of the lungs, and is most severe in the bases of the lobes Associated with 1- antitrypsin defeciency

EXPLAIN :

a ) Adenocarcinoma may occur in a majority of cases on top of Barrett s esophagus in which there is replacement of the normal distal stratified squamous epithelium of the esophagus by metaplastic columnar epithelium containing goblet cells. b) not in syllabus

PROBLEM : Aa) Pulmonary Tuberculosis b) Page 113 (buku basic general pathology) c) Page 118 (buku basic general pathology)

Ba) Colorectal Carcinoma b) Direct extension into adjacent structures. Lymphatic spread to regional lymph nodes. Hematogenous spread to liver, lungs and bones. Transcoelomic spread to serosal membranes of the peritoneal cavity, to the ovaries leading to krukenberg tumour. c) Environmental factors :  High content of Refined Carbohydrates stool bulk and toxic oxidative byproducts  High content of Fat - cholesterol , bile acids carcinogens  Low content of Unabsorbable vegetable fibres  Decreases intake of Vitamins A,C,E Precancerous lesions in the colon :  Inflammatory bowel disease especially ulcerative colitis  Adenomatous polyps especially large villous adenomas  Familial polyposis syndromes