University centre address and code No:

Role of CT Scan in detecting tumors

By

(Dinesh Kumar Ratnakar)

A project report submitted in partial fulfilment of the requirements for the degree of

Bachelor of Science- Health Information Administration of Sikkim Manipal University,

India

Sikkim Manipal University of Health, Medical and technological sciences

Distance education wing

Syndicate house

Manipal -576104
 I hereby declare that the project report entitled

(Role of CT Scan in detecting tumors)

Submitted in partial fulfillment of the requirements for the degree of Bachelor of Science
Health Information Administration to Sikkim Manipal University, India, is my original work
and not submitted for the award of any other degree, diploma, fellowship, or any other
similar title or prizes

Place: Lucknow (Dinesh Kumar Ratnakar)

Date: Reg. No: 610920574

Preliminary section

 Title of the project- Role of CT Scan in detecting tumors

 Chandan Institute of Medical Sciences Code: 2904

 Dinesh Kumar Ratnakar

 Date of submission
The projects taken though have a wide range of description to report. Then too this topic
has covered the analysis of few frequently occurring tumors in our regions. The data
presented are the description of the cases acquired in the radio diagnostic centre at
Lucknow.

I thank Mr. Mrityunjay and Dr. Gaurav Raj Agarwal to provide me guidance and
valuable suggestion time to time in compiling this project.
 Annexure - III (Examiner’s certification)

The project report of

(Dinesh Kumar Ratnakar)

(Role of CT Scan in detecting tumors)

Is approved and is acceptable in quality and form.

Internal Examiner External Examiners

(Name, qualification and designation) (Name & qualification)

 Annexure - IV (University learning centre certificate)

This is to certify that the project report entitled

(Role of CT Scan in detecting tumors)

Submitted in partial fulfilment of the requirements for the degree of

Bachelor of Science-Health Information Administration of Sikkim Manipal University of

Health, Medical and technological sciences

(Dinesh Kumar Ratnakar)

Has worked under my supervision and guidance and that no part of this report has been

submitted for the award of any other degree, diploma, fellowship or other similar titles or

prizes and that the work has not been published in any journal or Magazine.

(Regn. No) Certified

(Guide’s Name and Qualification)

 ACKNOWLEDGEMENT

My journey through the challenging assignment has enriched me with immense

knowledge, most invaluable experiences and sweet memories. Today, when my
endeavour has successfully reached its culmination, I look back with gratitude to one
and all whose generous help has made this dream come true. I feel short of words to
fully acknowledge the debts I owe to them.

I have not found words adequate enough to express my gratitude and reverence to my
chief guide, my esteemed teacher Mr. Mrityunjay, for his knowledge and valuable
guidance. His keen attention, constructive suggestion and constant help in day to day
work was a source of great encouragement to me without which, I am sure the present
work could never have seen the light of the day.

I will never be able to thank enough to my departmental staffs who helped me in imaging
recording and selection, graphical designing and typing of my thesis work. I will always
be thankful for their constant cooperation.

I have no words to thanks the writers of various books and Journals whose work I have
frequently consulted and quoted.

- Dinesh Kumar Ratnakar

 CONTENT

S. No. Particulars Pages

1. Introduction

2. Aims & Objects

3. Review of Literature

4. Material & Methods

5. Observation

6. Discussion

7. Conclusion

8. Bibliography

9. Appendix

10. Summary (Attached separately)

INTRODUCTION
Assessment of the clinical relevance of a widened or swelled parts detected on plain
radiography, ultrasound or palpable soft tissues superficially. Such widening or swelling
may be due to a normal anatomic variation, aneurysm, or a soft tissue mass (primary
neoplasm or enlarged lymph nodes). Comparison with any available previous
radiographs and clinical correlation are the initial stages in evaluating a tumor. Plain
skiagram may differentiate lesions from normal anatomical variations. It may indicate
differential diagnosis based on radiological signs. Conventional tomography,
fluoroscopic examination, or barium studies often confirm the presence of widened
tumor but rarely aid in defining the etiology. Distinction between a vascular and non
vascular mass on standard laminography is often difficult or impossible as is the
separation of benign cystic and fatty masses from solid lesions. Discovering the cause of
the tumors often has required invasive procedures.

Computed tomography (CT) has been described as a useful noninvasive modality in

evaluation of the significance and extent of tumors. Because of its superior contrast
resolution, it is also used to characterize the tissue component of masses. CT is also
useful for distinguishing vascular variants or benign processes of the tumors.

Advances in CT imaging such as spiral CT and multidetector-row spiral CT have further

improved the ability of CT to image the tumors. By significantly shortening scan time,
respiratory motion artifacts are limited and, in some instances, the total dose of iodinated
contrast medium can be reduced. Spiral CT and multidetector-row data sets can also be
effectively reconstructed in a variety of non axial planes. Two dimension (2D) and three
dimensional (3D) reconstruction techniques have proved most useful for imaging tumors.

AIMS AND OBJECTIVES

1. To study distribution of various tumors lesions using plain X-ray, ultrasound &
CT thorax in patients residing in and around Lucknow attending various
departments of institute and diagnostic centers, over a period of three months
extending from March , 2011 to June, 2011.

2. To compare radiological diagnosis with clinical diagnosis.

3. To correlate the radiological diagnosis with histopathological

diagnosis/preoperative findings, wherever possible.

4. To study the sensitivity of plain skiagram as a screening tool for tumors.

REVIEW OF LITERATURE
A tumor is an abnormal growth of body tissue. In general, tumors occur when cells divide
excessively in the body. Typically, cell division is strictly controlled. New cells are
created to replace older ones or to perform new functions. Cells that are damaged or no
longer needed die to make room for healthy replacements.

CT has revolutionized imaging of tumors and offers major advantages in detection and
characterization of tumors lesions when compared to radiograph and ultrasound.
Availability of spiral CT and multi detector row spiral CT in recent years have further
improved imaging of the tumors by significant reduction in scan time, respiratory motion,
cardiac motion, peristalsis artifacts and volume of intravenous contrast media.
Administration of intravenous contrast can differentiate vascular from non vascular
lesions or demonstrate effect of a lesion on adjacent vessels. Demonstration of invasion
of fat without compression of adjacent vessels strongly suggests malignant rather than
benign disease. This may also help in resectibility of mass lesion, planning treatment
and following response to therapy. Presence of other abnormalities in part of body in a
patient with tumors definitely influences the differential diagnosis. CT may provide image
guidance for biopsy or may help in determining the path for needle placement under
fluoroscopy.

Problems with the body's immune system can lead to tumors. If the balance of cell
division and death is disturbed, a tumor may form. Tobacco causes more deaths from
cancer than any other environmental substance. [1] Other causes include:

• Benzene and other chemicals and toxins

• Drinking too much alcohol

• Environmental toxins, such as certain poisonous mushrooms and a

type of poison that can grow on peanut plants

• Excessive sunlight exposure

• Genetic problems

• Obesity
 • Radiation

• Viruses

 Types of tumors known to be caused by viruses are:

 Cervical cancer (human papillomavirus)

 Hepatocellular carcinoma (hepatitis B virus)

Some tumors are more common in one gender than the other. Some are more common
among children or the elderly. Others are related to diet, environment, and family history.

Symptoms depend on the type and location of the tumor. For example, lung tumors may
cause coughing, shortness of breath, or chest pain. Tumors of the colon can cause
weight loss, diarrhea, constipation, iron deficiency anemia, and blood in the stool.

Some tumors may not cause any symptoms. In certain tumors, such as pancreatic
cancer, symptoms often do not start until the disease has reached an advanced stage.

The following symptoms occur with most tumors [1]:

• Chills

• Fatigue

• Fever

• Loss of appetite

• Malaise

• Night sweats

• Weight loss

Signs and tests

Like the symptoms, the signs of tumors vary based on their site and type. Some tumors
are obvious, such as skin cancer. However, most cancers cannot be seen during an
exam because they are deep inside the body.
When a tumor is found, a biopsy is performed to determine if the tumor is noncancerous
(benign) or cancerous (malignant). Depending on the location of the tumor, the biopsy
may be a simple procedure or a serious operation.
Most patients with tumors have CT or MRI scans to determine the exact location of the
tumor and how far it has spread. More recently, positron emission tomography (PET)
scans have been used to find certain tumor types.

Other tests include:

• Biopsy of the tumor

• Blood tests (to look for chemicals such as tumor markers)

• Bone marrow biopsy (most often for lymphoma or leukemia)

• Chest x-ray

• Complete blood count (CBC)

Treatment

Treatment varies based on:

• The type of tumor

• Whether it is noncancerous or cancerous

• Its location

If the tumor is benign (meaning it has no potential to spread) and is located in a "safe"
area where it will not cause symptoms or affect the function of the organ, sometimes no
treatment is needed.

Sometimes benign tumors may be removed for cosmetic reasons, however. Benign
tumors of the brain may be removed because of their location or harmful effect on the
surrounding normal brain tissue.

If a tumor is cancerous, possible treatments include:

 • Chemotherapy

• Radiation

• Surgery

• A combination of these methods

If the cancer is in one location, the goal of treatment is usually to remove the tumor with
surgery. If the tumor has spread to local lymph nodes only, sometimes these can also be
removed. If all of the cancer cannot be removed with surgery, the options for treatment
include radiation and chemotherapy, or both. Some patients need a combination of
surgery, radiation, and chemotherapy.

Lymphoma (cancer of the lymph glands) is rarely treated with surgery. Chemotherapy
and radiation therapy are most often used for treating lymphoma.

Support Groups

A cancer diagnosis often causes a lot of anxiety and can affect a patient's entire life.
There are many resources for cancer patients.

Expectations (prognosis)

The outlook varies greatly for different types of tumors. If the tumor is benign, the outlook
is generally very good. However, there are some instances where a benign tumor can
cause significant problems, such as in the brain.

If the tumor is malignant, the outcome depends on the type and stage of the tumor at
diagnosis. Some cancers can be cured. Some that are not curable can still be treated,
and patients can live for many years with the cancer. Still other tumors are quickly life-
threatening.
Complications

Complications can occur if a tumor is located in a region of the body where it affects the
function of the normal organ. If the tumor is malignant, it can also cause complications if
it spreads (metastasizes).

Calling your health care provider

Call your health care provider if you notice any suspicious lumps or bumps on your body,
or if you notice a new or changing mole on your skin.

Prevention

You can reduce the risk of cancerous (malignant) tumors by:

• Eating a healthy diet

• Exercising regularly

• Limiting alcohol

• Maintaining a healthy weight

• Minimizing exposure to radiation and toxic chemicals

• Not smoking or chewing tobacco

• Reducing sun exposure, especially if you burn easily

CT used in detecting tumors

Computed tomography is used in several ways:

• To detect or confirm the presence of a tumor;

• To provide information about the size and location of the tumor and
whether it has spread;
• To guide a biopsy (the removal of cells or tissues for examination under a
microscope);
• To help plan radiation therapy or surgery; and
• To determine whether the cancer is responding to treatment.

Expectations during the CT procedure

During a CT scan, the person lies very still on a table. The table slowly passes
through the center of a large x-ray machine. The person might hear whirring
sounds during the procedure. People may be asked to hold their breath at times,
to prevent blurring of the pictures.

Often, a contrast agent, or “dye,” may be given by mouth, injected into a vein,
given by enema, or given in all three ways before the CT scan is done. The
contrast dye can highlight specific areas inside the body, resulting in a clearer
picture.

Computed tomography scans do not cause any pain. However, lying in one
position during the procedure may be slightly uncomfortable. The length of the
procedure depends on the size of the area being x-rayed; CT scans take from 15
minutes to 1 hour to complete. For most people, the CT scan is performed on
an outpatient basis at a hospital or a doctor’s office, without an overnight hospital
stay.

Risks associated with a CT scan

Some people may be concerned about the amount of radiation they receive
during a CT scan. It is true that the radiation exposure from a CT scan can be
higher than from a regular x-ray. However,not having the procedure can be more
 risky than having it, especially if cancer is suspected. People considering CT
must weigh the risks and benefits.

In very rare cases, contrast agents can cause allergic reactions. Some people
experience mild itching or hives (small bumps on the skin). Symptoms of a more
serious allergic reaction include shortness of breath and swelling of the throat or
other parts of the body. People should tell the technologist immediately if they
experience any of these symptoms, so they can be treated promptly.

Spiral and Multidetector-row CT role in detection tumors

A spiral (or helical) and multidetectors-row CT scan are a new kind of CT. During
a these CT, the x-ray machine rotates continuously around the body, following a
spiral path to make cross-sectional pictures of the body. Benefits of spiral CT
include:

• It can be used to make 3–dimensional pictures of areas inside the body;

• It may detect small abnormal areas better than conventional CT; and
• It is faster, so the test takes less time than a conventional CT.
• Produce multiple images at a time.

Combined PET/CT scanning

Combined PET/CT scanning joins two imaging tests, CT and positron emission
tomography (PET), into one procedure. A PET scan creates colored pictures of
chemical changes in tissues. Because cancerous tumors usually are more active
than normal tissue, they appear different on a PET scan.

Combining CT with PET scanning may provide a more complete picture of a

tumor’s location and growth or spread than either test alone. Researchers hope
that the combined procedure will improve health care professionals’ ability to
diagnose cancer, determine how far it has spread, and follow
patients’ responses to treatment. The combined PET/CT scan may also reduce
the number of additional imaging tests and other procedures a patient needs.
However, this new technology is currently available only at some facilities.
TYPES OF TUMORS

A tumor or tumour is the name for a neoplasm or a solid lesion formed by an abnormal
growth of cells (termed neoplastic) which looks like a swelling[2]. Tumor is not
synonymous with cancer. A tumor can be benign or malignant, whereas cancer is by
definition malignant.

There are two basic types of tumors. One type of tumor is non-cancerous and referred to
as benign. The other type is cancerous and referred to as malignant.

BENIGN TUMOR

A benign tumor is a tumor that lacks the ability to metastasize. Benign tumors typically
are surrounded by an outer surface (fibrous sheath) that inhibits their ability to behave in
a malignant manner.

Benign neoplasms are typically composed of cells which bear a strong resemblance to a
normal cell type in their organ of origin.

These tumors are named for the cell or tissue type from which they originate, followed by
the suffix "-oma" (but not -carcinoma, -sarcoma, or -blastoma, which are generally
cancers).

For example, a lipoma is a common benign tumor of fat cells (lipocytes), and
a chondroma is a benign tumor of cartilage-forming cells (chondrocytes). Adenomas are
benign tumors of gland-forming cells, and are usually specified further by their cell or
organ of origin, as in hepatic adenoma (a benign tumor of hepatocytes, or liver cells).
There are a few cancers with 'benign-sounding' names which have been retained for
historical reasons, including melanoma (a cancer of pigmented skin cells,
or melanocytes) and seminoma (a cancer of male reproductive cells).[4]
Sign and symptoms

Benign tumors are very diverse, and may be asymptomatic or may cause specific
symptoms depending on their anatomic location and tissue type. Symptoms or
pathological effects of some benign tumors may include:

 Bleeding or occult blood loss causing anemia

 Pressure causing pain or dysfunction
 Cosmetic changes
 Itching
 'Hormonal syndromes' resulting from hormones secreted by the tumor
 Obstruction, e.g., of the intestines
 Compression of blood vessels or vital organs

MALIGNANT TUMORS

Cancers are classified by the type of cell that the tumor resembles and is therefore
presumed to be the origin of the tumor. These types include:

• Carcinoma: Cancer derived from epithelial cells. This group includes many of
the most common cancers, including those of
the breast,prostate, lung and colon.
• Sarcoma: Cancer derived from connective tissue, or mesenchymal cells.
• Lymphoma and leukemia: Cancer derived from hematopoietic (blood-forming)
cells
• Germ cell tumor: Cancer derived from pluripotent cells. In adults these are most
often found in the testicle and ovary, but are more common in babies and young
children.
• Blastoma: Cancer derived from immature "precursor" or embryonic tissue.
These are also commonest in children.
Cancers are usually named using -carcinoma, -sarcoma or -blastoma as a suffix, with
the Latin or Greek word for the organ or tissue of origin as the root.

For example,

a cancer of the liver is called hepatocarcinoma;

a cancer of fat cells is called a liposarcoma.

For some common cancers, the English organ name is used.

For example, the most common type of breast cancer is called ductal carcinoma of the
breast. Here, the adjective ductal refers to the appearance of the cancer under the
microscope, which suggests that it has originated in the milk ducts.

Sign and symptoms

Cancer symptoms can be divided into three groups:

• Local symptoms: are restricted to the site of the primary cancer. They
can include lumps or swelling (tumor), hemorrhage (bleeding from the skin,
mouth or anus), ulceration and pain. Although local pain commonly occurs in
advanced cancer, the initial swelling is often painless.
• Metastatic symptoms: are due to the spread of cancer to other locations
in the body. They can include enlarged lymph nodes (which can be felt or
sometimes seen under the skin),hepatomegaly (enlarged liver)
or splenomegaly (enlarged spleen) which can be felt in theabdomen, pain
or fracture of affected bones, and neurological symptoms.
• Systemic symptoms: occur due to distant effects of the cancer that are
not related to direct or metastatic spread. Some of these effects can
include weight loss (poor appetite and cachexia),fatigue,
excessive sweating (especially night sweats), anemia (low red blood cell count)
and other specific conditions termed paraneoplastic phenomena. These may be
mediated byimmunological or hormonal signals from the cancer cells.

None of these are diagnostic, as many of these symptoms commonly occur in

patients who donot have cancer.
Regional Tumors

Benign Tumor

• Brain

Adenoma, Meningioma

• Salivary Glands

Adenoma

• Nasopharyn

Angiofibroma

• Thyroid

Adenoma

• Parathyroid

Adenoma

• Lung

Carcinoid, Granular_Cell_Tumor, Hemangioma

• Breast

Schwannoma, Fibroadenoma, Papilloma

• Thymus

Thymoma

• Liver

Adenoma

• Adrenal
 Adenoma, Ganglioneuroma, Pheochromocytoma

• Kidney

Congenital_mesoblastic_nephroma

• Pancreas

Serous_Cystadenoma

• Colon

Adenoma, Polyposis

• Small Intestine

Adenoma

• Uterus

Cellular_Leiomyoma,

• Ovary

Mucinous_Neoplasm, Brenner, Cystadenoma, Dermoid, Fibroma, Fibrothecoma,

Granulosa_Cell_Tumor, Luteoma

• Soft Tissue

Cavernous_Hemangioma, Desmoid, Osteochondroma, Myelolipoma, Lipoma

• Bone

Cavernous_Hemangioma, Giant_Cell_Tumor

• Joint

Synovial_chondromatosis
Malignant Tumor

• Adrenal

Adenocarcinoma, Ganglioneuroblastoma, Neuroblastoma

• Appendix

Adenocarcinoma

• Colon

Adenocarcinoma, Carcinoid, Carcinoma, Liposarcoma

• Esophagus

Adenocarcinoma, Carcinoma, Squamous_Cell_Carcinoma

• Gall Bladder

Adenocarcinoma

• Lung

Adenocarcinoma, Adenosquamous_Carcinoma, Bronchiolo_alveolar_Carcinoma,

Carcinoid,_Atypical, Lymphoma, Metastatic_Carcinoma

• Pancreas

Adenocarcinoma

• Prostate

Adenocarcinoma

• Renal Pelvis

Adenocarcinoma

• Small Intestine

Carcinoid, Leiomyosarcoma, Metastatic_Adenocarcinoma

• Spleen

Adenocarcinoma

• Stomach

Adenocarcinoma, Carcinoma

• Uterus

Adenocarcinoma_of_Cervix, Endometrium, Adenosquamous_Carcinoma,

Sarcoma

• Ovary

Adenosarcoma, Clear_Cell_Carcinoma, Cystadenocarcinoma, Dysgerminoma,

LeiomyosarcomaEndometrioid_Carcinoma, Germ Cell Tumor,
Teratoma_Immature

• Brain

Astrocytoma, Ependymoma, Glioblastoma, Lymphoma, Metastatic_Carcinoma,

Oligodendroglioma

• Skin

Basal_Cell_Carcinoma, Dermatofibrosarcoma

• Sinus

Carcinoma

• Thyroid

Carcinoma

• Bone

Chondrosarcoma, Multiple_myeloma, Metastatic_adenocarcinoma,

Osteosarcoma

• Cartilage
 Chondrosarcoma

• Breast

Comedo_Carcinoma, Ductal_Carcinoma

• Appendix

Cystadenocarcinoma

• Testis

Endodermal_sinus_tumor, Seminoma

• Liver

Hepatoblastoma, Hepatocellular_Carcinoma, Lymphoma,

Metastatic_Adenocarcinoma

• Soft Tissue

Histiocytoma, Liposarcoma, Sarcoma

• Lymph Node

Hodgkins_Disease, Lymphoma, Melanoma

• Kidney

Liposarcoma, Neuroblastoma, Wilms_tumor

• Skin

Melanoma

• Thymus

Thymoma_Malignant
Causes of Tumor (Bening and Malignant)

Cancer is caused by several factors. These can be classified into the following:

• Heredity
• Tobacco smoking
• Spicy diet
• Sunlight
• Viruses
• Chemicals
• Radiation
• Occupational hazards like chimney sweepers
• Hormone producing tumors
 Common sites of tumor and cancers

Common causes

Chemicals

Cancer pathogenesis is traceable back to DNA mutations that impact cell growth and
metastasis. Substances that cause DNA mutations are known as mutagens, and
mutagens that cause cancers are known as carcinogens. Particular substances have
been linked to specific types of cancer. Tobacco smoking is associated with many forms
of cancer,[4] and causes 90% of lung cancer.[5]

Alcohol is an example of a chemical carcinogen that is not a mutagen.[6]

Decades of research has demonstrated the link between tobacco use and cancer in
the lung,larynx, head, neck, stomach, bladder, kidney, esophagus and pancreas.[8]

Radiation

Up to 10% of invasive cancers are related to radiation exposure, including both ionizing
radiation and non-ionizing radiation.[9] Additionally, the vast majority of non-invasive
cancers are non-melanoma skin cancers caused by non-ionizing radiation
from ultraviolet radiation.

Medical use of ionizing radiation is a growing source of radiation-induced cancers.

Ionizing radiation may be used to treat other cancers, but this may, in some cases,
induce a second form of cancer.[10] It is also used in some kinds of medical imaging. One
report estimates that approximately 29,000 future cancers could be related to the
approximately 70 million CT scans performed in the US in 2007.[11] It is estimated that
0.4% of current cancers in the United States are due to CTs performed in the past and
that this may increase to as high as 1.5–2% with 2007 rates of CT usage.[12]

Prolonged exposure to ultraviolet radiation from the sun can lead to melanoma and other
skin malignancies.[13] Clear evidence establishes ultraviolet radiation, especially the non-
ionizing medium wave UVB, as the cause of most non-melanoma skin cancers, which
are the most common forms of cancer in the world.[13]

Diet and exercise

Diet, physical inactivity, and obesity are related to approximately 30–35% of cancer
cases.[14] Physical inactivity is believed to contribute to cancer risk not only through its
effect on body weight but also through negative effects on immune
system and endocrine system.[15]

Diets that are low in vegetables, fruits and whole grains, and high in processed or red
meats are linked with a number of cancers.[14] A highsalt diet is linked to gastric cancer, a
frequent food contaminate, with liver cancer, and Betel nut chewing with oral cancer.[15]
Infection

Worldwide approximately 18% of cancers are related to infectious diseases.[9]

Viruses are usual infectious agents that cause cancer but bacteria andparasites may
also have an effect.

A virus that can cause cancer is called an oncovirus. These include cervical
carcinoma, and nasopharyngeal carcinoma, Sarcoma and primary effusion
lymphomas, hepatitis B and hepatitis C viruses (hepatocellular carcinoma). Bacterial
infection may also increase the risk of cancer, as seen in induced gastric carcinoma.[18]

Heredity

Less than 0.3% of the population are carriers of a genetic mutation which has a large
effect on cancer risk.[19] They cause less than 3–10% of all cancer.[19] Some of
these syndromes include:

 certain inherited mutations in the genes with a more than 75% risk of breast
cancer and ovarian cancer[19]
 tumors of various endocrine organs in multiple endocrine neoplasia
 various tumors such as osteosarcoma, breast cancer, soft tissue sarcoma, brain
tumors due to mutations
 brain tumors and colonic polyposis
 adenomatous polyposis an inherited mutation of the gene that leads to early
onset of colon carcinoma.
 Retinoblastoma, when occurring in young children, is due to a hereditary
mutation in the retinoblastoma gene.
 Down syndrome patients, who have an extra chromosome 21, are known to
develop malignancies such as leukemia and testicular cancer, though the reasons
for this difference are not well understood.
Physical agents

Some substances cause cancer primarily through their physical, rather than chemical,
effects on cells.[20]

A prominent example of this is prolonged exposure to asbestos, naturally occurring

mineral fibers which are a major cause of mesothelioma, a type of lung cancer.
Nonfibrous particulate materials that cause cancer include powdered
metallic cobalt and nickel, and crystalline silica .[20]

Usually, physical carcinogens must get inside the body (such as through inhaling tiny
pieces) and require years of exposure to develop cancer.[20]

Physical trauma and inflammation

Physical trauma resulting in cancer is relatively rare.[21] Claims that breaking bone
resulted in bone cancer, for example, have never been proven.[21] Similarly, physical
trauma is not accepted as a cause for cervical cancer, breast cancer, or brain cancer.[21]

One accepted source is frequent, long-term application of hot objects to the body. It is
possible that repeated burns on the same part of the body, may produce skin cancer,
especially if carcinogenic chemicals are also present.[21] Frequently drinking scalding hot
tea may produce esophageal cancer.[21]

Generally, it is believed that the cancer arises, or a pre-existing cancer is encouraged,

during the process of repairing the trauma, rather than the cancer being caused directly
by the trauma.[21] However, repeated injuries to the same tissues might promote
excessive cell proliferation, which could then increase the odds of a cancerous mutation.
There is no evidence that inflammation itself causes cancer.[21]

Hormones

Some hormones factor in the development of cancer by promoting cell proliferation.

[22]
Hormones are important agents in sex-related cancers such as cancer of the
breast, endometrium, prostate, ovary, and testis, and also of thyroid cancer and bone
cancer.[22]

An individual's hormone levels are mostly determined genetically, so this may at least
partly explains the presence of some cancers that run in families that do not seem to
have any cancer-causing genes.[22] For example, the daughters of women who have
breast cancer have significantly higher levels of estrogen and progesterone than the
daughters of women without breast cancer. These higher hormone levels may explain
why these women have higher risk of breast cancer, even in the absence of a breast-
cancer gene.[22]

However, non-genetic factors are also relevant: obese people have higher levels of
some hormones associated with cancer and a higher rate of those cancers.[22] Women
who take hormone replacement therapy have a higher risk of developing cancers
associated with those hormones.[22] On the other hand, people who exercise far more
than average have lower levels of these hormones, and lower risk of cancer.
[22]
Osteosarcoma may be promoted by growth hormones.[22] Some treatments and
prevention approaches leverage this cause by artificially reducing hormone levels, and
thus discouraging hormone-sensitive cancers.[22]

Other

Excepting the rare transmissions that occur with pregnancies and only a marginal few
organ donors, cancer is generally not a transmissible disease. Pregnant women having
a malignancy and transplacental transmission of acute
leukaemia, lymphoma, melanoma and carcinoma from mother to fetus has been
observed.[23]

The development of donor-derived tumors from organ transplants is exceedingly rare.

Material & Methods

A prospective study was undertaken on the patients in institutes and diagnostic

centers of Radiodiagnosis, Lucknow from March 2011 to May 2011. All patients
with probable clinical diagnosis of tumor lesions (based on subjective and
objective criteria of swelling and widening) and those found to have tumor lesions
were included in the study. They were investigated and provisional differential
diagnosis reached.

This was confirmed by the preoperative and Histopathological diagnosis, where

ever required.

Exclusion and inclusion criteria.

Exclusion criteria.

1. Patients with a known diagnosis prior to CT study, done merely to establish

extent of disease.

2. Patient with known sensitivity to radio contrast agents.

3. Pregnant patients.
Inclusion criteria.

1. Chronic Swelling on skin of different parts of body.

2. Symptom for specific tumors with respect to age.

3. Post contrast enhancement of the lesion.

4. Subjective change in the normal contours of tumors based on obliteration/

displacement of different organs lines. Any one or more of the above criteria on
plain skiagram, ultrasound, previous CT and clinical findings.

Routine imaging of tumors is done as follows:

Whole body spiral CT scan into.

SIEMEN’S SOMATOM ESPRIT+

Having 65cm gantry aperture, X-Ray tube of 2MHU, FOV 50mm-500mm with rotating
anode and slip ring technology.

- Minimum slice thickness : 1mm

- Minimum scanning time: 1sec

- With maximum 130kv and 180 mA

PHILIPS BRILIANCE 64 slice

Having 65cm gantry aperture, X-Ray tube of 2MHU, FOV 50mm-500mm with rotating
anode and slip ring technology.
Study had been performed on all the patients referred to department of radio diagnosis,
presenting with swelling or widening on plain skiagram, Ultrasound or clinical
observation and CT finding had compared with clinical diagnosis, Histopathologically
and preoperative findings.

Study comparised of following heads

1. Incidence rate in tumors (solid+cystic), all age groups.

2. Incidence rate of primary tumors in children’s.

3. Age related distribution of tumors.

4. Sex related distribution of tumors.

5. Percentage wise distribution of presenting symptoms in patients with tumors.

6. Distribution of tumors lesions on the basis of benign lesions/ malignant lesions.

7. Distribution of tumors lesions on the basis of consistency.

8. The utility of CT in the evaluation of tumors size and spreading.

To study efficiency and sensitivity of CT scan to diagnose tumors lesions and to

compare radiological diagnosis with histopathological findings.

The findings were subjected to statistical analysis, test of significance and sensitivity,
specificity, positive predictive value and negative predictive value with reference to
various parameters were calculated.

Limitations of the study

Since it was a three months study, shows the number of cases were rather small. But
still statistical significance has been seen. Those patients with tumors on plain skiagram,
Ultrasound and clinically who could not afford CT scan for financial reasons have to be
dropped (thus 13 patients were dropped out of 73 cases). Pregnant patients could not be
included in this study. Those patients who were sensitive to radio contrast agents could
not included in this study. It is suggested that studies on larger number of patients for
longer period of time will provide better information.

Ethical Issues Involved

1. Informed consent was taken from parents/ guardian of all the subjects
enrolled in the study.

2. Expenses of the cases in the study- investigations were done at a subsidized

rate.

3. The study was approved by the institutional ethical committee.

4. Those patients who were not showing tumors on plain skiagram could not be
subjected to CT scanning because neither would they get referred for CT
evaluation nor they were willing to pay without any definite indication. Further,
it is unethical to expose any person to radiation without proper indication just
for the sake of study design.

OBSERVATION

In present study

Three month prospective study on included 50 cases, which were showing tumor
on plain skiagram, ultrasound or clinically, but final study comprised of only 45 cases
presenting with tumor masses or lesions, however, 5 cases were abandoned due to
patients unable to afford CT scan.

In present study 40 cases with tumor lesions on skiagram, ultrasound or clinically were
included.

 CT scan of all 40 cases was available.

 Histopathological / Biopsy report of 25 cases were available.

The observations of the cases are given in the following tables:-

Table-6

Distribution of mediastinal masses (solid+cystic), all age group (in present

study)

Type of tumors Cases Precentage

Neurogenic Tumors 5 8.3%

Thymoma 3 5.0%

Lymphoma 10 16.7%

Teratoma 1 1.7%

Secondaries 6 10.0%
Inflammatory 6 10.0%

Cystic masses 5 8.3%

Fat containing masses 3 5.0%

Thyroid 1 1.7%

Vascular 5 8.3%

Primary Carcinoma 5 8.3%

Non Mediastinal 10 16.7%

Total 60 100.0%

Incidence rates of mediastinal lesions (% wise) were Lymphomas(16.7%) followed

by Secondaries & Inflammatory (10% each),Vascular,Cystic& Primary(8.3%each),
Thymomas&Fat Containing (5.4% each )&Non Mediastinal lesions(16.7%), Fat
Containing Masses,Thyroid(1.7%)
 Table -7

Distribution of mediastinal lesions in children

Type of tumors Cases Precentage

Neurogenic Tumors 3 21.4%

Lymphoma 0 0.0%

Germ Cell Neoplasm 0 0.0%

Primary Carcinoma 0 0.0%

Cystic masses 4 28.6%

Other 6 42.9%

Total 13 92.9%

Incidence rates of mediastinal lesions in childrens are neurogenic (42.9%) followed

by and Cystic lesions (14.3%)

Table-8

Age wise distribution in present study of mediastinal masses

Age Cases Precentage

0-10 7 14.0%

11-2O 4 8.0%

21-30 2 4.0%

31-40 6 12.0%

41-50 9 18.0%

51-60 13 26.0%

61-70 6 12.0%

71-80 3 6.0%
Table-6 : Distribution of mediastinal masses (solid+cystic),

all age proup (in present study)

Table -7 : Distribution of Primary Mediastinal Tumors & cysts in
children
Table-8 : Age wise distribution in present study of mediastinal masses
Table -9 Sex wise distribution of mediastinal masses
Table-10 Compartment wise distribution of mediastinal masses.
Table-11a Compartment wise distribution of various lesions
Table-11b Compartment wise distribution of various lesions
Table-11c Compartment wise distribution of various lesions
Table-12 Presenting Symptoms in patients with mediastinal
mass
Table-13 Distribution of Mediastinal lesions on the basis of nature of
lesion (benign / malignant)

Total number of cases studied=37

Table-14 Distribution of Mediastinal lesions on the basis of consistency.

 DISCUSSION

A prospective study was carried out from September 2007 to January 2009 which
included 73 cases, which were showing mediastinal widening on plain skiagram, however,
13 cases were abandoned due to inability of patients to afford CT scan (Thorax).

In present study, 60 cases with mediastinal widening on plain skiagram were

included.
9. CT Scans of 60 cases were performed on Helical CT (Single Slice) Siemens,
Somatom Esprit +, Scans were obtained in full inspiration using 1 cm collimation
at 1cm or 2 cm intervals. Scans were performed routinely after contrast
administration. Thin slices were taken, wherever required. Histopathological /
Biopsy report of cases were available. The utility of CT in the evaluation of
mediastinal widening was categorized as followed:

a. Incorrect

b. Indeterminate, CT was unable to determine whether a normal variant, soft

tissue density mass or a vascular abnormality had produced the
mediastinal widening.

c. Correctly differentiated a soft tissue density mass from a mass or a

vascular abnormality. However further evaluation of the tissue density mass
or vascular abnormality was required for specific diagnosis.

CT interpretation was diagnostic and obviated further evaluation.

Out of 60 cases presenting with mediastinal widening on plain skiagram, CT

identified 10 cases that were due to non mediastinal etiology. These cases included cases
of pneumonitis, lung aplasia, pleural effusions, cystic adenomatoid malformation;
mesothelioma etc. So finally 50 cases were left in the study. Sensitivity of X-ray as
compared to CT scan is (83.3%, 95% C.I.: 73.9% - 92.7%)

In 5 out of 50 cases, vascular causes were responsible for mediastinal widening.

CT correctly demonstrated the vascular cause of abnormality in all cases including two
cases of aneurysm of aorta, two cases of tortuous great vessels and one normal variant of
pulmonary vessels. In all these cases, CT obviated further investigation (category D)

Table 15

Vascular causes of mediastinal widening.

Aetiology No. of Cases CT Category

A B C D

Aortic aneurysm 2 2
Tortuous vessels 2 2

Large Pulmonary Art. 1 2

Total 5 5

In 23 of the 50 cases, mediastinal widening was produced by benign avascular

causes. In all cases, an explanation for the chest radiograph abnormality was suggested
by CT. In 8 cases, a definitive diagnosis was established requiring no further evaluation
(Category D): These included 4 mediastinal cysts, 3 mediastinal lipomatosis and one
retrosternal thyroid.

In the remaining 15 cases, CT showed lesions which required further investigations

for establishing a final diagnosis.

Table 16

Benign causes of mediastinal widening

Etiology No. of cases CT category

A B C D

Inflamatory 8 8

(Solid&Cystic)

Lipomatosis 3 3

Cystic Masses 4 4

(Congenital)

Thymoma 3 3

Benign Neurogenic 3 3
Tumour

Teratoma 1 1
Thyroid 1 1

Total 23 15 8

CT correctly identified malignant masses in 22 patients. These included 10

lymphomas, 6 metastases to mediastinal lymph nodes and 6 primary neoplasms (4
Bronchogenic Carcinoma and 2 malignant neurogenic tumors). Further evaluation was
required in 18 cases for establishing definitive diagnosis. In all primary bronchogenic Ca,
lesions were present in thorax which made H/P examination redundant.

Table 17

Malignant masses producing mediastinal widening

Etiology No. of Cases CT Category

A B C D

Primary Neoplasm 6 2 4

Lymphoma 10 10

Metastases 6 6

Total 22 18 4

In final analysis, CT correctly identified 10 of the 60 cases presenting with

mediastinal widening on plain skiagram to be due to non mediastinal lesions, and 17 of the
50 mediastinal lesions were diagnostically identified, thus obviating further investigations.
However, 33 of the remaining 50 cases required further investigation for diagnostic
identification.

Statistical Analysis

1. Total number of cases studied, presenting with mediastinal widening 73.

2. Total number of cases followed with CT scan 60.

3. Lesions correctly identified to be due to non-mediastinal causes 10.

4. Lesions correctly identified to be due to mediastinal causes 50.

5. Histopathological / FNAC done 40.

6. Definitive mediastinal diagnosis made by CT 17.

a) Benign 13

b) Malignant 4

7. Mediastinal lesions detected by CT, but definitive benign / malignant nature not
ascertained 33.

Table 18

Association between CT and Gold standard (n=60) in cases presenting with

mediastinal widening

CT Scan Test Final Diagnosis

Mediastinal Mediastinal
(Definite)
Lesion Present Lesion Absent
Positive 17 (a) 0 (b)
Negative 0 (c) 10 (d)
Total 50 (a+c) 10 (b+d)

Sensitivity = a/(a+c) = (17/50)x100 = 34% C.I.(25.4%,42.6%)

Specificity = d/(b+d) = (10/10)x100 = 100%

Table 19
 Association between CT Diagnosis and X- ray Finding (n=60)

Mediastinal CT Findings Total

Mediastinal Mediastinal
Widening
Lesion Present Lesion Absent
X- RAY

Abnormal 50 10 60

Plain X-ray chest was able to detect correctly 50/60X100= 83.33% mediastinal lesions in
patients presenting with mediastinal widening, considering CT as a Gold standard.

Table 20

Association between CT Diagnosis and nature of lesion (n=50)

CT Scan Test Final Diagnosis Total

Benign Non Benign
(Definite)
Mediastinal
Mediastinal
Lesions
Lesions
Positive 13 (a) 4 (b) 17 (a+b)
Negative 15(c) 18 (d) 33( c+d)
Total 28 (a+c) 22 (b+d) 50

Sensitivity = a/(a+c) = (13/28)x100 = 62.9% C.I.(52.3%,72.5%)

Specificity = d/(b+d) = (18/33)x100 = 81.8% C.I.(74.2%,89.4%)

PPV = a/(a+b) = (13/17)x100 = 76.4% C.I.(67.9%,84.8%)

NPV = d/(c+d) = (18/33)x100 = 54.5% C.I.(44.6%,64.4%)

Over all distribution of mediastinal lesions (percentage wise), lymphoma (16.7%)

followed by inflamatory (10%), secondaries (10%), neurigenic tumors (8.3%), primary
carcinoma (8.3%), vascular (8.3%), fat containing masses (5%), thymoma (5%), while
the western studies (by Levy 1973, Ovrum etc.) suggested as below:

INCIDENCE RATES OF PRIMARY MEDIASTNAL TUMORS AND CYSTS

Type of Vidne and Dvrum and Nandi et Adkins et Parish et Duke medical Total % Percentage
Tumours Levy 1973 Birkeland al 1980 al 1984 al 1984 center 1998
Neurogenic Tumor 9 19 27 8 212 71 510 20
Thymoma 9 10 18 4 206 94 484 19
Lymphoma 6 11 4 7 107 77 316 13
Germ Cell neoplasm 3 5 7 11 99 53 250 10
Prmary carcinoma 2 9 0 5 25 37 114 5
Mesenchymal tumor 4 4 2 0 60 29 144 6
Endocrine tumor 2 21 6 2 56 19 197 6
Other 1 2 1 1 36 10 65 3
Cysts 8 10 9 0 196 124 464 18
Pericardial 2 7 2 0 72 45 153 6
Bronchogenic 2 0 0 0 54 38 160 6
Entire 1 0 0 0 29 12 56 2
Other 3 3 7 0 41 19 95 4
Total 44 91 74 38 997 514 2504

The difference is probably due to following reasons:

a. Different demographic profile and incidence of mediastinal disease in western

studies.

b. Non inclusion of secondaries and inflammatory lesions in

above mentioned western studies and which form a significant part of spectrum in
developing countries.

c. The prevalence of different lesions is different due to

different patient input in particular hospitals catering to specific specialties and non
detection of slow growing lesions (eg. Benign posterior mediastinal lesions)
coupled with lack of awareness and investigative facilities in developing countries.

Largest number of mediastinal lesions were noted in sixth decade (26%) followed
by fifth (18%), first (14%), and fourth (12%). This was similar to as seen in the western
studies.

60% males were affected while 40% female affected by mediastinal lesions. This
discrepancy was probably due to less female coming to the hospitals for treatment and
due to lack of certain risk factors (eg. Smoking).

Percentage wise distribution of various mediastinal lesions in various

compartments; anterosuperior 34%, middle 24%, posterior 10% and multiple 32%, while
study by Azrow 1993 et al has suggested the following percentages; in adults, anterior
56%, middle 18%, posterior 26%; in children, anterior 42%, middle 18%, posterior 40%.
Both study show maximum lesions from anterior mediastinum while different in other
compartments which may be due to separation of adult and child populations in Azrow’s
study.

In our study, in anterosuperior compartment vascular lesions (29.4%) was most

common followed by lymphoma (23.5%) and thymoma (17.6%) while in western studies
(referred table no. :) thymoma (31%) followed by lymphoma (23%). This discrepancy is
probably due to non inclusion of vascular causes in their studies.

Cystic lesions and secondaries (33.3% each) were most common in our study,
while cystic lesions followed by lymphomas were most common in western studies.

In posterior mediastinum, neurogenic tumors were as common as western studies.

Most of the mediastinal lesions presented clinically with chest pain (21%) followed
by dyspnoea (17%), cough (13%), fever (10%), myasthenia gravis (7%). This was nearly
similar to western studies (referred table no.: ).

Benign lesions in this study were 60% and malignant were 40%.

All cases of mediastinal lipomatosis, vascular and cystic lesions could be

definitively diagnosed and no further investigation was required. This was similar to as
suggested by previous studies of Baron 1981, Chauhan 2001, Boiselle 2001, Santosh
Kumar 2007, Thulkar Sanjay 2007.
 CONCLUSION

A prospective study was carried out from September 2007 to January 2009 in which 73
cases, who showed mediastinal widening on plain skiagram were, advised CT (Thorax)
examination, however, 13 cases were abandoned due to inability of patients to afford CT
(Thorax).

Out of 60 cases, 10 cases were found to be due to non mediastinal aetiology, 5

cases were found to be due to vascular causes, 23cases due to non vascular benign
aetiology and 22 cases due to malignant aetiology.

1. Overall, the commonest lesion in the current study was lymphoma (16.7% and the
rarest were fat containing masses (5%).
2. In children the commonest lesion were cystic masses (28.6%) followed by
neurogenic tumors (21.4%).

3. Largest number of mediastinal lesions were noted in sixth decade (26%), and least
in third ( 4%) decade

4. 60% males were affected while 40% females were affected

5. Commonest compartment with mediastinal lesions was anterosuperior (34%) and

the least common was posterior (10%)

6. a) Vascular lesions were most common in anterosuperior compartment.

b) In middle mediastinum, cystic lesions and secondaries (33.3%) were most

common.

c) In posterior mediastinum, neurogenic tumors were most common.

7. Most of the mediastinal lesions presented with chest pain (25%) followed by
dyspnoea (17%), cough (13%), fever (10%), myasthemia gravis (7.1%).

8. Overall, benign lesions were 60% and malignant were 40%.

9. All cases of mediastinal lipomatosis, vascular and cystic lesions could be definitive
diagnosed.

10. Chest X-ray proved to be a sensitive screening test and in 83.3% of cases, it could
definitively diagnose mediastinal lesions as cause of mediastinal widening on plain
skiagram. Thus it is a good first line screening test.

11. In definitively diagnosing a mediastinal lesion (compared to gold standard), CT was

found to be moderately sensitive and highly specific modality.

12. In confirmatively differentiating benign lesion from malignant lesion, CT was found
to be moderately sensitive and highly specific with good positive predictive value.
Thus, CT appears to be a good first follow up modality in cases presenting with
mediastinal widening on plain skiagram.

The ability of CT scanning to better distinguish specific tissue densities than

conventional radiography and to display mediastinum in axial plane, makes it a
useful technique in evaluating a widened mediastinum detected on conventional
 radiography. A mediastinum widened by abundant fat, with its characteristic low CT
attenuation value, is easily diagnosed. Vascular dilatation or aneurysm formation
responsible for mediastinal widening can also be diagnosed by CT in almost all
cases. In most patients sufficient mediastinal fat is present to outline and allow
identification of the normal aorta and great vessels, superior vena cava and major
venous channels on scans even without contrast agent. The enlargement of these
vascular structures is easily detected. At times, the identification of a soft tissue
density as tortuous or ectatic vessel is uncertain on non-contrast scans. An
intravenous injection of iodinated contrast media will raise the CT attenuation value
of a vascular structure well beyond the range of other solid mediastinal structure
and permit definite identification of a tortuous or dilated vessel with proper contrast
administration sometimes requiring bolus injections, enhancement of the major
vessels is always grossly obvious and there is no need to measure attenuation
values. Solid mediastinal lesion never enhances to such a degree.

While CT differentiated vascular from avascular causes of mediastinal widening in 5/60

cases in this study, the 35/50 cases in which CT detected solid (soft tissue density)
lesions still required further evaluation of diagnosis. CT alone could not differentiate the
many causes of solid mediastinal masses. Yet, vascular abnormalities, non mediastinal
causes, normal variants, fat containing and cystic avascular masses accounted for 35/60
of the cases in this series. In 34 percentages of these cases, CT provides a specific and
correct diagnosis, thus obviating more invasive evaluation, such as surgery. With the
proper use of contrast enhancement techniques and with increased interpretive
experience, accurate CT differentiation of vascular and avascular causes of mediastinal
widening should approximate 100%. As others have emphasized, CT should be the next
radiological procedure used when mediastinal widening of unknown aetiology is
detected on plain chest radiograph.
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APPENDIX

Patients were examined as per the following case sheet:

Case sheet no:

Name Age Sex Hospital

registration
no.

Address

Date of admission Date of discharge

Chief complaints

Presenting symptom

Past history

History of amenorrhoea (In females)

History of contrast reaction

History of drug intake (steroid, chemotherapy,

ATT, antibiotics etc.)

History of trauma

History suggestive of SVC syndrome,

myasthenia gravis etc.

Chest X-ray –CRITERIA OF MEDIASTINAL Subjective Objective

WIDENING
CT examination findings NCCT CECT

FNAC/histopathology/MRI/aspiration cytology Nature of lesion

(where ever indicated) Benign Malignant

Mediastinal lesion CT Gold standard

diagnosis MRI/ FNAC/ H/P exam
* Absent

* Present

Normal Variant

Vascular

Benign

Malignant
SUMMARY

1. Name of specialty Radiodiagnosis

2. Name of the system of the body Mediastinum (Thorax)

3. Title of thesis CT EVALUATION OF CASES WITH

MEDIASTINAL WIDENING ON PLAIN
SKIAGRAM

4. Year of submission of thesis January 2009

5. Name of the candidate VIVEK GUPTA

6. Name of supervisor

Name of chief supervisor Dr. G.N. Dey M.D., Radiodiagnosis

(Pune), Consultant Radiologist

Vivekananda Polyclinic and Institute of

Medical Sciences, Lucknow

Name of co-supervisor Dr. Ratni Gujral, M.D. (AIIMS),

FICRI,FAMS, Senior Consultant,

DNB Coordinator (Radiogiagnosis)

Department of radiogiagnosis, VPIMS,

Lucknow

(Ex. Profesror & Head of Department of

 Radiogiagnosis, SGPGIMS, Lucknow)

Prof. Neera Kohli, M.D. FICRI, FIMSA

Professor, Department of
Radiogiagnosis

CSMMU (King George's Medical

University), Lucknow

Prof. M.L.B. Bhatt, M.D.,

Professor & Radiation Oncologist

Department of Radiotherapy CSMMU

(King George's Medical University)

Lucknow

7. Name of hospital Vivekananda Polyclinic and Institute of

Medical Sciences

Objective of study

Meterial & Methods

1. Study area: The present study was done in department of radiodiagnosis,

VPIMS Lucknow. VPIMS is a multi specialty and super specialty hospital
catering to patients of U.P. and adjoining areas of Nepal and city of plain X-
ray, digital X-ray, USG, spiral CT facilities. Department receives good number
patients from department of chest, medicine, pediatrics, pediatric surgery,
surgery, cardiovascular surgery department for radiological investigation. MRI
 facilities (1.5T) other higer were available at K. G’s. M. U. (GM & AH) and
tertiary referral centre for further investigation.

2. Study population: Data was collected from both indoor and outdoor
patients. Patients comprised of both urban and rular (including Nepal Terai),
children and adult. Study population excluded pregnant females and patients
with a known sensitivity to radio contrast agents.

3. Data collection technique and tools: The present study is observational

analytic study. The cohort in this study consists of patients showing
mediastinal widening on plain skiagram

Data analysis: The data was analyzed with percentages and confidence interval
calculated. The sensitivity of plain skiagram with reference to

Salient findings of study

1. distribution of mediastinal lesions

a) Most common lesions was lymphoma (16.7%) followed by inflammatory (10%),
secondaries (10%), neurogenic tumors (8.3%), primary carcinoma (8.3%),
vascular (8.3%), fat containing masses (5%), thymoma (5%)
b) Largest number of mediastinal lesions were noted in sixth decade (26%) followed
by fifth (18%), first (14%) and fourth (12%)
c) 60% males were affected while 40% female.
d) Percentage wise distribution of various mediastinal lesions in various
compartments anterosuperior 34%, middle 24%, posterior 10% and multiple
32%.
I. Vascular lesions (29.4%) were most common followed by lymphoma
(23.5%), thymoma (17.6%) in anterosuperior mediastinum.
II. In middle mediastinal, cystic lesions and secondaries were most common.
III. In posterior mediastinal, neurogenic tumors were most common.
e) Most of the mediastinal lesions pretended clinically with chest pain (21%)
followed by dyspnea (17%), cough (13%), fever (10%), myasthenia gravis (71%)
Benign lesions were 60% and malignant were 40%.
Definition

A tumor is an abnormal growth of body tissue. Tumors can be cancerous (malignant) or

non-cancerous (benign).

Alternative Names

Mass; Neoplasm

Causes, incidence, and risk factors

In general, tumors appear to occur when there is a problem with the dividing of cells in
the body. Typically, the division of cells in the body is strictly controlled. New cells are
created to replace older ones or to perform new functions. Cells that are damaged or no
longer needed die to make room for healthy replacements.

If the balance of cell division and death is disturbed, a tumor may form.

Problems with the body's immune system can lead to tumors. Tobacco causes more
deaths from cancer than any other environmental substance. Other causes include
obesity, inactivity (sedentary lifestyle), excessive alcohol consumption, radiation, genetic
problems, excessive sunlight exposure, benzene, and a number of other chemicals and
toxins.
Certain viruses can play a role in the development of tumors, such as cervical cancer
and hepatocellular carcinoma.

Some tumors are more common in one sex than the other, some are more common
among children or the elderly, and some vary with diet, environment, and your family
history.

Symptoms

Symptoms depend on the type and location of the tumor. For example, lung tumors may
cause coughing, shortness of breath, or chest pain, while tumors of the colon can cause
weight loss, diarrhea, constipation, iron deficiency anemia, and blood in the stool. Some
tumors produce no symptoms, but symptoms that often accompany tumors include:

• Fever
• Chills
• Night sweats
• Weight loss
• Loss of appetite
• Fatigue
• Malaise

Signs and tests

Like the symptoms, the signs of tumors vary based on their site and type. When a tumor
is found, a biopsyis performed to determine if the tumor is benign or malignant.
Depending on the location of the tumor, the biopsy may be a simple procedure or a
serious operation. Most patients with tumors undergo CT scans or MRI to determine the
exact location of the tumor and its extent. More recently, positron emission tomography
(PET) scans have been used to visualize certain tumors types.

Common tests to most patients with tumors include:

• CT scan
• MRI
• PET scan
 • Complete blood count (CBC)
• Blood chemistries
• Biopsy of the tumor
• Bone marrow biopsy (most often for lymphoma or leukemia)
• Chest x-ray

Treatment

Treatment also varies based on the type of tumor, whether it is benign or malignant, and
its location. If the tumor is benign (meaning it has no potential to spread) and is located
in a "safe" area where it will not cause symptoms or disturb the proper functioning of the
organ, sometimes no treatment is needed. Sometimes benign tumors may be removed
for cosmetic reasons, however. Benign tumors of the brain may be removed because of
their location or harmful effect on the surrounding normal brain tissue.

If a tumor is malignant, treatments include surgery, radiation, chemotherapy, or a

combination of these methods.

If the cancer is confined to one location, the goal of treatment is usually surgical removal
of the tumor and cure. If the tumor has spread to local lymph nodes only, sometimes
these can also be removed. If all of the cancer cannot be removed with surgery, the
options for treatment include radiation and chemotherapy, or both. Some patients
require a combination of surgery, radiation and chemotherapy.

In contrast, lymphoma is rarely treated with surgery. Chemotherapy and radiation

therapy are most often used for treating lymphoma.

Expectations (prognosis)

The outlook varies widely among different types of tumor. If the tumor is benign, the
prognosis is generally very good. However, there are some instances where a benign
tumor can cause significant problems, for instance, in the brain.

If the tumor is malignant, the outcome varies depending on the stage of the tumor at
diagnosis. Some cancers can be cured. Some that are not curable can still be treated
and patients can live for many years with the cancer. Still other tumors are rapidly fatal.
Complications

Complications can occur if a tumor is located in a region of the body where it

compromises the function of the normal organ. If the tumor is malignant, it can also
cause complications if it spreads or metastasizes.

Calling your health care provider

Call your healthcare provider if you notice any suspicious lumps or bumps
on your body or if you notice a new or changing mole on your skin.

Prevention

The risk of malignant tumors (cancer) can be reduced by not smoking or chewing
tobacco, avoiding heavy alcohol consumption, eating a healthy diet, exercising regularly,
maintaining a healthy weight, reducing sun exposure if you burn easily, and minimizing
exposure to radiation and toxic chemicals
Classification of tumours is an important subject: incorrect classification can
have huge impact on patients. In addition, the misuse of terms by health care
professionals can also have devastating consequences. Hence although a rather
dull subject it is essential that the principles of classification are understood and
that the student is comfortable and confident in the use of terms.

PRECISE CLASSIFICATION OF A NEOPLASM FROM A PATIENT IS

ESSENTIAL

FOR THE CORRECT AND APPROPRIATE PLANNING OF TREATMENT

The purpose of classification

is to provide an aid to diagnosis

to allow the accurate exchange of information

to define clinical sub-groups who

have different biological or clinical features

will benefit from particular types of treatment

have different outcomes (prognosis)

to facilitate epidemiological analysis

It should be recognised that classification changes with time since our knowledge
improves.

There are two central and complimentary aspects of classification of tumours:

Histogenetic classification Behavioural classification

based upon the presumedcell of based upon the probable

origin a tumour behaviour of a tumour

eg. epithelium eg. benign or malignant

Another component of classification of tumours is the use of assessment of

differentiation in a tumour (termed GRADE) and the assessment of the spread of a
tumour (termed STAGE).

Grade & stage

Having considered each of these key concepts (histogenesis, behaviour, grade &
stage) in isolation, it is important to see how these words can be used in
combinations in practice.

Some conditions such as dysplasia are considered as pre-neoplasia. This is

important since evidence shows that early diagnosis and treatment at this stage is
much better than when neoplasms have become well established.

Some aspects of classification are rather unsatisfactory and over history a range
of terms have been used. This complicates the subject. In addition some
tumours are described by the names of people who first described them or some
aspect of them. An EPONYM is thus a term derived from a person. This and some
other problems with classification are considered further in the next page.

Eponyms and other problems

Finally some simple exercises in the use of nomenclature are presented.

Simple exercises in nomenclature

As we have discussed before

Confusing words . . . . . .

The word TUMOUR simply means swelling and not all swellings are neoplasms
and some neoplasms do not form swellings per se (eg. leukaemia - a tumor of
blood cells derived from the bone marrow). Nevertheless the word tumor is often
used interchangeably with neoplasm. Note also that not all neoplasms are
malignant. This is discussed further in the section on classification.

Another potentially confusing word is CANCER. This is usually used to denote a

malignant neoplasm as opposed to a benign neoplasm. It is very easily confused
with the word CARCINOMA which denotes a malignant tumor of epithelial tissues
specific Brain tumor types.

• Acoustic Neuroma
• Astrocytoma:
o Grade I - Pilocytic Astrocytoma
o Grade II - Low-grade Astrocytoma
o Grade III - Anaplastic Astrocytoma
o Grade IV - Glioblastoma (GBM)
• Chordoma
• CNS Lymphoma
• Craniopharyngioma
• Other Gliomas:
o Brain Stem Glioma
o Ependymoma
 o Mixed Glioma
o Optic Nerve Glioma
o Subependymoma
• Medulloblastoma
• Meningioma
• Metastatic Brain Tumors
• Oligodendroglioma
• Pituitary Tumors
• Primitive Neuroectodermal (PNET)
• Other Brain-Related Conditions
• Schwannoma

The following tumor types are more common in children than in adults:

• Brain Stem Glioma

• Craniopharyngioma
• Ependymoma
• Juvenile Pilocytic Astrocytoma (JPA)
• Medulloblastoma
• Optic Nerve Glioma
• Pineal Tumor
• Primitive Neuroectodermal Tumors (PNET)
• Rhabdoid Tumor

What causes cancer?

Cancer is caused by several factors. These can be classified into the following:

• Heredity
• Tobacco smoking
• Spicy diet
• Sunlight
• Viruses
• Chemicals
• Radiation
• Occupational hazards like chimney sweepers
• Hormone producing tumors
Formation of a cancerous tumor

The single cell containing the abnormal oncogene multiplies quickly. It divides to form
two cells, which in turn divides to form four cells, then eight and so on. Each and every
cell of the tumor then has the ability to turn cancerous. Tumor growth is measured by the
time taken for the number of cells in a tumor to double. This period usually varies from
about 1 month to 2 years. A patient usually detects a solid tumor after 25 to 30 such
doublings. In this phase the tumor contains approximately billion cells and has a
diameter of half an inch.

What is a cancerous tumor?

A cancerous tumor is a collection of many abnormal cells, most of which divide without
any control. This tumor spreads to neighboring tissues by forcing its way between
normal cells. The abnormal cells of the tumor bear little or no resemblance to the cells of
their origin. They are irregular in size and shape.

What does the cancerous tumor consist of?

The cancer cell has a large nucleus. They may also consist of calcium deposits that can
be seen on an X-ray. These characteristic coupled with the irregular appearance of the
cells are often the diagnostic feature of the detection of cancer.

How does cancer spread?

A cancerous tumor spreads not only locally but also migrates to different sites in the
body by a process called as metastasis.

The tumor cells multiply and proliferate to form outgrowths from the original tumor.
These cells then spread to the surrounding tissue. The involvement of nerve fibers near
the spreading tumor causes pain. The spread of cancer can be considered in the blood
as well as the lymphatic fluid. Spread of cancer in the lymphatic fluid. As the tumor
grows it spreads into the neighboring lymphatic vessels. The cancer cells detach from
the primary tumor and are carried by the lymphatic flow until they settle in a lymph node.
In the lymph node the cancer cell again starts dividing to form another tumor. The tumor
then remains in the node. It is temporarily stopped from spreading by the immune cells
in the lymphatic system. The tumor soon overcomes the immune system and may
spread throughout the body in the same manner.

Spread of cancer in the blood

Cancer cells mostly spread to organs having a good blood supply. These organs are the
liver, lungs, bones and brain. The growing tumor invades nearby blood vessels by
growing into their walls. A cancer cell detaches itself from the primary tumor. This cancer
cell flows with blood until it lodges itself in a very small blood vessel called as a capillary.
Here it starts forming a secondary tumor.
Metastasis

The spread of the cancer from one site to a distant site is by a process called as
metastasis. Cancerous cells become detached from the primary tumor. The blood or
lymphatic system carries these to distant sites like the liver, lungs, bones and brain. The
cancer cell then proliferates as these sites to form secondary tumors or secondaries.

What are the symptoms of cancer?

At times cancer is detected while investigating for some other disease. But usually it is
detected when symptoms gradually develop and become noticeable over a period of
weeks or months. The symptoms of cancer are:

• A lump, which is often firm or painless, present beneath the skin

• Non-healing wounds.
• Blood in the urine, sputum or in the vomitus.
• Changes in bowel movements.
• Constant pain in the abdomen.
• Weight loss, which is significant in a short period of time.
• Fatigue.
• Loss of appetite.
• Long standing hoarseness of voice.

These are the most common symptoms of cancer and if you present with any of these
symptoms, do consult your doctor immediately.

How are cancers diagnosed?

Cancers can be diagnosed in various ways. Emphasis should be laid on the detection of
cancer at an early stage. Detection of late stage of cancers is no doubt easier, but it
serves no purpose, as treatment of terminal stage cancers is difficult and survival rates
are low.

Cancers can be detected by the following methods

Routine screening

This type of screening is improving the early diagnosis of cancer. Screening is a

procedure to detect cancers before it presents with any symptoms. Cancers that can be
diagnosed with this method are:

• Breast cancer, which is detected by a procedure called as mammography.

• Cancer of the large intestine, which is detected by colonoscopy, or a simple
rectal examination.
• PAP smear, which is the screening-test for cancer of the cervix of the uterus.

Cancer Treatment

The three main techniques to treat cancer are surgery, chemotherapy and radiation
therapy. Other treatments include hormonal and biological therapies.

Surgical treatment

Surgical treatment involves removal of the tumor. Usually some normal tissue
surrounding the cancerous tissue is also removed. This ensures maximal removal of
cancerous cells from the tumor site. The lymph nodes surrounding the tumor are also
removed to prevent the tumor from spreading. Rarely surgery may be performed to
remove tumor growth from remote sites where the cancer has spread. Cancer surgery is
not useful if the tumor site is deep within the body and is inaccessible for surgery. It is
also not advisable in old patients and in those in whom the cancer has spread
extensively.

Chemotherapy

Treatment of cancers with anticancer drugs is called as chemotherapy. These drugs can
be taken orally, but can be given as injection into a vein. This therapy is used when the
cancer is widespread throughout the body, such as in leukemia. It can also be used to
arrest the spread of cancers by metastasis. The drawback of chemotherapy is its side
effects. These include nausea, vomiting, temporary hair loss, constipation, diarrhea,
fatigue, kidney damage and anemia. The duration of treatment depends on the type of
cancer and the purpose of the treatment.

Radiation therapy

In this procedure, focused radioactive rays are used to destroy or slow the growth of
cancerous tissue. This therapy can however have severe side effects. They include
reddened or painful skin, loss of appetite, vomiting, nausea, and fatigue.

Hormone therapy

Therapy with hormones plays a major part in cancer treatment. For example, estrogens
are responsible for stimulating growth of most breast cancers. They are also responsible
for suppressing the growth of prostate cancer in men. Treatment with sex hormones
plays a vital role in these types of cancers.

Biological therapy

These drugs involve the latest in the treatment of cancers. They are called as cancer
vaccines. They are interferon like drugs. Interferon is a substance present in the body
that offers resistant to foreign agents like viruses. These drugs produce an interferon like
substance, which stimulates the white blood cells of the body to engulf abnormal cells.

The many treatment modalities of cancer treatment include surgery chemotherapy,

radiotherapy, immunotherapy, and gene therapy, are all directed towards killing tumor
cells or preventing cell proliferation. Although conventional chemotherapies have
traditionally been used to treat patients with various types of cancer, their side effects
and damage to normal cells have been of monumental concern. Blood-forming bone
marrow cells are the first cells to be adversely effected by chemotherapy, leading to a
decline in the number of peripheral blood cells. It is therefore highly desirable to search
for alternative chemical agents that can effectively destroy cancer cells but have minimal
or no side effect on normal cells.

Complementary and Alternative cancer therapy

Complementary and alternative medicine (CAM) refers to a broad range of healing

philosophies, approaches, and therapies that exist largely outside the institutions where
conventional health care is taught and provided. However, some of these therapies are
now making way to the mainstream medicine. Use of CAM is widespread among cancer
patients. Throughout the world cancer patients try many forms of questionable or
unproven treatment methods. The reasons for adopting these therapies most certainly
are complex and are related to the social and cultural contexts. In case of severe illness,
the hope to leave no stone unturned is a powerful motivator. In developing countries
factors like ignorance, socioeconomics, and inadequate access to mainstream medical
facilities are some major factors that play an important role for patients to opt alternative
therapies that are replacement for, rather than adjunct to, mainstream therapy. Whereas
in developed countries a significant proportion of cancer patients try complementary
therapies viz. acupuncture, relaxation therapy and massage for anxiety as adjuncts to
mainstream care for management of symptoms and to improve quality of life. Evidence
from randomized trial supports the value of hypnosis for cancer pain and nausea.

Regional Tumors

Benign Tumor
Diagnosis G/M Organ Caption
Adrenal Adenoma
Adenoma G Adrenal
(Composite view)
Adrenal Adenoma (Cut
Adenoma G Adrenal
section)
Adenoma G Brain Adenoma
Colon - Adenomatous Polyp
Adenoma M Colon
- Cross Section
Adenomatous Polyp of
Adenoma G Colon
Colon
Adenoma G Liver Adenoma of liver
Adenoma G Liver Adenoma of liver
Parathyroid Adenoma
Adenoma G Parathyroid
(External View)
Parathyroid Adenoma (Cut
Adenoma G Parathyroid
Surface)
 Parathyroid Adenoma
Adenoma G Parathyroid
(Composite View)
Adenoma G Parathyroid Parathyroid Adenoma
Salivary
Adenoma G Pleomorphic Adenoma
Glands
Small Villous Adenoma of Small
Adenoma M
Intestine Intestine
Small Villous Adenoma of Small
Adenoma M
Intestine Intestine
Small Villous Adenoma of Small
Adenoma M
Intestine Intestine
Adenoma,_Tubulovillous G Colon Tubulovillous Adenoma
Adenoma,_Tubulovillous G Colon Tubulovillous Adenoma
Adenoma,_Tubulovillous G Colon Tubulovillous Adenoma
Adenoma,_Tubulovillous G Colon Tubulovillous Adenoma
Adenoma,_Tubulovillous G Colon Tubulovillous Adenoma
Adenoma,_Villous G Colon Villous Adenoma
Angiofibroma G Nasopharyn Nasal Angiofibroma
Angiofibroma G Nasopharyn Nasal Angiofibroma
Angiofibroma G Nasopharyn Nasal Angiofibroma
Atypical_Proliferating_Mucinous_Neopla Atypical Proliferating
M Ovary
sm Mucinous Neoplasm
Atypical_Proliferating_Mucinous_Neopla Atypical Proliferating
M Ovary
sm Mucinous Neoplasm
Brenner M Ovary Brenner Tumor of Ovary
Brenner M Ovary Brenner Tumor of Ovary
Brenner M Ovary Brenner Tumor of Ovary
Brenner M Ovary Brenner Tumor of Ovary
Brenner M Ovary Brenner Tumor of Ovary
Brenner M Ovary Brenner Tumor of Ovary
Brenner M Ovary Brenner Tumor of Ovary
Carcinoid Tumor of the
Carcinoid G Lung
Lung
Cavernous_Hemangioma G Bone Cavernous Hemangioma
Cavernous Hemangioma -
Cavernous_Hemangioma G Bone
Orbital Ridge
Cavernous Hemangioma -
Cavernous_Hemangioma G Bone
Orbital Ridge
Cavernous Hemangioma -
Cavernous_Hemangioma G Bone Orbital Ridge - fixed
specimen
Cavernous_hemangioma M Soft Tissue Cavernous_hemangioma_10
 x
Cavernous_hemangioma_10
Cavernous_hemangioma M Soft Tissue
x
Cavernous_hemangioma_10
Cavernous_hemangioma M Soft Tissue
x
Cavernous_hemangioma_20
Cavernous_hemangioma M Soft Tissue
x
Cavernous_hemangioma_20
Cavernous_hemangioma M Soft Tissue
x
Cavernous_hemangioma_40
Cavernous_hemangioma M Soft Tissue
x
Cavernous_hemangioma_40
Cavernous_hemangioma M Soft Tissue
x
Cavernous_hemangioma M Soft Tissue Cavernous_hemangioma_4x
Cavernous_hemangioma_4x
Cavernous_hemangioma M Soft Tissue
3
Cellular_Leiomyoma M Uterus Uterine Cellular Leiomyoma
Cellular_Leiomyoma M Uterus Uterine Cellular Leiomyoma
Cellular_Leiomyoma M Uterus Uterine Cellular Leiomyoma
Chorangioma G Placenta Chorioangioma
Chorangioma M Placenta Chorangioma
Chorangioma M Placenta Chorangioma 20x
Chorangioma M Placenta Chorangioma 40x
Chorangioma - infarcted
Chorangioma M Placenta
10x
Chorangioma - infarcted
Chorangioma M Placenta
20x
Chorangioma - infarcted
Chorangioma M Placenta
40x
Chorangioma G Placenta Placental Chorangioma
Congenital Mesoblastic
Congenital_mesoblastic_nephroma G Kidney
Nephroma
Cystadenoma_Mucinous M Ovary Mucinous Cystadenoma
Cystadenoma_Mucinous M Ovary Mucinous Cystadenoma
Cystadenoma_Mucinous M Ovary Mucinous Cystadenoma
Cystadenoma_Mucinous M Ovary Mucinous Cystadenoma
Mucinous cystadenoma of
Cystadenoma_Mucinous M Ovary
ovary
Mucinous cystadenoma of
Cystadenoma_Mucinous M Ovary
ovary
Mucinous cystadenoma of
Cystadenoma_Mucinous M Ovary
ovary
 Mucinous cystadenoma of
Cystadenoma_Mucinous M Ovary
ovary
Papillary cystadenoma of
Cystadenoma_Serous M Ovary
ovary
Papillary cystadenoma of
Cystadenoma_Serous M Ovary
ovary
Papillary cystadenoma of
Cystadenoma_Serous M Ovary
ovary
Papillary Serous
Cystadenoma_Serous G Ovary
Cystadenoma
Ovarian Papillary Serous
Cystadenoma_Serous G Ovary
Cystadenoma
Dermoid M Ovary Dermoid Cyst of Ovary
Dermoid M Ovary Dermoid Cyst of Ovary
Dermoid M Ovary Dermoid Cyst of Ovary
Dermoid M Ovary Dermoid Cyst of Ovary
Dermoid M Ovary Dermoid Cyst of Ovary
Dermoid M Ovary Dermoid Cyst of Ovary
Dermoid M Ovary Dermoid Cyst of Ovary
Dermoid M Ovary Dermoid Cyst of Ovary
Benign cystic
Dermoid G Ovary
teratoma/Dermoid cyst
Dermoid Cyst of Ovary
Dermoid G Ovary
(composite)
Dermoid Cyst of Ovary
Dermoid G Ovary
(External View)
Dermoid Cyst of Ovary
Dermoid G Ovary
(Interior)
Ovarian Teratoma (External
Dermoid G Ovary
view)
Ovarian Teratoma (Cut
Dermoid G Ovary
surface)
Ovarian Teratoma
Dermoid G Ovary
(composite view)
Low power view of an
Desmoid M Soft Tissue
abdominal desmoid
Low power view of an
Desmoid M Soft Tissue
abdominal desmoid
Low power view of an
Desmoid M Soft Tissue
abdominal desmoid
High power view of an
Desmoid M Soft Tissue
abdominal desmoid
Desmoid G Soft Tissue Desmoid Tumor -
 abdominal wall - cut surface
Fibroadenoma M Breast Fibroadenoma (Low Power)
Fibroadenoma (Low Power
Fibroadenoma M Breast
view)
Fibroadenoma (Medium
Fibroadenoma M Breast
Power)
Fibroadenoma M Breast Fibroadenoma (High Power)
Fibroadenoma M Breast Fibroadenoma (High Power)
Fibroma M Ovary Fibroma of Ovary
Fibroma M Ovary Fibroma of Ovary
Fibroma M Ovary Fibroma of Ovary
Ovarian Fibroma (composite
Fibroma G Ovary
view)
Ovarian Fibroma (external
Fibroma G Ovary
view only)
Ovarian Fibroma (internal
Fibroma G Ovary
view only)
Ovarian Fibrothecoma
Fibrothecoma G Ovary
(External view)
Ovarian Fibrothecoma (cut
Fibrothecoma G Ovary
surface)
Follicular Adenoma (Low
Follicular_Adenoma M Thyroid
Power)
Follicular Adenoma
Follicular_Adenoma M Thyroid
(Medium Power)
Follicular Adenoma
Follicular_Adenoma M Thyroid
(Medium Power)
Follicular Adenoma (High
Follicular_Adenoma M Thyroid
Power)
Follicular Adenoma of
Follicular_Adenoma M Thyroid
Thyroid (FNA MedPow)
Follicular Adenoma of
Follicular_Adenoma M Thyroid
Thyroid (FNA Hi Pow)
Adrenal Ganglioneuroma
Ganglioneuroma G Adrenal
(Cut surface)
Giant Cell Tumor - head of
Giant_Cell_Tumor G Bone
femur
Giant_Cell_Tumor G Bone Giant Cell Tumor of Bone
Granular Cell Tumor of
Granular_Cell_Tumor G Lung
Bronchus
Granulosa Cell Tumor of
Granulosa_Cell_Tumor M Ovary
Ovary
Granulosa_Cell_Tumor M Ovary Granulosa Cell Tumor of
 Ovary
Granulosa Cell Tumor of
Granulosa_Cell_Tumor M Ovary
Ovary
Pulmonary Hemangioma
Hemangioma G Lung
(External View)
Intraductal Papilloma of
Intraductal_Papilloma M Breast
Breast
Islet Cell Carcinoma in
Islet_Cell_Carcinoma G Islet
Mesenteric Fat
Islet_Cell_Tumor G Islet Pancreatic Islet Cell Tumor
Leiomyoma M Uterus Leiomyoma (Low Power)
Leiomyoma (Medium
Leiomyoma M Uterus
Power)
Leiomyoma with
Leiomyoma M Uterus
Degeneration (Low Power)
Leiomyoma with
Leiomyoma M Uterus Degeneration (Medium
Power)
Leiomyoma with
Leiomyoma M Uterus
Degeneration (High Power)
Uterine Leiomyomoma
Leiomyoma G Uterus
(external view)
Uterine Leiomyoma with
Leiomyoma G Uterus
Degeneration
Uterine Leiomyoma (cut
Leiomyoma G Uterus
surface)
Leiomyoma G Uterus Uterine Leiomyoma
Uterine Leiomyoma (close
Leiomyoma G Uterus
up cut surface)
External surface of a
Lipoma G Soft Tissue
(benign) lipoma
External surface of (benign)
Lipoma G Soft Tissue
lipoma
Luteoma M Ovary Luteoma
Luteoma M Ovary Luteoma
Luteoma M Ovary Luteoma
Meningioma M Brain Meningioma
Meningioma M Brain Meningioma
Meningioma M Brain Meningioma
Meningioma G Brain Meningioma
Meningioma G Brain Meningioma
Meningioma G Brain Meningioma
Meningioma G Brain Meningioma
Meningioma G Brain Meningioma
Mole M Placenta Partial hydatidiform mole
Mole M Placenta Partial hydatidiform mole
Mole M Placenta Partial hydatidiform mole
Mole M Placenta Partial hydatidiform mole
Mole G Placenta Partial Mole
Complete Hydatidiform
Mole G Placenta
Mole (close up)
Complete Hydatidiform
Mole G Placenta
Mole
Myelolipoma G Soft Tissue Myelolipoma - cut surface
Myocardiu
Myxoma G Atrial Myxoma
m
Myocardiu
Myxoma G Atrial Myxoma
m
Myocardiu
Myxoma G Atrial Myxoma
m
Peripherial
Neurofibroma G Neurofibroma
Nerve
Peripherial
Neurofibroma G Myxoid Neurofibroma
Nerve
Giant Congenital
Nevus G Skin
Intradermal Nevus
Giant Congenital
Nevus G Skin
Intradermal Nevus
Giant Congenital
Nevus G Skin
Intradermal Nevus
Exterior and cut surfaces of
Osteochondroma G Soft Tissue
an osteochondroma
Exterior surface of an
Osteochondroma G Soft Tissue
osteochondroma
Attachment surface of an
Osteochondroma G Soft Tissue
osteochondroma
Osteochondroma G Soft Tissue Osteochondroma - bisected
Adrenal Pheochromocytoma
Pheochromocytoma G Adrenal
(Cut Surface)
Pheochromocytoma G Adrenal Adrenal Pheochromocytoma
Polyposis Coli - Opened
Polyposis G Colon
Colon
Polyposis G Colon Polyposis Coli
Polyposis G Colon Polyposis Coli
Polyposis G Colon Polyposis Coli
Polyposis G Colon Multiple Polyposis of Colon
Polyposis G Colon Multiple Polyposis of Colon
Schwannoma G Breast Schwannoma of breast
Peripherial
Schwannoma M Schwannoma
Nerve
Peripherial
Schwannoma M Schwannoma
Nerve
Peripherial
Schwannoma M Schwannoma
Nerve
Peripherial Acoustic Neurinoma
Schwannoma G
Nerve ( Schwannoma)
Serous_Cystadenoma G Pancreas Serous Cystadenoma
Struma_Ovarii M Ovary Struma ovarii
Struma_Ovarii M Ovary Struma ovarii of ovary
Struma_Ovarii M Ovary Struma ovarii of ovary
Struma_Ovarii M Ovary Struma ovarii of ovary
Struma_Ovarii M Ovary Struma ovarii of ovary
Struma_Ovarii G Ovary Struma Ovarii
Struma_Ovarii G Ovary Struma Ovarii (Close up)
Struma_Ovarii G Ovary Struma Ovarii
Synovial_chondromatosis G Joint Synovial Chondromatosis
Thymoma_Benign G Thymus Thymoma
Malignant Tumor
G/
Diagnosis Organ Caption
M
Adenocarcinoma G Adrenal Metastatic Adenocarcinoma
Metastatic Adenocarcinoma to
Adenocarcinoma G Adrenal
Adrenal
Adenocarcinoma G Appendix Adenocarcinoma
Adenocarcinoma M Colon Adenocarcinoma of Colon
Adenocarcinoma M Colon Adenocarcinoma of Colon
Adenocarcinoma M Colon Adenocarcinoma of Colon
Adenocarcinoma of Colon (full
Adenocarcinoma M Colon
spectrum of changes)
Colonic Adenocarcinoma -
Adenocarcinoma g Colon
Endoscopy
Adenocarcinoma M Colon Adenocarcinoma of Colon
Adenocarcinoma M Colon Adenocarcinoma of Colon
Adenocarcinoma M Colon Adenocarcinoma of Colon
Adenocarcinoma M Colon Adenocarcinoma of Colon
Adenocarcinoma G Colon Adenocarcinoma of rectum
Adenocarcinoma of rectum -
Adenocarcinoma G Colon
close up
Adenocarcinoma with Lymph
Adenocarcinoma G Colon
Node Metastases
Adenocarcinoma G Colon Adenocarcinoma of Cecum
Adenocarcinoma G Colon Adenocarcinoma of Rectum
Adenocarcinoma G Colon Adenocarcinoma of Colon
Adenocarcinoma of Colon -
Adenocarcinoma G Colon
high power
Adenocarcinoma G Colon Adenocarcinoma of Colon
Adenocarcinoma G Colon Adenocarcinoma of Colon
Adenocarcinoma G Colon Adenocarcinoma of Colon
Adenocarcinoma G Colon Adenocarcinoma of Colon
Adenocarcinoma G Colon Adenocarcinoma of Colon
Adenocarcinoma of G-E
Adenocarcinoma G Esophagus
Junction
Adenocarcinoma G Esophagus Adenocarcinoma
Esophageal adenocarcinoma -
Adenocarcinoma g Esophagus
Endoscopy
Gall Adenocarcinoma of
Adenocarcinoma G
Bladder Gallbladder
Adenocarcinoma G Lung Adenocarcinoma
Adenocarcinoma G Lung Adenocarcinoma
Adenocarcinoma G Lung Adenocarcinoma of Lung
Adenoarcinoma of Lung (Low
Adenocarcinoma M Lung
Power)
Adenocarcinoma of Lung (Low
Adenocarcinoma M Lung
Power)
Adenocarcinoma of Lung
Adenocarcinoma M Lung
(Mucin Stain)
Adenocarcinoma of Lung
Adenocarcinoma M Lung
(Mucin Stain)
Low Grade Adenocarcinoma of
Adenocarcinoma M Lung
Lung
Low Grade Adenocarcinoma of
Adenocarcinoma M Lung
Lung (Med)
Low Grade Adenocarcinoma of
Adenocarcinoma M Lung
Lung (Hi Pow)
Pulmonary Adenocarcinoma
Adenocarcinoma G Lung
(External View)
Adenocarcinoma G Lung Adenocarcinoma of the Lung
 Primary Adenocarcinoma of
Adenocarcinoma G Lung
Lung
Adenocarcinoma G Lung Mucinous Adenocarcinoma
Adenocarcinoma G Lung Adenocarcinoma
Adenocarcinoma G Pancreas Adenocarcinoma
Adenocarcinoma M Prostate Prostatic_adenocarcinoma
Adenocarcinoma M Prostate Prostatic Adenocarcinoma
Adenocarcinoma M Prostate Prostatic Adenocarcinoma
Adenocarcinoma M Prostate Prostate Adenocarcinoma
Adenocarcinoma M Prostate Prostatic Adenocarcinoma
Adenocarcinoma M Prostate Prostatic Adenocarcinoma
Prostatic Adenocarcinoma
Adenocarcinoma G Prostate
(Low power)
Adenocarcinoma G Prostate Prostate Adenocarcinoma
Adenocarcinoma M Prostate Adenocarcinoma of prostate
Adenocarcinoma M Prostate Adenocarcinoma of prostate
Adenocarcinoma M Prostate Adenocarcinoma of prostate
Adenocarcinoma M Prostate Adenocarcinoma of prostate
Adenocarcinoma of prostate -
Adenocarcinoma M Prostate
perineural invasion
Adenocarcinoma of prostate -
Adenocarcinoma M Prostate
perineural invasion
Adenocarcinoma of prostate -
Adenocarcinoma M Prostate
perineural invasion
Renal
Adenocarcinoma G Renal Cell Carcinoma
Pelvis
Small
Adenocarcinoma M Adenocarcinoma
Intestine
Small
Adenocarcinoma M Adenocarcinoma of Duodenum
Intestine
Small Adenocarcinoma of Small
Adenocarcinoma G
Intestine Intestine
Adenocarcinoma G Spleen Metastatic Adenocarcinoma
Adenocarcinoma extending
Adenocarcinoma G Stomach
into pancreas
Adenocarcinoma G Stomach Adenocarcinoma
Gastric adenocarcinoma -
Adenocarcinoma g Stomach
Endoscopy
Adenocarcinoma in Situ of
Adenocarcinoma_in_Situ_of_Cervix M Uterus
Endocervix (Medium Power)
Adenocarcinoma in Situ of
Adenocarcinoma_in_Situ_of_Cervix M Uterus
Endocervix (High Power)

Adenocarcinoma_in_Situ_of_Cervix
Adenocarcinoma_in_Situ_of_Cervix
Adenocarcinoma_of_Cervix
Adenocarcinoma_of_Cervix
Adenocarcinoma_of_Cervix
Adenocarcinoma_of_Endometrium
Adenocarcinoma_of_Endometrium
Adenocarcinoma_of_Endometrium
Adenocarcinoma_of_Endometrium
Adenocarcinoma_of_Endometrium
Adenocarcinoma_of_Endometrium
Adenocarcinoma_of_Endometrium
Adenosarcoma
Adenosarcoma
Adenosarcoma
Adenosquamous_Carcinoma
Adenosquamous_Carcinoma
Adenosquamous_carcinoma_of_Endome
trium
Adenosquamous_carcinoma_of_Endome
trium
Astrocytoma,_Cerebellar
Astrocytoma,_Cerebellar
Astrocytoma,_Cerebellar
Astrocytoma,_Cerebral
Astrocytoma,_Cerebral
Basal_Cell_Carcinoma
Basal_Cell_Carcinoma
Basal_Cell_Carcinoma
Bronchiolo_alveolar_Carcinoma
Adenocarcinoma in Situ of
M Uterus
Endocervix (Low Power)
Adenocarcinoma in Situ of
M Uterus
Endocervix (High Power)
Invasive Adenocarcinoma of
M Uterus
Cervix (Low Power)
Invasive Adenocarcinoma of
M Uterus
Cervix (High Power)
Invasive Adenocarcinoma of
M Uterus
Cervix (Low Power)
Adenocarcinoma of
M Uterus
Endometrium (High Power)
Adenocarcinoma of
M Uterus
Endometrium (Medium Power)
Adenocarcinoma of
M Uterus
Endometrium (High Power)
M Uterus Endometrial Adenocarcinoma
M Uterus Endometrial Adenocarcinoma
M Uterus Endometrial Adenocarcinoma
M Uterus Endometrial Adenocarcinoma
Malignant Mixed Tumor of
G Ovary
Ovary (closeup)
Ovarian Mixed Mullerian
G Ovary
Tumor (interior)
Ovarian Mixed Mullerian
G Ovary
Tumor (exterior)
G Lung Adenosquamous Carcinoma
G Lung Adenosquamous Carcinoma
Adenosquamous carcinoma of
M Uterus
Endometrium (Low Power)
Adenosquamous carcinoma of
M Uterus
Endometrium (Medium Power)
M Brain Cerebellar Astrocytoma
M Brain Cerebellar Astrocytoma
M Brain Cerebellar Astrocytoma
G Brain Cerebral Astrocytoma
G Brain Astrocytoma
M Skin Basal Cell Carcinoma
M Skin Basal Cell Carcinoma
G Skin Basal Cell Carcinoma
Bronchioloalveolar carcinoma
M Lung
(Low Power)
 Bronchioloalveolar carcinoma
Bronchiolo_alveolar_Carcinoma M Lung
(Med Power)
Bronchioloalveolar carcinoma
Bronchiolo_alveolar_Carcinoma M Lung
(Hi Power)
Bronchioloalveolar carcinoma
Bronchiolo_alveolar_Carcinoma M Lung
(Med Power)
Bronchioloalveolar carcinoma
Bronchiolo_alveolar_Carcinoma M Lung
(PAS stain)
Bronchiolo_alveolar_Carcinoma G Lung Bronchioloalveolar carcinoma
Bronchiolo-alveolar carcinoma
Bronchiolo_alveolar_Carcinoma M Lung
(low power)
Bronchiolo-alveolar carcinoma
Bronchiolo_alveolar_Carcinoma M Lung
(high power)
Carcinoid G Colon Carcinoid Tumor of Colon
Small Carcinoid with Lymph Node
Carcinoid G
Intestine Metastases
Carcinoid,_Atypical G Lung Atypical Carcinoid
Squamous Cell Carcinoma of
Carcinoma G Colon
Anus
Squamous Cell Carcinoma of
Carcinoma G Sinus
Maxillary Sinus
Squamous Carcinoma of
Carcinoma G Sinus
Maxillary Sinus
Squamous Carcinoma of
Carcinoma G Sinus
Maxillary Sinus
Carcinoma G Stomach Gastric Carcinoma
Carcinoma G Stomach Gastric Carcinoma High Power
Papillary Carcinoma of the
Carcinoma G Thyroid
Thyroid
Poorly differentiated
Carcinoma,_NOS G Esophagus
Carcinoma
Poorly differentiated
Carcinoma,_NOS G Esophagus
Carcinoma
Chondrosarcoma G Bone Chondrosarcoma of the pelvis
Chondrosarcoma lower end of
Chondrosarcoma G Bone
humerus
Chondrosarcoma from the
Chondrosarcoma G Bone
pelvis
Low power view of a
Chondrosarcoma M Cartilage
chrondrosarcoma
Medium power view of a
Chondrosarcoma M Cartilage
chondrosarcoma
Chondrosarcoma M Cartilage Medium power view of a
 chondrosarcoma
High power view of a
Chondrosarcoma M Cartilage
chondrosarcoma
High power view of a
Chondrosarcoma M Cartilage
chondrosarcoma
Low power view of a
Chondrosarcoma M Cartilage
chondrosarcoma
Low power view of a
Chondrosarcoma M Cartilage
chondrosarcoma
Clear_Cell_Carcinoma M Ovary Clear Cell Carcinoma of Ovary
Clear_Cell_Carcinoma M Ovary Clear Cell Carcinoma of Ovary
Clear_Cell_Carcinoma M Ovary Clear Cell Carcinoma of Ovary
Clear_Cell_Carcinoma M Ovary Clear Cell Carcinoma of Ovary
Clear_Cell_Carcinoma M Ovary Clear Cell Carcinoma of Ovary
Clear_Cell_Carcinoma M Ovary Clear Cell Carcinoma of Ovary
Clear_Cell_Carcinoma M Ovary Clear Cell Carcinoma of Ovary
Clear_Cell_Carcinoma M Ovary Clear Cell Carcinoma of Ovary
Clear_Cell_Carcinoma M Ovary Clear Cell Carcinoma of Ovary
Comedo_Carcinoma M Breast Comedo Carcinoma of Breast
Comedo_Carcinoma M Breast Comedo Carcinoma of Breast
Mucinous Cystadenocarcinoma
Cystadenocarcinoma G Appendix
of Appendix
Cystadenocarcinoma_Mucinous G Ovary Mucinous Cystadenocarcinoma
Papillary Serous
Cystadenocarinoma_Serous M Ovary
Cystadenocarcinoma
Papillary Serous
Cystadenocarinoma_Serous M Ovary
Cystadenocarcinoma
Papillary Serous
Cystadenocarinoma_Serous M Ovary
Cystadenocarcinoma
Papillary Serous
Cystadenocarinoma_Serous M Ovary
Adenocarcinoma
Papillary Serous
Cystadenocarinoma_Serous M Ovary
Adenocarcinoma
Papillary Serous
Cystadenocarinoma_Serous M Ovary
Adenocarcinoma
Papillary Serous
Cystadenocarinoma_Serous G Ovary
Cystadenocarcinoma
Ovarian Carcinoma involving
Cystadenocarinoma_Serous G Ovary
the omentum
Dermatofibrosacoma
Dermatofibrosarcoma G Skin
Protuberans
Ductal_Carcinoma G Breast Infiltrating Duct Carcinoma
 Infiltrating Duct Carcinoma
Ductal_Carcinoma M Breast
(Low Power)
Infiltrating Duct Carcinoma
Ductal_Carcinoma M Breast
(Low Power)
Infiltrating Duct Carcinoma
Ductal_Carcinoma M Breast
(Hi Power)
Ductal Carcinoma in
Ductal_Carcinoma M Breast
Lymphatic (Low Pow)
Ductal Carcinoma in
Ductal_Carcinoma M Breast
Lymphatic (Med Pow)
Ductal Carcinoma in
Ductal_Carcinoma M Breast
Lymphatic
Infiltrating Duct Carcinoma of
Ductal_Carcinoma G Breast
breast
Infiltrating Duct Carcinoma
Ductal_Carcinoma G Breast
(Closer View)
Ductal_Carcinoma G Breast Infiltrating Duct Carcinoma
Dysgerminoma M Ovary Dysgerminoma of Ovary
Dysgerminoma M Ovary Dysgerminoma of Ovary
Dysgerminoma M Ovary Dysgerminoma of ovary
Dysgerminoma M Ovary Dysgerminoma of ovary
Dysgerminoma M Ovary Dysgerminoma of ovary
Dysgerminoma G Ovary Dysgerminoma
Dysgerminoma G Ovary Ovarian Dysgerminoma
Embryonal_carcinoma M Testis Embryonal Carcinoma
Endodermal_sinus_tumor M Testis Endodermal Sinus Tumor
Endodermal_sinus_tumor M Testis Endodermal Sinus Tumor
Endodermal_sinus_tumor M Testis Endodermal Sinus Tumor
Endodermal_sinus_tumor M Testis Endodermal Sinus Tumor
Endometrioid Carcinoma of
Endometrioid_Carcinoma G Ovary
Ovary
Ependymoma M Brain Ependymoma
Ependymoma M Brain Ependymoma
Ependymoma M Brain Ependymoma
Ependymoma G Brain Brainstem ependymoma
Adrenal ganglioneuroblastoma
Ganglioneuroblastoma G Adrenal
(External)
Adrenal Ganglioneuroblastoma
Ganglioneuroblastoma G Adrenal
(Internal)
Adrenal Ganglioneuroblastoma
Ganglioneuroblastoma G Adrenal
(Composite)
Ganglioneuroblastoma G Adrenal Adrenal Ganglioneuroblastoma
Ganglioneuroblastoma G Adrenal Ganglioneuroblastoma
Ganglioneuroblastoma G Adrenal Adrenal Ganglioneuroblastoma
Germ Cell Tumor G Ovary Germ Cell Tumor
Small Gastrointestinal Stromal
GIST G
Intestine Tumor(GIST)
Glioblastoma M Brain Glioblastoma
Glioblastoma M Brain Glioblastoma
Glioblastoma M Brain Glioblastoma
Glioblastoma M Brain Glioblastoma
Glioblastoma G Brain Glioblastoma Multiforme
Glioblastoma G Brain Glioblastoma
Glioblastoma G Brain Glioblastoma
Glioblastoma G Brain Glioblastoma
Glioblastoma G Brain Glioblastoma
Hemangioblastoma G Brain Cerebellar hemangioblastoma
Hepatoblastoma G Liver Hepatoblastoma
Hepatocellular_Carcinoma G Liver Hepatocellular Carcinoma
Hepatocellular_Carcinoma G Liver Hepatocelluar Carcinoma
Hepatocellular_Carcinoma G Liver Hepatocellular Carcinoma
Hepatocellular_Carcinoma G Liver Hepatocellular Carcinoma
Hepatocellular_Carcinoma G Liver Hepatoma
Hepatoma in a macronodular
Hepatocellular_Carcinoma G Liver
cirrhosis
Hepatoma with Rupture and
Hepatocellular_Carcinoma G Liver
Hemoperitoneum
Hepatoma Invading Portal
Hepatocellular_Carcinoma G Liver
Vein
Multifocal hepatoma in
Hepatocellular_Carcinoma G Liver
cirrhosis
Hepatocellular_Carcinoma G Liver Hepatoma
Hepatocellular_Carcinoma G Liver Hepatoma
Hepatocellular_Carcinoma G Liver Hepatoma
Hepatocellular_Carcinoma G Liver Hepatocellular Carcinoma
Hepatocellular_Carcinoma G Liver Hepatocellular Carcinoma
Malignant Fibrous
Histiocytoma G Soft Tissue
Histiocytoma
Malignant Fibrous
Histiocytoma G Soft Tissue
Histiocytoma
Lymph Hodgkins Disease - Mixed
Hodgkins_Disease M
Node Cellularity (Low Power)
Lymph Hodgkins Disease - Mixed
Hodgkins_Disease M
Node Cellularity (Med Power)
 Lymph Hodgkins Disease - Mixed
Hodgkins_Disease M
Node Cellularity (Med Power)
Lymph Hodgkins Disease - Mixed
Hodgkins_Disease M
Node Cellularity (Hi Pow)
Lymph Hodgkins Disease - Mixed
Hodgkins_Disease M
Node Cellularity (Hi Pow)
Lymph Hodgkins Diseas - Mixed
Hodgkins_Disease M
Node Cellularity (Med Pow)
Lymph Hodgkins Disease - Nodular
Hodgkins_Disease M
Node Sclerosis (Low Power)
Lymph Hodgkins Disease - Nodular
Hodgkins_Disease M
Node Sclerosis (Low Power0
Lymph Hodgkins Disease - Nodular
Hodgkins_Disease M
Node Sclerosis (Low Power)
Lymph Hodgkins Disease - Nodular
Hodgkins_Disease M
Node Sclerosis
Lymph Hodgkins Disease - Nodular
Hodgkins_Disease M
Node Sclerosis
Lymph Hodgkins Disease - Nodular
Hodgkins_Disease M
Node Sclerosis
Lymph Hodgkins Disease -
Hodgkins_Disease M
Node lymphocyte predominance
Lymph Hodgkins Disease -
Hodgkins_Disease M
Node lymphocyte predominance
Lymph Hodgkins Disease -
Hodgkins_Disease M
Node lymphocyte predominance
Lymph Hodgkins Disease - nodular
Hodgkins_Disease M
Node sclerosis
Lymph Hodgkins Disease - nodular
Hodgkins_Disease M
Node sclerosis
Lymph Hodgkins Disease - nodular
Hodgkins_Disease M
Node sclerosis
Lymph Hodgkins Disease - nodular
Hodgkins_Disease M
Node sclerosis
Lymph Hodgkins Disease - mixed
Hodgkins_Disease M
Node cellularity
Lymph Hodgkins Disease - mixed
Hodgkins_Disease M
Node cellularity
Lymph Hodgkins Disease - mixed
Hodgkins_Disease M
Node cellularity
Lymph Hodgkins Disease -
Hodgkins_Disease M
Node lymphocyte depletion
Hodgkins_Disease M Lymph Hodgkins Disease -
 Node lymphocyte depletion
Lymph Hodgkins Disease -
Hodgkins_Disease M
Node lymphocyte depletion
Intraductal Carcinoma of
Intraductal_Carcinoma M Breast
Breast
Intraductal Carcinoma
Intraductal_Carcinoma M Breast
(Medium Power)
Intraductal_Carcinoma M Breast Intraductal Carcinoma
Ductal Carcinoma in Situ (Low
Intraductal_Carcinoma M Breast
Power)
Ductal Carcinoma in Situ (Med
Intraductal_Carcinoma M Breast
Power)
Ductal Carcinoma in Situ
Intraductal_Carcinoma M Breast
(High Power)
Intraductal Carcinoma (Low
Intraductal_Carcinoma M Breast
Power)
Ductal Carcinoma in situ (Med
Intraductal_Carcinoma M Breast
Power)
Ductal Carcinoma in situ (High
Intraductal_Carcinoma M Breast
Power)
Ductal Carcinoma in situ (Low
Intraductal_Carcinoma M Breast
Power)
Ductal Carcinoma in situ
Intraductal_Carcinoma M Breast
(Medium Power)
Ductal Carcinoma in situ (Med
Intraductal_Carcinoma M Breast
Power)
Ductal Carcinoma in situ (Hi
Intraductal_Carcinoma M Breast
Power)
Ductal Carcinoma in situ (Low
Intraductal_Carcinoma M Breast
Power)
Ductal Carcinoma in situ
Intraductal_Carcinoma M Breast
(Medium Power)
Ductal Carcinoma in situ (High
Intraductal_Carcinoma M Breast
Power)
Ductal Carcinoma in situ
Intraductal_Carcinoma M Breast
(Medium Power)
Ductal Carcinoma in situ (High
Intraductal_Carcinoma M Breast
Power)
Adenocarcinoma of Lung (Low
Large_Cell_Carcinoma M Lung
Power)
Large Cell Carcinoma of Lung
Large_Cell_Carcinoma M Lung
(Low Power)
Large_Cell_Carcinoma M Lung Large Cell Carcinoma of Lung
 (Med Power)
Leiomyosarcoma_of_bladder_
Leiomyosarcoma G Bladder
neck
Gastrointestinal Stromal
Leiomyosarcoma G Colon
Tumor
Leiomyosarcoma G Colon Leiomyosarcoma of Colon
Small Gastrointestinal Stromal
Leiomyosarcoma G
Intestine Tumor
Small Gastrointestinal Stromal
Leiomyosarcoma G
Intestine Tumor(GIST)
Leiomyosarcoma of
Leiomyosarcoma M Uterus
Myometrium (Low Power)
Leiomyosarcoma M Uterus Leiomyosarcoma (Low Power)
Leiomyosarcoma of the
Leiomyosarcoma M Uterus
Myometrium (Low Power)
Leiomyosarcoma of the Uterus
Leiomyosarcoma M Uterus
(Medium Power)
Leiomyosarcoma of the Uterus
Leiomyosarcoma M Uterus
(Medium Power)
Leiomyosarcoma of the Uterus
Leiomyosarcoma M Uterus
(High Power)
Leiomyosarcoma of the Uterus
Leiomyosarcoma M Uterus
(High Power)
Leiomyosarcoma of the Uterus
Leiomyosarcoma M Uterus
(High Power)
Linitis_Plastica G Stomach Linitis Plastica
Linitis_Plastica G Stomach Linitis Plastica
Linitis_Plastica G Stomach Linitis Plastica
Liposarcoma G Colon Liposarcoma
Liposarcoma Encasing The
Liposarcoma G Kidney
Kidney
Liposarcoma Encasing The
Liposarcoma G Kidney
Kidney
Liposarcoma G Soft Tissue Liposarcoma
Liposarcoma G Soft Tissue Pleomorphic Liposarcoma
Low power view of a
Liposarcoma M Soft Tissue
liposarcoma
Medium power view of a
Liposarcoma M Soft Tissue
liposarcoma
Medium power view of a
Liposarcoma M Soft Tissue
liposarcoma
Medium power view of a
Liposarcoma M Soft Tissue
liposarcoma
 Medium power view of a
Liposarcoma M Soft Tissue
liposarcoma
Low power view of an myxoid
Liposarcoma M Soft Tissue
area in a liposarcoma
Medium power view of an
Liposarcoma M Soft Tissue
myxoid area in a liposarcoma
High power view of an myxoid
Liposarcoma M Soft Tissue
area in a liposarcoma
Cut and external surfaces of a
Liposarcoma G Soft Tissue
liposarcoma
External surface of a
Liposarcoma G Soft Tissue
liposarcoma
Liposarcoma G Soft Tissue Cut surface of a liposarcoma
Lobular Carcinoma of Breast
Lobular_Carcinoma M Breast
(Low Power)
Lobular Carcinoma of Breast
Lobular_Carcinoma M Breast
(Med Power)
Lobular Carcinoma of Breast
Lobular_Carcinoma M Breast
(High Power)
Lobular Carcinoma of Breast
Lobular_Carcinoma M Breast
(Low Power)
Lobular Carcinoma of Breast
Lobular_Carcinoma M Breast
(Med Power)
Lobular Carcinoma of Breast
Lobular_Carcinoma M Breast
(High Power)
Lobular Carcinoma In Situ of
Lobular_Carcinoma_in_situ M Breast
Breast
Lymphoma M Brain Lymphoma of Brain
Lymphoma G Liver Lymphoma in liver
Lymphoma G Liver Lymphoma
Non-Hodgkin Lymphoma of
Lymphoma M Lung
Lung (Med Power)
Non-Hodgkins Lymphoma of
Lymphoma M Lung
Lung (Hi Power)
Non-Hodgkins Lymphoma of
Lymphoma M Lung
Lung (Lo Power)
Non-Hodgkin Lymphoma of
Lymphoma M Lung
Lung (Med Power)
Non Hodgkin Lymphoma of
Lymphoma M Lung
Lung (Low power)
Malignant Lymphoma - low
Lymph
Lymphoma M grade diffuse small
Node
lymphocytic
 Malignant Lymphoma - low
Lymph
Lymphoma M grade diffuse small
Node
lymphocytic
Malignant Lymphoma - low
Lymph
Lymphoma M grade diffuse small
Node
lymphocytic
Malignant Lymphoma - low
Lymph
Lymphoma M grade diffuse small
Node
lymphocytic
Malignant Lymphoma
Lymph
Lymphoma M -intermediate grade diffuse
Node
small cleaved cell type
Malignant Lymphoma -
Lymph
Lymphoma M intermediate grade diffuse
Node
small cleaved cell type
Lymph
Lymphoma M
Node
Lymph
Lymphoma M
Node
Lymph
Lymphoma M
Node
Lymph
Lymphoma M
Node
Malignant Lymphoma -
Lymph
Lymphoma M intermediate grade large cell
Node
type
Malignant Lymphoma -
Lymph
Lymphoma M intermediate grade large cell
Node
type
Malignant Lymphoma -
Lymph
Lymphoma M intermediate grade large cell
Node
type
Malignant Lymphoma - high
Lymph
Lymphoma M grade small non-cleaved cell
Node
type (Burkitts)
Malignant Lymphoma - high
Lymph
Lymphoma M grade small non-cleaved cell
Node
type (Burkitts)
Malignant Lymphoma - high
Lymph
Lymphoma M grade small non-cleaved cell
Node
type (Burkitts)
Pericardiu Malignant Lymphoma
Lymphoma G
m Invading Visceral Pericardium
Malignant_fibrous_histiocytoma M Soft Tissue Medium power of a malignant
 fibrous histiocytoma
Medium power of a malignant
Malignant_fibrous_histiocytoma M Soft Tissue
fibrous histiocytoma
High power of a malignant
Malignant_fibrous_histiocytoma M Soft Tissue
fibrous histiocytoma
Malignant Fibrous
Malignant_Fibrous_Histiocytoma M Soft Tissue
Histiocytoma
Lymph
Malignant_Histiocytosis M Malignant Histiocytosis
Node
Lymph
Malignant_Histiocytosis M Malignant Histiocytosis
Node
Lymph
Malignant_Histiocytosis M Malignant Histiocytosis
Node
Lymph
Malignant_Histiocytosis M Malignant Histiocytosis
Node
Malignant_rhabdoid_tumor G Kidney Malignant Rhabdoid Tumor
Medullary_Carcinoma M Breast Medullary Carcinoma of Breast
Melanoma G Eye Melanoma
Lymph Metastatic Malignant
Melanoma G
Node Melanoma
Melanoma G Skin Malignant Melanoma
Melanoma G Vulva Melanoma of vulva
Melanoma G Vulva Vulvar Melanoma
Lymph Metastatic Breast Carcinoma to
Metastatic G
Node lymph node
Medium power view of a
Metastatic_adenocarcinoma M Bone metastatic - well-differentiated
adenocarcinoma in bone
Medium power view of a
Metastatic_adenocarcinoma M Bone metastatic - well-differentiated
adenocarcinoma in bone
Medium power view of a
Metastatic_adenocarcinoma M Bone metastatic - well-differentiated
adenocarcinoma in bone
Medium power view of a
Metastatic_adenocarcinoma M Bone metastatic - well-differentiated
adenocarcinoma in bone
Medium power view of a
Metastatic_adenocarcinoma M Bone metastatic - well-differentiated
adenocarcinoma in bone
Medium power view of a
Metastatic_adenocarcinoma M Bone metastatic - well-differentiated
adenocarcinoma in bone
 High power view of a
Metastatic_adenocarcinoma M Bone metastatic - well-differentiated
adenocarcinoma in bone
High power view of a
Metastatic_adenocarcinoma M Bone metastatic - well-differentiated
adenocarcinoma in bone
High power view of a
Metastatic_adenocarcinoma M Bone metastatic - well-differentiated
adenocarcinoma in bone
Metastatic Renal Cell
Metastatic_adenocarcinoma G Bone
Carcinoma to Scapula
Metastatic Carcinoma from
Metastatic_adenocarcinoma G Bone
breast in spinal column
Metastatic Adenocarcinoma in
Metastatic_adenocarcinoma G Bone
spinal column
Metastatic colon
Metastatic_Adenocarcinoma G Liver
adenocarcinoma to liver
Metastatic Pancreatic
Metastatic_Adenocarcinoma G Liver
Adenocarcinoma
Metastatic_Adenocarcinoma G Liver Metastatic Gastric Carcinoma
Metastatic Colonic
Metastatic_Adenocarcinoma G Liver
Adenocarcinoma
Metastatic_Adenocarcinoma G Liver Metastatic Adenocarcinoma
Metastatic_Adenocarcinoma G Liver Metastatic Adenocarcinoma
Metastatic Renal Cell
Metastatic_Adenocarcinoma Lung
Carcinoma
Small Metastatic Adenocarcinoma to
Metastatic_Adenocarcinoma G
Intestine Small bowel
Metastatic_Carcinoma G Brain Metastatic carcinoma to brain
Metastatic adenocarcinoma to
Metastatic_Carcinoma G Brain
cerebellum
Metastatic adenocarcinoma to
Metastatic_Carcinoma G Brain
cerebrum
Metastatic_Carcinoma G Brain Metastatic Adenocarinoma
Metastatic_Carcinoma G Brain Metastatic Adenocarcinoma
Metastatic_Carcinoma G Brain Metastatic Adenocarcinoma
Metastatic Carcinoma in
Metastatic_Carcinoma G Lung
Lymphatics
Spinal Metastatic Carcinoma to Spinal
Metastatic_Carcinoma G
Cord Column
Epididymu Metastatic Colonic
Metastatic_colonic_adenocarcinoma G
s Adenocarcinoma
Metastatic_Esophageal_Carcinoma G Liver Metastatic esophageal
 carcinoma to liver
Metastatic_Esophageal_Carcinoma G Liver Metastatic Carcinoma
Metastatic Small Cell
Metastatic_Small_Cell_Carcinoma G Liver
Carcinoma
Metastatic Small Cell
Metastatic_Small_Cell_Carcinoma G Liver
Carcinoma
Malignant Mixed Muellerian
MMMT M Uterus
Tumor of Uterus (Low Power)
Malignant Mixed Mullerian
MMMT M Uterus Tumor of Uterus (Medium
Power)
Malignant Mixed Mullerian
MMMT M Uterus
Tumor of Uterus (High Power)
Malignant Mixed Mullerian
MMMT M Uterus
Tumor of Uterus (High Power)
Oil immersion view of a
Multiple_myeloma M Bone deposit of multiple myeloma in
bone
Oil immersion view of a
Multiple_myeloma M Bone deposit of multiple myeloma in
bone
Oil immersion view of a
Multiple_myeloma M Bone deposit of multiple myeloma in
bone
Medium power view of a
Multiple_myeloma M Bone deposit of multiple myeloma in
bone
Medium power view of a
Multiple_myeloma M Bone deposit of multiple myeloma in
bone
Medium power view of a
Multiple_myeloma M Bone deposit of multiple myeloma in
bone
High power view of a deposit
Multiple_myeloma M Bone
of multiple myeloma in bone
High power view of a deposit
Multiple_myeloma M Bone
of multiple myeloma in bone
High power view of a deposit
Multiple_myeloma M Bone
of multiple myeloma in bone
Multiple Myeloma Involving
Multiple_myeloma G Bone
Skull
Multiple_myeloma G Bone Multiple myeloma in a rib
Multiple_myeloma G Bone Multiple Myeloma - Rib
 Small Myeloma Metastatic to Small
Myeloma G
Intestine Bowel
Anaplastic neoplasm of
Neuro_ectodermal_tumor G Soft Tissue peripheral neuro-ectodermal
origin
Adrenal Neuroblastoma (Cut
Neuroblastoma G Adrenal
Surfaces)
Adrenal Neuroblastoma (Cut
Neuroblastoma G Adrenal
surface)
Neuroblastoma encasing
Neuroblastoma G Kidney
kidney
Peripherial
Neurofibrosarcoma G Neurofibrosarcoma
Nerve
Oligodendroglioma M Brain Oligodendroglioma
Oligodendroglioma M Brain Oligodendroglioma
Oligodendroglioma M Brain Oligodendroglioma
Low power view of an
Osteosarcoma M Bone
osteosarcoma
Low power view of an
Osteosarcoma M Bone
osteosarcoma
Osteosarcoma eroding through
Osteosarcoma G Bone
epiphysis
Osteosarcoma involving
Osteosarcoma G Joint
epiphysis
Osteosarcoma,_Parosteal G Bone Parosteal Osteosarcoma
Osteosarcoma,_Parosteal G Bone Parosteal osteosarcoma
Pagets M Vulva Pagets Disease of Vulva
Pagets M Vulva Pagets Disease of Vulva
Pagets M Vulva Pagets Disease
Pagets M Vulva Pagets Disease
Pagets M Vulva Pagets Disease
Pagets M Vulva Pagets Disease
Gall Papillary Adenocarcinoma of
Papillary_Adenocarcinoma G
Bladder Gallbladder
Papillary_Carcinoma M Breast Papillary Carcinoma of Breast
Papillary Carcinoma of
Papillary_Carcinoma M Thyroid
Thyroid (FNA)
Papillary Carcinoma of
Papillary_Carcinoma M Thyroid
Thyroid
Papillary Carcinoma of
Papillary_Carcinoma M Thyroid
Thyroid (FNA)
Papillary Carcinoma of
Papillary_Carcinoma M Thyroid
Thyroid (Low Pow)
 Papillary Carcinoma of
Papillary_Carcinoma M Thyroid
Thyroid (Med Pow)
Papillary Carcinoma of
Papillary_Carcinoma M Thyroid
Thyroid (Med Pow)
Papillary Carcinoma of
Papillary_Carcinoma M Thyroid
Thyroid (Hi Pow)
Papillary Carcinoma of the
Papillary_Carcinoma G Thyroid
Thyroid
Thyroid Papillary Carcinoma
Papillary_Carcinoma G Thyroid
(Sectioned)
Renal_cell_adenocarcinoma M Kidney Renal Cell Adenocarcinoma
Renal_cell_adenocarcinoma G Kidney Renal Cell Adenocarcinoma
Renal_cell_adenocarcinoma G Kidney Renal Cell Adenocarcinoma
Renal_cell_adenocarcinoma G Kidney Renal Cell Adenocarcinoma
Renal_cell_adenocarcinoma G Kidney Renal Cell Adenocarcinoma
Renal_cell_adenocarcinoma G Kidney Renal Cell Adenocarcinoma
Renal_cell_adenocarcinoma G Kidney Renal Cell Adenocarcinoma
Renal_cell_adenocarcinoma G Kidney Renal Cell Adenocarcinoma
Renal_cell_adenocarcinoma G Kidney Renal Cell Adenocarcinoma
Renal_cell_adenocarcinoma G Kidney Renal Cell Adenocarcinoma
Renal_cell_adenocarcinoma G Kidney Renal Cell Adenocarcinoma
Renal_cell_adenocarcinoma G Kidney Renal Cell Adenocarcinoma
Renal_cell_adenocarcinoma G Kidney Cystic Renal Cell Carcinoma
Renal_papillary_carcinoma G Kidney Renal Papillary Carcinoma
Rhabdomyosarcoma G Lung Rhabdomyosarcoma
Myocardiu
Sarcoma G Sarcoma of heart
m
Soft tissue sarcoma -
Sarcoma G Soft Tissue
infiltrating muscle
Soft tissue sarcoma of thigh -
Sarcoma G Soft Tissue
infiltrating muscle
Close up view of soft tissue
Sarcoma G Soft Tissue
sarcoma of thigh.
Close up view of soft tissue
Sarcoma G Soft Tissue
sarcoma of the thigh
Uterine Sarcoma - not
Sarcoma G Uterus
otherwise specified
Sarcoma G Uterus Uterine Sarcoma (Close up)
Seminoma G Testis Seminoma
Seminoma M Testis Seminoma
Seminoma M Testis Seminoma
Seminoma M Testis Seminoma
Seminoma G Testis Seminoma
Seminoma G Testis Seminoma
Small Cell Carcinoma of Lung
Small_Cell_Carcinoma M Lung
(Low Power)
Small Cell Carcinoma of Lung
Small_Cell_Carcinoma M Lung
(Medium Power)
Small Cell Carcinoma of Lung
Small_Cell_Carcinoma M Lung
(High Power)
Small_cell_carcinoma G Lung Small cell carcinoma
Small cell carcinoma (closer
Small_cell_carcinoma G Lung
view)
Squamous_Carcinoma G Lung Squamous Cell Carcinoma
Squamous_Carcinoma G Lung Squamous Cell Carcinoma
Squamous_Carcinoma G Lung Squamous Cell Carcinoma
Squamous_Carcinoma G Lung Squamous Carcinoma of Lung
Squamous Carcinoma of Lung
Squamous_Carcinoma G Lung
(Close-up)
Squamous Carcinoma of Lung
Squamous_Carcinoma M Lung
(Low Power)
Squamous Carcinoma of Lung
Squamous_Carcinoma M Lung
(Medium Power)
Squamous Carcinoma of Lung
Squamous_Carcinoma M Lung
(High Power)
Squamous_Carcinoma G Lung Squamous Carcinoma of Lung
Squamous_Carcinoma G Lung Squamous Carcinoma of Lung
Squamous Cell Carcinoma in
Squamous_Carcinoma_in_situ M Vulva
Situ
Squamous Cell Carcinoma in
Squamous_Carcinoma_in_situ M Vulva
Situ
Squamous Cell Carcinoma in
Squamous_Carcinoma_in_situ M Vulva
Situ
Squamous Cell Carcinoma in
Squamous_Carcinoma_in_situ M Vulva
Situ
Squamous Cell Carcinoma in
Squamous_Carcinoma_in_situ M Vulva
Situ
Squamous Cell Carcinoma in
Squamous_Carcinoma_in_situ M Vulva
Situ
Squamous Cell Carcinoma in
Squamous_Carcinoma_in_situ M Vulva
Situ
Squamous Cell Carcinoma in
Squamous_Carcinoma_in_situ M Vulva
Situ
Squamous Cell Carcinoma in
Squamous_Carcinoma_in_situ M Vulva
Situ
 Squamous Cell Carcinoma in
Squamous_Carcinoma_in_situ M Vulva
Situ
Squamous Cell Carcinoma in
Squamous_Carcinoma_in_situ M Vulva
Situ
Squamous_Cell_Carcinoma G Esophagus Squamous Cell Carcinoma
Early Invasive Squamous Cell
Squamous_Cell_Carcinoma M Esophagus
Carcinoma
Squamous Carcinoma of
Squamous_Cell_Carcinoma G Esophagus
Esophagus
Squamous cell carcinoma of
Squamous_Cell_Carcinoma G Larynx
larynx
Laryngeal Squamous Cell
Squamous_Cell_Carcinoma G Larynx
Carcinoma
Laryngeal Squamous
Squamous_Cell_Carcinoma G Larynx
Carcinoma
Squamous Carcinoma of the
Squamous_Cell_Carcinoma G Larynx
Larynx
Squamous Carcinoma of
Squamous_Cell_Carcinoma G Larynx
Pyriform Sinus
Squamous Carcinoma of
Squamous_Cell_Carcinoma G Larynx
Pyriform Sinus
Squamous Carcinoma of
Squamous_Cell_Carcinoma G Larynx
Larynx
Squamous_Cell_Carcinoma G Larynx Squamous Cell Carcinoma
Squamous_Cell_Carcinoma G Skin Squamous Cell Carcinoma
Squamous_Cell_Carcinoma G Skin Squamous Cell Carcinoma
Squamous_Cell_Carcinoma G Vulva Squamous Carcinoma of Vulva
Squamous_Cell_Carcinoma G Vulva Squamous Carcinoma
Squamous Carcinoma (close
Squamous_Cell_Carcinoma G Vulva
up)
Squamous Carcinoma of the
Squamous_Cell_Carcinoma G Vulva
Vulva
Squamous Carcinoma of the
Squamous_Cell_Carcinoma G Vulva
Vulva
Squamous Carcinoma of the
Squamous_Cell_Carcinoma G Vulva
Vulva
Squamous Cell Carcinoma in
Squamous_Cell_Carcinoma_in_situ M Esophagus
situ x4
Squamous Cell Carcinoma in
Squamous_Cell_Carcinoma_in_situ M Esophagus
situ x10
Squamous Cell Carcinoma in
Squamous_Cell_Carcinoma_in_situ M Esophagus
situ x10
Squamous_Cell_Carcinoma_in_situ M Esophagus Squamous Cell Carcinoma in
 situ x20
Squamous Cell Carcinoma-in-
Squamous_Cell_Carcinoma_in_situ M Esophagus
situ x40
Squamous Carcinoma of the
Squamous_Cell_Carcinoma_of_Cervix M Uterus
Cervix
Squamous Carcinoma of
Squamous_Cell_Carcinoma_of_Cervix M Uterus
Cervix
Squamous Carcinoma of
Squamous_Cell_Carcinoma_of_Cervix M Uterus
Cervix
Squamous Carcinoma of
Squamous_Cell_Carcinoma_of_Cervix M Uterus
Cervix
Keratinizing Squamous Cell
Squamous_Cell_Carcinoma_of_Cervix M Uterus Carcinoma of Cervix (Medium
Power)
Non-Keratinizing Squamous
Squamous_Cell_Carcinoma_of_Cervix M Uterus Cell Carcinoma of Cervix
(Low Power)
Non-Keratinizing Squamous
Squamous_Cell_Carcinoma_of_Cervix M Uterus Carcinoma of Cervix (Medium
Power)
Non-Keratinizing Squamous
Squamous_Cell_Carcinoma_of_Cervix M Uterus Carcinoma of Cervix (High
Power)
Non-Keratinizing Squamous
Squamous_Cell_Carcinoma_of_Cervix M Uterus Carcinoma of Cervix (High
Power)
Squamous Cell Carcinoma of
Squamous_Cell_Carcinoma_of_Cervix G Uterus
Cervix
Squamous_Cell_Carcinoma_of_Cervix G Uterus SquamousCarcinoma of Cervix
Stromal G Stomach Gastric Stromal Tumor
Teratoma_Immature M Ovary Immature Teratoma of Ovary
Teratoma_Immature M Ovary Immature Teratoma of Ovary
Teratoma_Immature M Ovary Immature Teratoma of ovary
Teratoma_Immature M Ovary Immature Teratoma of ovary
Teratoma_Immature M Ovary Immature Teratoma of ovary
Teratoma_Immature G Ovary Immature Teratoma
Thymoma_Malignant G Thymus Thymoma - Malignant
Squamous Cell Carcinoma of
Tongue,_Squamous_Carcinoma G Mouth
Tongue
Squamous Cell Carcinoma of
Tongue,_Squamous_Carcinoma G Mouth
Tongue
Transitional Cell Carcinoma of
Transitional_cell_carcinoma Kidney
Kidney
 Transitional Cell Carcinoma of
Transitional_cell_carcinoma Kidney
kidney
Transitional_cell_carcinoma G Kidney Transitional Cell Carcinoma
Renal
Transitional_cell_carcinoma G Transitional Cell Carcinoma
Pelvis
Renal
Transitional_cell_carcinoma G Transitional Cell Carcinoma
Pelvis
Renal Papillary Transitional Cell
Transitional_cell_carcinoma G
Pelvis Carcinoma
Renal Papillary Transitional Cell
Transitional_cell_carcinoma G
Pelvis Carcinoma
Renal
Transitional_Cell_Carcinoma G Transtional Cell Carcinoma
Pelvis
Renal
Transitional_cell_carcinoma G Transitional Cell Carcinoma
Pelvis
Tubular_Carcinoma M Breast Tubular Carcinoma of Breast
Wilms_tumor M Kidney Wilms Tumor
Wilms_tumor M Kidney Wilms Tumor
Wilms_tumor M Kidney Wilms Tumor
Wilms_tumor M Kidney Wilms Tumor
Wilms_tumor M Kidney Wilms Tumor
Wilms_tumor G Kidney Wilms tumor
Wilms_tumor G Kidney Wilms tumor
Wilms_tumor G Kidney Wilms tumor
Wilms_tumor G Kidney Wilms tumor
Wilms_tumor G Kidney Wilms tumor
Wilms_tumor G Kidney Wilms Tumor
Wilms_tumor G Kidney Treated Wilms tumor
Wilms_tumor G Kidney Wilms tumor
Wilms_tumor G Kidney Wilms Tumor/Renal Blastema