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Metaplasia is the replacement of one differentiated tissue by another (Figure 1-2). Cellular swelling, or hydropic change, is characterized by the presence of large vacuoles in the cytoplasm. Swelling of the endoplasmic reticulum is one of the first ultrastructural changes evident in reversible injury. Swelling of the mitochondria progresses from reversible, low-amplitude swelling to irreversible, high-amplitude swelling, which is characterized by marked dilation of the inner mitochondrial space. Myelin figures, whorl-like structures, probably originating from damaged membranes b. The point of no return is marked by irreversible damage to cell membranes, leading to massive calcium influx, extensive calcification of the mitochondria, and cell death. Important examples include the troponins (troponin I and troponin T) and myoglobin. Purkinje cells of the cerebellum and neurons of the hippocampus are more susceptible to hypoxic injury than are other neurons. Oxygen toxicity, such as in the alveolar damage that can cause adult respiratory distress 3. Intracellular enzymes, such as glutathione peroxidase, catalase, and superoxide dismutase 2. Autolysis refers to degradative reactions in cells caused by intracellular enzymes indigenous to the cell. Coagulative necrosis results most often from a sudden cutoff of blood supply to an b. Nuclear changes, the morphologic hallmark of irreversible cell injury and necrosis, (1) Pyknosis, chromatin clumping and shrinking with increased basophilia (2) Karyorrhexis, fragmentation of chromatin (3) Karyolysis, fading of chromatin material (4) Disappearance of stainable nuclei 2. Suppurative infections characterized by the formation of pus (liquefied tissue debris 3. This type of necrosis most often affects the lower extremities or bowel and is secondary to vascular occlusion. When complicated by infective heterolysis and consequent liquefactive necrosis, gangrenous necrosis is called wet gangrene. When characterized primarily by coagulative necrosis without liquefaction, gangrenous necrosis is called dry gangrene. This deposition of fibrin-like proteinaceous material in the arterial walls appears b. Traumatic fat necrosis, which occurs after a severe injury to tissue with high fat conb. Enzymatic fat necrosis, which is a complication of acute hemorrhagic pancreatitis, a (1) Proteolytic and lipolytic pancreatic enzymes diffuse into inflamed tissue and (2) Fatty acids liberated by the digestion of fat form calcium salts (saponification, or soap formation). In addition, apoptosis is an important mechanism for physiologic cell removal during development and in programmed cell cycling. This involutional process is similar to the physiologic loss of leaves from a tree; apoptosis is a Greek term for "falling away from. Progression through a series of changes marked by a lack of inflammatory response a. Involution and shrinkage of affected cells and cell fragments, resulting in small round eosinophilic masses often containing chromatin remnants, exemplified by Councilman bodies in viral hepatitis C. Caspases are aspartate-specific cysteine proteases that have been referred to as "major executioners" or "molecular guillotines. The initial activating caspases are caspase-8 and caspase-9, and the terminal caspases (executioners) include caspase-3 and caspase-6 (among other proteases). This loss results in increased mitochondrial permeability, the release of cytochrome c, and the stimulation of proapoptotic proteins such as bax and bak. Cytotoxic T-cell activation is characterized by direct activation of caspases by granzyme B, a cytotoxic T-cell protease that perhaps directly activates the caspase cascade. The entry of granzyme B into target cells is mediated by perforin, a cytotoxic T-cell protein. The caspases consist of a group of aspartic acid­specific cysteine proteases that are activated during apoptosis.

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Clinical features In most cases reported in adult patients, the neoplasms caused symptoms that led to their discovery and removal. Macroscopy these neoplasms typically appear as a cystic mass with a diameter of 4-10 cm (mean, 6 cm) . Ultrastructure Electron microscopy shows a single row of uniform epithelial cells lining the cysts and resting on a basal lamina {49, 160, 915}. The cytoplasm contains numerous glycogen granules but only a few mitochondria, short profiles of endoplasmic reticulum, lipid droplets, and multivesicular bodies. Synonyms this tumour category includes macrocystic serous cystadenoma {257, 1062}, serous oligocystic and ill-demarcated adenoma , and some cystadenomas observed in children . Epidemiology Serous oligocystic adenomas are much less common than serous microcystic adenomas {445, 1062}. Adults are usually 60 years and over (age range, 30-69 years; mean, 65 years); the tumour has been described in two male and two female infants, aged between 2 and 16 months . The cysts usually vary between 1 and 2 cm in diameter, but cysts as large as 8 cm have been reported . The irregularly arranged cysts, sometimes separated by broad septa, lie within a fibrous stroma that lacks a central stellate scar. The cysts and the supporting fibrous tissue may extend into the adjoining pancreatic tissue so that the tumours are poorly demarcated. Histopathology Serous oligocystic adenoma has generally the same histological features as serous microcystic adenoma. Occasionally, however, the lining epithelium may be more cuboidal and less flattened, and the nuclei are generally larger. The tumour border is not well defined and small cysts often extend into the adjoining pancreatic tissue. The immunohistochemical and ultrastructural features are the same as for serous microcystic adenoma {445, 2057}. Characteristic cuboidal epithelium forms intracystic papillary structures in this field. Clinical features Clinical symptoms reported in the cases so far observed include bleeding from gastric varices due to tumour invasion of the wall of the stomach and the splenic vein, a palpable upper abdominal mass, and jaundice. Histopathology the histological features in the primary tumour as well as in the metastases are remarkably similar to those of serous microcystic adenoma, although focal mild nuclear pleomorphism can be found {573, 2182}. Prognosis Serous cystadenocarcinomas are slowly growing neoplasms and palliative resection may be helpful even in advanced stages . Serous cystadenocarcinoma Definition A malignant cystic epithelial neoplasm composed of glycogen-rich cells. These patients were Serous cystic neoplasms 233 Mucinous cystic neoplasms of the pancreas G. Adler Definition Cystic epithelial neoplasms occurring almost exclusively in women, showing no communication with the pancreatic ductal system and composed of columnar, mucin-producing epithelium, supported by ovarian-type stroma. According to the grade of intraepithelial neoplasia (dysplasia), tumours may be classified as adenoma, borderline (low-grade malignant) and non-invasive or invasive carcinoma. It has been hypothesized that ectopic ovarian stroma incorporated during embryogenesis in the pancreas, along the biliary tree or in the retroperitoneum may release hormones and growth factors causing nearby epithelium to proliferate and form cystic tumours . Since the left primordial gonad and the dorsal pancreatic anlage lie side by side during the fourth and fifth weeks of development, this hypothesis could explain 8470/0 8470/1 8470/2 8470/3. Localization the overwhelming majority of cases occur in the body-tail of the pancreas {328, 1932, 2148, 2198}. The head is only rarely involved, with a predilection for mucinous cystadenocarcinomas {1932, 2198}. Patients with mucinous cystadenocarcinomas are about 10 years older than patients with adenomatous or borderline tumours. The pancreatic duct, which does not communicate with the cyst lumen, has been opened over the surface of the tumour (left, arrowheads). The thick wall and irregular lining of the bisected neoplasm are shown on the right.

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Javed F, Chotai M, Mehmood A et al: Oral mucosal disorders associated with habitual gutka use, Oral Surg Oral Med Oral Pathol Oral Radiol Endod 109:857­864, 2010. Congenital hemangiomas and congenital vascular malformations appear at or around the time of birth and are more common in females. Because of the confusion surrounding the basic origin of many of these lesions, classification of clinical and microscopic varieties has been difficult. None of the numerous proposed classifications has had uniform acceptance, although there is merit in separating benign neoplasms from vascular malformations because of different clinical and behavioral characteristics (Table 4-1). The term congenital hemangioma is used to identify benign congenital neoplasms of proliferating endothelial cells. Congenital vascular malformations include lesions resulting from abnormal vessel morphogenesis. Separation of vascular lesions into these two groups can be of considerable significance relative to the treatment of patients. Unfortunately, in actual practice, some difficulty may be encountered in classifying lesions in this way because of overlapping clinical and histologic features. In any event, congenital hemangiomas have traditionally been subdivided into two microscopic types, capillary and cavernous, essentially reflecting differences in vessel diameter. Vascular malformations may exhibit similar features but may also show vascular channels that represent arteries and veins. Clinical Features Intravascular Lesions Congenital Vascular Anomalies Congenital Hemangiomas and Congenital Vascular Malformations Etiology the terms congenital, hemangioma, and congenital vascular malformation have been used as generic designations for many vascular proliferations, and they have been used Congenital hemangioma, also known as strawberry nevus, usually appears around the time of birth but may not be apparent until early childhood (Figure 4-1). This lesion may exhibit a rapid growth phase that is followed several years later by an involution phase. In contrast, congenital vascular malformations are generally persistent lesions that grow with the individual and do not involute (Figures 4-2 to 4-6). They may represent arteriovenous shunts and exhibit a bruit or thrill on auscultation. Both types of lesions may range in color from red to blue, depending on the degree of congestion and their depth in tissue. When they are compressed, blanching occurs as blood is pressed peripherally from the central vascular spaces. This simple clinical test (diascopy) can be used to separate these lesions from hemorrhagic lesions in soft tissue (ecchymoses), where the blood is extravascular and cannot be displaced by pressure. Other clinical signs include the presence of a bruit or thrill, features associated predominantly with congenital vascular malformations. Lesions that affect bone are probably congenital vascular malformations rather than congenital hemangiomas. Recognition of this syndrome is significant because many of those afflicted may suffer overt life-threatening gastrointestinal bleeding or occult blood loss with severe anemia and iron deficiency. Congenital hemangiomas are composed of abundant capillary spaces lined by endothelium without muscular support. Congenital vascular malformations may consist not only of capillaries, but also of venous, arteriolar, and lymphatic channels. Lesions may be of purely one type of vessel, or they may consist of two or more vessels. Vascular morphology accounts for lesions exhibiting rapid flow versus those exhibiting slow flow. As a generic group, the diagnosis of congenital vascular lesions is usually self-evident on clinical examination. When they affect the mandible or the maxilla, a radiolucent lesion with a honeycomb pattern and distinct margins is expected. Differentiation between congenital hemangiomas and congenital vascular malformations can be difficult and occasionally impossible. A complete history, a clinical examination, and angiography or angiographic magnetic resonance imaging should be definitive in lesion identification and characterization. A B · Figure 4-2 A and B, Oral vascular malformation causing slight facial asymmetry. Laser therapy is another accepted form of primary treatment of selected vascular lesions. Because the margins of these lesions are often ill defined, total elimination may not be practical or possible.

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All material and data on common Topotheque platform are delivering further to Europeana, thus building individual and local stories in shared European history10. Smart novel Vilijun Topotheque Smart novel Vilijun Topotheque was open to the public on 20 June 2017. It is private collection made by author of novel, consisting of various materials (archival records) connected with the novel: parts of the original text, illustrations in the novel, recordings made on book promotions, photos made on novels 8 9 Project partners list is available at: coop. Mogunosti suradnje arhiva i zajednice ­ co:op projekt // Glasnik arhiva i Arhivistickog udruzenja BiH. In the annot the s tation of the novel is the following descriptio on: "The p protagonists of Vilijun ar Marco Po and Kubla Khan in th year re olo ai he of the farewell. Marko Polo tells Kubla Khan abou the cities on the eir o ai ut Silk R Road, and Kh is interest in Marko Polo stories to decide w han ted o s whether to allo him to ret ow turn to his ho omeland. It is bond of tw nomads an two i wo and culture within wh Marko P es hich Polo also des scribes nume erous other c cultures he me and got to know on the Silk Road. It is a novel about noma et e adism ­ 1 though and traveller, but also about trust, friendship an loyalty. Topotheque Vilijun in r e many wa is unique archive ­ it keeps vario records (presentation promoays e t ous (ns, tions, new wspaper artic cles, theatric plays, per cal rformances at book fairs thematic a s, talks, pub blished cultu and liter ural rary criticism scientific papers) wh ms, c hich document the life of this novel; it cons n sists of all ty ypes of medi (document photos, ia ts, 11 Knjizara Ljevak, w As live, timeless public archives that links the story and the characters, readers, scientists, artists, users and all those whose paths are connected with them at a particular moment ­through the theme and life of the novel Vilijun ­ Topotheque Vilijun is an archive of the information global society of the 21st century and at the same time a new form of promotion of heritage themes and the very novel itself as a product of the creative industry. Multimedia novel Novel Vilijun is an example of contemporary literary text that links the media of printed books with the Internet ­ a global digital media. This is, on the one hand, conscious, planned, organized and thematic re-conceived permutation of the Vilikon novel. In the first, textual layer of a novel, the author is playing with her own novel Vilikon and his reconceptualization. Ma atija Dedi and Milivoj Juras i the in mu usical performance of poem M Million Stipe Gugi rea poem Millio ads on Figure 2. Since in Vilijun novel there is a "none fictive, le exical part" that "fully fu t functions in accordance with the prin inciples of lexicon a a lexicogr as raphic type o text"14, Ta of able 1 lists the lexicogra t aphic sections that the novel br rings forth. Thus, it becomes part of an "open society" and affects the understanding and use of terms such as "access" and "re-use". This problem begins with the well-known phenomenon of a broken link if a website is no longer maintained and no more of use to verify information. This is a collective task, which includes many stakeholders, from researchers to digital preservation specialists. Considering the basic role of Topotetheque in linking the places of creation of archival records with the main theme of Topotheque collection, it is possible to conclude that Topotheque realizes the mapping of "cultural geography" and that the "archive map", along with the effects of long-term memory, also promotes archived content on long time. Conclusion Topotheque Vilijun is real example how archives can "come out of a box". It is open and borderless in all senses ­ by its scope (type and quantity of records), content, use and opportunities. It also shows how digital archives can actively link heritage, education, community, creative industries and other potentials, be resource and inspiration for creation of new information and cultural products and services, speed up and facilitate sharing, gathering, presentation, research, publishing and documenting sources and making it accessible to the whole world. Archives, memories and identities // Records, archives and memory: selected papers from the Conference and School on records, archives and memory studies, University of Zadar, Croatia, May 2013 / Willer, M. Survey and Analysis of Basic Social Science and Humanities Research at the Science Academies and Related Research Organisations of Europe. Archives and society ­ what archives are, can and should be ­ Croatia case study // Proceeding book with peer review / Symposium Archives in the Service of People ­ People in the Service of archives in conjuction with 5th International Scientific Conference All About People: Interdisciplinarity, Transnationality and Building Bridges, Maribor, 10. The results of the research study indicate high level of awareness of students about internet security threats as well as the fact that they are exposed to widely internet security known threats to a certain degree. While students demonstrated knowledge about application of security threats countermeasures, that part of their activities could be improved further. Generally, students need additional and updated knowledge to raise the level of their readiness in order to be able to respond to known and emerging internet security threats. The results of the research will be applied in planning of university courses related to the internet security. Recent cyber-attacks showed the importance of intrusion prevention by monitoring vulnerabilities and reducing security threats (Abazari, Madani and Gharaee, 2016). Vulnerabilities of computer and other networked devices (like smartphones and other smart devices) consist of "weaknesses in a system which can be exploited by the attackers that may lead to dangerous impact" (Jouini, Rabai and Aissa, 2014, 490). At this moment, there are many active security threats related to the use of the internet (Sherr, 2017; Burgess, 2017; Schroeder, 2017) that could exploit weaknesses in computer and other networked systems and cause substantial financial and other damages.

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In order to encourage participation in this survey, we offered a $100 Amazon gift certificate to one member/fellow who took the time to respond. The Metropolitan Hotel is within a 20-25 minute walk on the promenade from the Dan Panorama Hotel or a short taxi ride away. The balance is payable (less deposit) upon your arrival at the Hospitality Desk with a 3% surcharge. If full payment is made together with reservation (or at least one month prior to arrival) there will be no surcharge. Check out of the hotel and board the bus for a short ride to the awesome Stalactite Caves. Following a tour of this wonderful cave, continue to the village of Abu Gosh for a typically Mediterranean style lunch. Standard Itinerary of the Tour: 8:00 am departure from hotel to Rome Tour with a 1:00 pm departure from Rome for Civitavecchia. Tour includes: Colosseum, Forums, Aventino and Palatino Hills, Piazza Venezia, Fontana di Trevi, Piazza di Spagna, Pantheon and if there is enough time, St. To book a Royal Caribbean shore excursion you will need to create a My Cruises Account on the Royal Caribbean website at secure. D-F 3 Introduction the Medical College of Georgia at Georgia Regents University is part of the University System of Georgia. The hospital also serves as the designated Level I Trauma Center for the East Central Georgia Health District. It is the responsibility of the faculty, residents and staff of the Department of Radiology to provide high quality patient care and to demonstrate professionalism in their daily activities. The purpose of this Resident Manual is to present the Policies and Procedures of the Radiology Department, the curriculum, goals and objectives of the residency program and to describe the various activities and expectations associated with being a resident in our department. In addition to the policies included in this manual, residents need to familiarize themselves with Department and Hospital Policies and Procedures that apply to their practice of radiology and administration of patient care services. The Goal of the program is that by the time of their graduation, all residents should be fully competent to practice as general radiologists utilizing all imaging modalities. All graduating residents will be fully qualified to complete their certification by the American Board of Radiology and will be expected to obtain full privilege credentialing in general diagnostic radiology. To provide comprehensive education, training and experience in all areas of Diagnostic Imaging, including but not limited to, plain film radiography and fluoroscopy, computed tomography, ultrasound, magnetic resonance imaging, vascular and interventional procedures, mammography, nuclear radiology, physics, radiobiology and radiation protection. To provide clinical and didactic experiences that will enable the resident to correlate information obtained through the application of various diagnostic modalities with appropriate pathologic differential diagnoses, leading to accurate patient diagnosis. To provide didactic experiences that will enable the resident to become knowledgeable in the application of physical, technical, and biomedical principles of diagnostic procedures. Laboratory sessions will provide additional technical experience when appropriate. To provide an intellectual environment that encourages residents to actively learn throughout their residency and to establish a pattern of lifetime continuous medical education following completion of the training program. To stimulate interest in radiology research and create an environment conducive to the performance of research projects during the period of residency training. To promote in all residents the vision of the radiologist as a medical consultant and clinical/academic educator. Policies and Procedures: Overview Residents and faculty share the major responsibility for radiology patient care. The scope of activities and levels of supervision vary according to the types of activities performed within each subspecialty rotation of the radiology department. Resident Supervision the Radiology faculty has the overall responsibility for the radiology care of our patients and the supervision of the residents sharing in their care. Residents are given progressively increased responsibility and independence throughout their training according to their level of education, ability and experience. Radiology faculty provide on-call primary or backup coverage for all imaging disciplines 24-hours per day and, are always available for radiology resident consultation, personally or via teleradiology digital access. Lane Estes Karen Panzitta James Craft Clarence Joe Julia Melenevsky Norman Thomson Clarence Joe Bennett Greenspan Jayanth Keshavamurthy Ramуn E. Curtiss Gilbert Nestor Nieves Scott Forseen Cargill Alleyne** Julio Araque Ramуn E.

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It describes the multifactorial nature of the condition that leads to very different rates of progression in different patients and allows comparisons between epidemiological data in various countries. Each clinical class is further characterized by either a subscript S or A depending on whether the categorized limb is symptomatic or asymptomatic, respectively. The number of subjects complaining solely of symptoms, the so-called C0S patients, was 15 290 (19. There is evidence for an association between age-related alterations of deep venous valves and high incidences of deep venous thrombosis18 because deep venous valves change with age and are thicker in older individuals. The increase in valve thickness with age would explain the age gradient seen in the incidence of venous thrombosis. In the Edinburgh Vein Study,9,26 the prevalence of varicose veins and chronic venous insufficiency was higher in men. Severe stages (C3 to C6) of chronic venous insufficiency were also more frequent in men than in women in the study by Scott et al. Hormones and pregnancies It is a widely held view that hormones may be important in the development of postpartum varicose veins. The belief that pregnancy leads to varicose veins due to pressure from the uterus that obstructs venous return from the legs has been refuted because the majority of varices appear during the first trimester of pregnancy when the uterus is not large enough to cause mechanical obstruction. Hormonal factors or the additional burden of increased circulating blood volume could be important. Epidemiological studies, including the Basel study,31 the Edinburgh Vein Study,9 and the study by Jawien et al6 observed a relationship between obesity and varicose veins in women, but not in men, while others failed to show an association in either sex. Cornu-Thenard et al studied the role of the family history in varicose disease in a prospective case-controlled study. Lifestyle factors Smoking was found to be a risk factor for varicose veins in the Framingham study,12 but only in men, not in women. In the San Diego survey16 and the Vein Consult Program,28 current smoking was associated with increased rates of chronic venous insufficiency in men. In a recent study from Finland,37 the 5-year incidence of varicose veins in both sexes was higher in smokers compared with nonsmokers. The mechanisms responsible for the harmful effects of smoking on the venous system might involve the oxidative stress related to the smoke, which causes hypoxia and endothelial damage. For men, increased daily walking was associated with moderate disease, and men who worked as laborers were more likely to have severe disease than those in positions that typically required more desk time. Regular movement when sitting for long periods was related to lower rates of moderate disease in men. Increased intra-abdominal pressure from straining at stool may be transmitted down the veins of the legs, leading to dilation of the veins and nonapposition of the valve cusps, rendering the valves incompetent. Abnormal static posture of the foot may account for improper emptying of the plantar venous pump while walking. Limbs that underwent a superficial or deep venous procedure remained stable or improved over time; those that underwent elastic compression alone had worsening hemodynamic and clinical status. Telangiectasias and reticular veins were noted early on, independently of the presence of reflux. Large varicosities appeared in older subjects, often preceded by reflux in the saphenous veins. The incidence of progress to chronic venous insufficiency (C3-C6) was approximately 2. The presence of the symptom of a "sensation of swelling" significantly increased the risk for developing chronic venous insufficiency. The risk of ulceration is related to the severity of varicosities and venous insufficiency, and this risk is increased following deep vein thrombosis (incompetence). However, the risks may also be increased in those who smoke, are obese, and have restricted ankle movement and reduced power in the calf muscle pump. No, never = 0 Only in hot weather or during long trips by plane, train, or car = 1 Yes, almost every day, but only in the evening = 2 Yes, every day, from the morning onward = 3 Q5 ­ Your age Under 15 = 0 15-29 = 3 30-50 = 6 Over 50 = 9 Q6 ­ Heredity: do you have a family history (father or mother) of varicose veins? No = 0 One parent = 3 Both parents = 6 Both parents, one with complications (leg ulcer) = 9 Q7 ­ Pregnancy: how many full-term pregnancies have you had? Balanced and varied: I eat a lot of vegetables, some meat or fish, starchy vegetables, etc, and I keep up to date on the latest news regarding diet = 0 Home cooking, simple and easy-to-prepare dishes, while trying to follow a balanced diet consisting of vegetables, starch, some meat and fish = 2 Commercially prepared foods and dishes, frozen prepared vegetables = 4 Fast food, I go out a lot and eat in fast food restaurants = 6 Q12 ­ Muscular fitness: do you walk, swim, cycle, jog, and/or go to the gym? Yes, at least 3 hours per week = 0 Less than 3 hours per week = 2 Occasionally (during vacation time) = 4 Never = 6 Q13 ­ Posture at work: in your opinion, how long do you remain seated, standing, or standing in place during the working day?

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Clinical features Small intestinal metastases can cause bleeding and obstruction as well as nonspecific symptoms such as abdominal discomfort, gas distension, and diarrhoea {1378, 580}. Macroscopy Typical features of intestinal metastases include intestinal wall thickening, submucosal spread, and ulcers. Histopathology Metastases are typically submucosal or subserosal making the distinction between primary and secondary tumours relatively easy. Cytokeratin immunohistochemistry may help to differentiate between primary colon cancer (positive for cytokeratin 20), metastases from ovary and breast (usually positive for cytokeratin 7) and those from liver, kidney and prostate (usually negative for both cytokeratins 7 and 20) {2047, 129}. On the other hand, the distinction between multiple primary small bowel carcinoids and their metastases may not be possible. Prognosis Intestinal metastases usually represent a late stage of disease in which other haematogenous metastases are also frequently found. Exceptions are melanoma and renal cancer in which metastases confined to the bowel may be associated with prolonged survival after resection. Imaging the identification of a small bowel tumour always raises the question of whether the tumour is primary or secondary. Contrast radiography shows narrowing and abnormalities of the small intestinal wall. Adenocarcinomas of the appendix also show interesting morphological variations, from those that resemble the usual colorectal carcinoma to those that arise from a carcinoid and to mucinous tumours that may appear well differentiated and indistinguishable from adenoma and yet spread widely through the peritoneal cavity. Behaviour is coded /0 for benign tumours, /3 for malignant tumours, and /1 for unspecified, borderline or uncertain behaviour. This includes cancer cells confined within the glandular basement membrane (intraepithelial) or lamina propria (intramucosal) with no extension through muscularis mucosae into submucosa. Sobin Definition A malignant epithelial neoplasm of the appendix with invasion beyond the muscularis mucosae. Intraepithelial neoplasia of the appendix may occur concurrently with a carcinoma elsewhere in the large intestine . Macroscopy In cases of primary adenocarcinoma, the appendix may be enlarged, deformed or completely destroyed {250, 251, 1612}. Well differentiated lesions are often cystic and may be called cystadenocarcinomas. A grossly appreciated swelling of the appendix due to the accumulation of mucus within the lumen can be termed mucocoele, but this is descriptive not a pathological diagnosis {250, 251}. This is particularly important because of the special nature of pseudomyxoma peritonei, where malignant cells may be scarce and acellular mucin may seem to have spread further than the malignant cells . Well differentiated mucinous appendiceal adenocarcinomas generally grow slowly, and typically produce the clinical picture of pseudomyxoma peritonei. The behaviour of non-mucinous carcinomas resembles that of their colonic counterparts. Pseudomyxoma peritonei Pseudomyxoma peritonei is the presence of mucinous material on peritoneal surfaces. It is not a complete histological 8140/3 8480/3 8490/3 Epidemiology Adenocarcinoma of the appendix occurs in 0. Both adenoma and adenocarcinoma of the appendix have been described in patients affected by long-standing ulcerative colitis . Clinical features Signs and symptoms Many patients with appendiceal adenocarcinoma have clinical features indistinguishable from acute appendicitis. Spread to the peritoneal cavity may produce large volumes of mucus, causing pseudomyxoma peritonei. B Well differentiated mucus producing epithelium embedded in a fibrous matrix; mucus is present within the lumen and is extravasated into the stroma. Nevertheless, pseudomyxoma peritonei is often applied to a distinctive clinical picture produced by well differentiated mucinous adenocarcinomas in which the growth of malignant cells within the peritoneal cavity causes a slow but relentless accumulation of mucin. A distinctive feature of well differentiated mucinous carcinomatosis is its distribution in the abdomen. There is a tendency to spare the peritoneal surfaces of the bowel, whereas large-volume disease is found in the greater omentum, beneath the right hemidiaphragm, in the right retrohepatic space, at the ligament of Treitz, in the left abdominal gutter and in the pelvis . In these cases, tumour growth tends to remain confined to the abdomen for many years.

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The association of squamous cancer with anal manifestations of lymphogranuloma venereum. Expression of tachykinins by ileal and lung carcinoid tumors assessed by combined in situ hybridization, immunocytochemistry, and radioimmunoassay. Diagnosis of duodenal and ampullary epithelial neoplasms by endoscopic biopsy: a clinicopathologic and immunohistochemical study. Cystadenoma of the pancreas: a histological, histochemical and ultrastructural study of seven cases. Condylomata acuminata, giant condyloma acuminatum (BuschkeLoewenstein tumour) and verrucous squamous carcinoma of the perianal and anorectal region: a continuous precancerous spectrum? Concerted nonsyntenic allelic losses in hyperploid hepatocellular carcinoma as determined by a high-resolution allelotype. A National Cancer Institute Workshop on Microsatellite Instability for cancer detection and familial predisposition: development of international criteria for the determination of microsatellite instability in colorectal cancer. Aggressive forms of gastric neuroendocrine tumors in multiple endocrine neoplasia type I. Metastatic carcinomatosis of the liver mimicking cirrhosis: case report and review of the literature. In: Handbuch der Speziellen Pathologischen Anatomie und Histologie, Henke F, Lubarsch O (eds), Springer-Verlag: Berlin. Malignant carcinoid of the gallbladder: third reported case and review of the literature. Hepatoblastoma in a child with trisomy 18: cytogenetics, liver anomalies, and literature review. Cohort study of internal malignancy in genetic hemochromatosis and other chronic nonalcoholic liver diseases. An integration of classical cytogenetic and molecular analyses in pancreatic adenocarcinoma. Progression of pancreatic intraductal neoplasias to infiltrating adenocarcinoma of the pancreas. Helicobacter pylori causes hyperproliferation of the gastric epithelium: preand post-eradication indices of proliferating cell nuclear antigen. Selective G to T mutations of p53 gene in hepatocellular carcinoma from southern Africa. Progression of atypical ductal hyperplasia/carcinoma in situ of the pancreas to invasive adenocarcinoma. Primary sclerosing cholangitis and ulcerative colitis: evidence for increased neoplastic potential. A metastatic endocrine-neurogenic tumor of the ampulla of Vater with multiple endocrine immunoreaction - malignant paraganglioma? Loss of heterozygosity suggests tumor suppressor gene responsible for primary hepatocellular carcinoma. Carcinoids of the jejunum and ileum: an immunohistochemical and clinicopathologic study of 167 cases. Risk and surveillance of individuals with heritable factors for colorectal cancer. Butturini G, Bassi C, Falconi M, Salvia R, Caldiron E, Iannucci A, Zamboni G, Graziani R, Procacci C, Pederzoli P (1998). Is the multiple endocrine neoplasia type 1 gene a suppressor for fundic argyrophil tumors in the Zollinger-Ellison syndrome? Adenosquamous carcinoma of the colon, rectum, and anus: epidemiology, distribution, and survival characteristics. Detection of K-ras mutations in the stool of patients with pancreatic adenocarcinoma and pancreatic ductal hyperplasia. Capella C, Riva C, Rindi G, Sessa F, Usellini L, Chiaravalli A, Carnevali L, Solcia E (1991).


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