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37 Cards in this Set
- Front
- Back
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What do we need to consider when evaluating a patient |
Histological diagnosis of the tumour Extent of disease both locally and at distant sites and tumour related complications Concurrent disease and ability to tolerate treatment |
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What 2 questions do we need to answer when presented with a neoplasm? |
What type of tumour is it What is the extent of the disease |
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What is the grade of the tumour |
Refers to the pathological description of the tumour and is based on several criteria Not to be confused with the stage which refers to the clinical extent of disease |
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How do we stage tumours |
TNM system |
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How do we evaluate the primary tumour |
Physical examination and diagnostic imaging Scoping and biopsies |
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What is diagnostic imaging required for? |
Deep tumours that cannot be physically evaluated Tumours involving vital structures Tumours involving bone Tumours adjacent to bone Deep lymph nodes |
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When would we use scoping to evaluate a tumour |
Urogenital, GI, Respiratory tracts |
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What do we look for when examining a primary tumour? |
Size of the tumour Mobility with respect to underlying tissues Presence, absence or degree of erythema and ulceration Relationship with associated structures |
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What do we look for when examining a lymph node |
Size Mobility and degree of fixation to underlying tissues Texture and concitstency Presence of ulceration Relationship with associated structures |
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How do we evaluate metastatic disease |
Physical examination and history Diagnostic imaging and biopsy of suspected tissue |
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How do we stage for multicentric disease such as lymphoma |
According to various organ systems involved and assigned numerical figure |
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How do we assess general clinical health |
History - onset, duration, weight change, U and D, V/D, Coughing, Dyspnoea Clinical exam Haematology and biochemistry Urine sampling |
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What is a post surgical biopsy essential for? |
To see if surgical margins were adequate To see the histological type and grade of tumour That no follow up is required To inform prognosi |
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What does biopsy have the potential to inform? |
The detection of neoplastic disease Tumour type Grade of tumour Adequacy of surgical excision |
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What do we need to consider before a biopsy |
Amount of tissue that should be recovered Position within the tumour tissue the biopsy should be recovered from Type of tissue to be biopsied Anatomic location of the tumour |
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What is cytology |
Examination of individual cells or small group of cells that have been recovered from tumour masses or neoplastic effusions
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What are the indications of cytology |
Identify the presence of neoplastic disease
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What is the problem with cytology |
Cells in the sample often bear no relationship to their orignal arrangement within the tumour or to its archetecture |
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What are the advantages of cytology |
Easily recovered with minimal instrumentation Speciments can be recovered with little tissue distruption Multiple sites can be sampled No special processing equipemtn |
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What do general practicioners need to do |
Able to tell whether a sample is of sufficient quality Inflammation vs neoplasia |
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What are the properties of inflammation |
70% neutrophils if acute 30-50% monocytes if chronic active Macrophage dominant is chronic granulomatous |
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What are the properties of benign neoplasia |
Cells small with little vatiation Low nuclear to cytoplasmic ratio Similar appearence to normal tissue |
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How would vets view samples under microscope |
10x objective to ensure adequate cellularity Review with 100x and oil of interpret inflammation, hyperplasia or neoplasia |
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What are the properties of malignant neoplasia |
Pleomorphic cell population with mitosis Anisocytosis Anaplasia Large nuclear to cyoplasmic ratio Nuclear polymorphism Multiple nuclei Hyperchromatic nuclei |
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What do you use a needle biopsy for |
Small cores of tumour tissue without surgical procedures, bone lesions |
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What are the advantages of needle biopsy |
Recover substantially more tissue than needle aspirates Recovered tissue retains much of its archetecture and is suitable for routine processing techniques Comparatively inaccessible sites may be biopsied without need for surgery Multiple samples may be removed through a single approach |
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Disadvantages of needle biopy |
Complications post biopsy compared to FNA Caution if potentially vascular tumours |
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What is a skin punch biopsy good for |
Superficial soft tissue tumours Substansially more tissue than needle aspirates Recovered tissue retains much of its archetecture and is suitable for routine processing techniques Multiple samples from single apppriach |
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What is an incisional biopsy |
Surgical removal of a solid pience of tissue from a tumour for histopath exam
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What are the advantages of incisional biopsy |
Opportunity for exposure of biopsy site and accurate selection Where substansial amount of tissue needed for grading |
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What are the disadvantages of an incisional biopsy |
General anaesthesia of the patient Surgical procedures are generally more time consuming than needle techniques |
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What are the general principles of incisional biopsy |
Should be positioned within surgical or radiation field Be as small as required and orientated so as to not unecessarily increase size of treatment area Specimens should be handled carefully Samples should be taken from different areas of the lesion Minimal risk of dissemination Adequate exposure |
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What is an excisional biopsy |
Complete surgical extirpation of a tumour following which tissue samples are removed for histopathological examination
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When should you do excisional biopsy |
Where pre treatment histopathology was not performed |
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When is bone marrow biopsy indicated? |
Non regenerative anemia Investigation of secondary immune mediated haemolytic anaemia Staging and diagnosis of haematopoetic tumours |
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What is the procedure for bone marrow biopsy |
Humerus or iliac crest Rosenthal needle advanced and introduced in a corkscrew fashion Bone marrow is aspirated with a syringe , smears are made |
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What is the procedure for a bone marrow core sample |
Jamesidi needle Needle advanced to obtain a core sample and rocked back and forth to sever the done in the needle Wire obturator used to retrograde the biopse material out of the needle Formalin fixed |
