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Biopsy Report Guide (monthly posting, 30K, v. 1.004)

Version: 1.004
Last-modified: September 2, 1996
Archive-name: pathology/biopsy-report-guide
Posting-Frequency: monthly (first Wednesday)
URL: http://www.neosoft.com/~uthman
Maintainer: Ed Uthman <uth…@neosoft.com>

                      THE BIOPSY REPORT

                      A Patient’s Guide
           Edward O. Uthman, MD <uth…@neosoft.com>
           Diplomate, American Board of Pathology

INTRODUCTION

     Many medical conditions, including all cases of cancer,
must be diagnosed by removing a sample of tissue from the
patient and sending it to a pathologist for examination.
This procedure is called a biopsy, a Greek-derived word that
may be loosely translated as "view of the living." Any organ
in the body can be biopsied using a variety of techniques,
some of which require major surgery (e.g., staging
splenectomy for Hodgkin’s disease), while others do not even
require local anesthesia (e.g., fine needle aspiration
biopsy of thyroid, breast, lung, liver, etc). After the
biopsy specimen is obtained by the doctor, it is sent for
examination to another doctor, the anatomical pathologist,
who prepares a written report with information designed to
help the primary doctor manage the patient’s condition
properly.

     The pathologist is a physician specializing in
rendering medical diagnoses by examination of tissues and
fluids removed from the body. To be a pathologist, a medical
graduate (M.D. or D.O.) undertakes a five-year residency
training program, after which he or she is eligible to take
the examination given by the American Board of Pathology. On
successful completion of this exam, the pathologist is
"Board-certified." Almost all American pathologists
practicing in JCAHO-accredited hospitals and in reputable
commercial labs are either Board-certified or Board-eligible
(a term that designates those who have recently completed
residency but have not yet passed the exam). There is no
qualitative difference between M.D.-pathologists and D.O.-
pathologists, as both study in the same residency programs
and take the same Board examinations.

TYPES OF BIOPSIES

     1. Excisional biopsy. A whole organ or a whole lump is
removed (excised). These are less common now, since the
development of fine needle aspiration (see below). Some
types of tumors (such as lymphoma, a cancer of the
lymphocyte blood cells) have to be examined whole to allow
an accurate diagnosis, so enlarged lymph nodes are good
candidates for excisional biopsies. Some surgeons prefer
excisional biopsies of most breast lumps to ensure the
greatest diagnostic accuracy. Some organs, such as the
spleen, are dangerous to cut into without removing the whole
organ, so excisional biopsies are preferred for these.

     2. Incisional biopsy. Only a portion of the lump is
removed surgically. This type of biopsy is most commonly
used for tumors of the soft tissues (muscle, fat, connective
tissue) to distinguish benign conditions from malignant soft
tissue tumors, called sarcomas.

     3. Endoscopic biopsy.This is probably the most commonly
performed type of biopsy. It is done through a fiberoptic
endoscope the doctor inserts into the gastrointestinal tract
(alimentary tract endoscopy), urinary bladder (cystoscopy),
abdominal cavity (laparoscopy), joint cavity (arthroscopy),
mid-portion of the chest (mediastinoscopy), or trachea and
bronchial system (laryngoscopy and bronchoscopy), either
through a natural body orifice or a small surgical incision.
The endoscopist can directly visualize an abnormal area on
the lining of the organ in question and pinch off tiny bits
of tissue with forceps attached to a long cable that runs
inside the endoscope.

     4. Colposcopic biopsy.This is a gynecologic procedure
that typically is used to evaluate a patient who has had an
abnormal Pap smear. The colposcope is actually a close-
focusing telescope that allows the physician to see in
detail abnormal areas on the cervix of the uterus, so that a
good representation of the abnormal area can be removed and
sent to the pathologist.

     5. Fine needle aspiration (FNA) biopsy.This is an
extremely simple technique that has been used in Sweden for
decades but has only been developed widely in the US over
the last ten years. A needle no wider than that typically
used to give routine injections (22 to 25 gauge) is inserted
into a lump (tumor), and a few tens to thousands of cells
are drawn up (aspirated) into a syringe. These are smeared
on a slide, stained, and examined under a microscope by the
pathologist. A diagnosis can often be rendered in a few
minutes. Tumors of deep, hard-to-get-to structures
(pancreas, lung, and liver, for instance) are especially
good candidates for FNA, as the only other way to sample
them is with major surgery. Such FNA procedures are
typically done by a radiologist under guidance by ultrasound
or computed tomography (CT scan) and require no anesthesia,
not even local anesthesia. Thyroid lumps are also excellent
candidates for FNA.

     6. Punch biopsy. This technique is typically used by
dermatologists to sample skin rashes and small masses. After
a local anesthetic is injected, a biopsy punch, which is
basically a small (3 or 4 mm in diameter) version of a
cookie cutter, is used to cut out a cylindrical piece of
skin. The hole is typically closed with a suture and heals
with minimal scarring.

     7. Bone marrow biopsy. In cases of abnormal blood
counts, such as unexplained anemia, high white cell count,
and low platelet count, it is necessary to examine the cells
of the bone marrow. In adults, the sample is usually taken
from the pelvic bone, typically from the posterior superior
iliac spine. This is the prominence of bone on either side
of the pelvis underlying the "bikini dimples" on the lower
back/upper buttocks. Hematologists do bone marrow biopsies
all the time, but most internists and pathologists and many
family practitioners are also trained to perform this
procedure.

     With the patient lying on his/her stomach, the skin
over the biopsy site is deadened with a local anesthetic.
The needle is then inserted deeper to deaden the surface
membrane covering the bone (the periosteum). A larger rigid
needle with a very sharp point is then introduced into the
marrow space. A syringe is attached to the needle and
suction is applied. The marrow cells are then drawn into the
syringe. This suction step is occasionally uncomfortable,
since it is impossible to deaden the inside of the bone. The
contents of the syringe, which to the naked eye looks like
blood with tiny chunks of fat floating around in it, is
dropped onto a glass slide and smeared out. After staining,
the cells are visible to the examining pathologist or
hematologist.

     This part of procedure, the aspiration, is usually
followed by the core biopsy, in which a slightly larger
needle is used to extract core of bone. The calcium is
removed from the bone to make it soft, the tissue is
processed (see "Specimen Processing," below) and tissue
sections are made. Even though the core biopsy procedure
involves a bigger needle, it is usually less painful than
the aspiration.

SPECIMEN PROCESSING

     After the specimen is removed from the patient, it is
processed in one or both of two major ways:

     1. Histologic sections. This involves preparation of
stained, thin (less than 5 micrometers, or 0.005
millimeters) slices mounted on a glass slide, under a very
thin pane of glass called a coverslip. There are two major
techniques for preparation of histologic sections:

        a. Permanent sections. This technique gives the best
quality of specimen for examination, at the expense of time.
The fresh specimen is immersed in a fluid called a fixative
for several hours (the necessary time dependent on the size
of the specimen). The fixative, typically formalin (a 10%
solution of formaldehyde gas in buffered water), causes the
proteins in the cells to denature and become hard and
"fixed." Adequate fixation is probably the most important
technical aspect of biopsy processing.

     The fixed specimen is then placed in a machine that
automatically goes through an elaborate overnight cycle that
removes all the water from the specimen and replaces it with
paraffin wax. The next morning, a technical professional,
called a histologic technician, or "histotech," removes the
paraffin-impregnated specimen and "embeds" it in a larger
bloc of molten paraffin. This is allowed to solidify by
chilling and is set in a cutting machine, called a
microtome. The histotech uses the microtome to cut thin
sections of the paraffin block containing the biopsy
specimen. These delicate sections are floated out on a water
bath and picked up on a glass slide.

     The the paraffin is dissolved from the tissue on the
slide. With a series of solvents, water is restored to the
sections, and they are stained in a mixture of dyes. The
most common dyes used are hematoxylin, a natural product of
the heartwood of the logwood tree, Haematoxylon
campechianum, which is native to Central America, and eosin,
an artifcial aniline dye. The stain combination, casually
referred to by pathologists as "H and E" yields pink,
orange, and blue sections that make it easier for us to
distinguish different parts of cells. Typically, the nucleus
of cells stains dark blue, while the cytoplasm stains pink
or orange.

        b. Frozen sections. This technique allows one to
examine histologic sections within a few minutes of removing
the specimen from the patient, but the price paid is that
the quality of the sections is not nearly as good as those
of the permanent section. Still, a skilled pathologist and a
knowledgeable surgeon can work together to use the frozen
section’s rapid availability to the patient’s great benefit.

     2. Smears. The specimen is a liquid, or small solid
chunks suspended in liquid. This material is smeared on a
microscope slide and is either allowed to dry in air or is
"fixed" by spraying or immersion in a liquid. The fixed
smears are then stained, coverslipped, and examined under
the microscope.

     Like the frozen section, smear preparations can be
examined within a few minutes of the time the biopsy was
obtained. This is especially useful in FNA procedures (see
above), in which a radiologist is using ultrasound or CT
scan to find the area to be biopsied. He or she can make one
"pass" with the needle and immediately give the specimen to
the pathologist, who can within a few minutes determine if a
diagnostic specimen was obtained. The procedure can be
terminated at that point, sparing the patient the discomfort
and inconvenience of repeated sticks.

PATHOLOGIC EXAMINATION

A. THE GROSS DESCRIPTION

     The pathologist begins the examination of the specimen
by dictating a description of the specimen as it looks to
the naked eye. This is the "gross exam" or the "gross." Some
pathologists may refer to the gross exam as the
"macroscopic." Most biopsies are small, nondescript bits of
tissue, so the gross description is brief and serves mostly
as a way to code which biopsy came from what area and to use
for troubleshooting if there is a question of specimen
mislabeling. A typical gross description of an endoscopic
colon biopsy follows:

     "Polyp of sigmoid colon." An ovoid, smooth-
     surfaced, firm, pale tan nodule, measuring
     0.6 x 0.4 x 0.3 cm. Cassette ‘A’, all,
     bisected.

     In the above example, the first item (in quotes) is an
exact recitation of how the specimen was labeled by the
doctor who took the biopsy. After that is a textual
description of what the specimen looked like, followed by
measurements indicating its size. The "Cassette ‘A’, all,
bisected" phrase indicates that the specimen was cut in half
("bisected"), submitted for tissue processing in its
entirety ("all") in a small container (cassette) labeled
"A," which will eventually be placed in the tissue
processor.

     Larger organs removed as biopsies have correspondingly
longer and more detailed gross descriptions. The following
is the gross description of a spleen removed to assess
whether Hodgkin’s disease (a cancer of lymph tissues) has
spread into it:

     "Spleen". An entire spleen, weighing 127 grams,
     and measuring 13.0 x 4.1 x 9.2 cm. The external
     surface is smooth, leathery, homogeneous, and dark
     purplish-brown. There are no defects in the
     capsule. The blood vessels of the hilum of the
     spleen are patent, with no thrombi or other
     abnormalities. The hilar soft tissues contain a
     single, ovoid, 1.2-cm lymph node with a dark grey
     cut surface and no focal lesions

     On section of the spleen at 2 to 3 mm intervals,
     there are three well-defined pale-grey nodules on
     the cut surface, ranging from 0.5 to 1.1 cm in
     greatest dimension. The remainder of the cut
     surface is homogeneous, dark purple, and firm.

     Summary of cassettes: 1, hilar blood vessels; 2,
     hilar lymph node, entirely submitted; 3 – 6 spleen
     nodules, entirely submitted; 7 – 8, spleen, away
     from nodules.

     In the spleen described above, the pathologist found a
few lumps (nodules), representing the most important data in
this gross examination. These possibly represent the tumors
of Hodgkin’s disease, subject to confirmation by the
microscopic examination. Much of the remainder of the
verbage relates to "pertinent negatives," or things that
were routinely looked for but not found, such as a rupture
of the spleen capsule (suggesting an intraoperative
accident), blood clots ("thrombi") in the vessels supplying
the spleen, and evidence of an infection (in which case the
cut surface of the spleen would be soft instead of firm). In
addition, a lymph node was serendipitously found adherent to
the spleen, and this was briefly described as having a
normal appearance.

     The last paragraph of the gross description gives the
identifying "codes" of the slices of the specimen submitted
for microscopic examination in cassettes. The microscope
slides prepared from the processed samples will be labeled
with the same numbers as the cassettes, and the pathologist
doing the microscopic examination can, by referring to the
typed gross description, know from what part of the specimen
the tissue on the slide came.

B. THE MICROSCOPIC EXAMINATION

     The microscopic description, or the "micro" is a
narrative description of the findings gained from
examination of the glass slides under the microscope. The
micro is considered somewhat "optional" in a written report.
In such a case, the diagnosis (see below) is considered to
speak for itself. Here is a the microscopic description on
the report of the colon biopsy given above:

     Specimen A: The sections show a polypoid structure
     consisting of a central fibrovascular core,
     surrounded by a mantle of mucosa showing an
     adenomatous architecture with a predominantly
     tubular pattern. The tubules are lined by tall
     columnar epithelium showing nuclear
     pseudostratification, hyperchromasia, increased
     mitotic activity, and loss of cytoplasmic mucin.
     There in no evidence of stromal invasion.

     It can be readily seen that the language of microscopy
is much more arcane than that used for gross descriptions.
It is way beyond the scope of this monograph to cover the
nuances of descriptive microscopic pathology. In general,
microscopic descriptions are communications between
pathologists for referral and quality assurances purposes.

C. THE DIAGNOSIS

     This is analogous to the "bottom line" of a financial
report. The purpose of the gross examination, the processing
of the tissue, and the microscopic examination is to build a
logical argument toward a terse assessment of what
significance the biopsy has in regard to the patient’s
health. Here is the diagnosis for the colon biopsy, above:

          Colon, sigmoid, endoscopic biopsy:
          tubular adenoma (adenomatous polyp)

     This format is widely used, but variations occur. The
first term is the organ or tissue involved ("colon"). The
second term ("sigmoid") specifies the site in the colon from
which the biopsy was obtained. The next term ("endoscopic
biopsy") denotes the type of surgical procedure used in
obtaining the biopsy. Then follows the diagnosis proper, in
this case "tubular adenoma," a common benign tumor of the
large intestine and rectum, which increases the risk for
developing colorectal cancer in the future. In this
particular case, an older synonym for tubular adenoma,
"adenomatous polyp," follows in parentheses.

GLOSSARY OF IMPORTANT DIAGNOSTIC TERMS

     Finally, it may be useful to present a brief glossary
of important terms used in pathologic diagnoses. Terms in
the definition that are in ALL CAPS have their own entry.

ABSCESS. A closed pocket containing pus. Some abscesses are
  easily diagnosed clinically, as they are painful and may
  "point out" such that pus becomes visible, but deep and
  chronic abscesses may just look like a TUMOR clinically
  and require biopsy to distinguish them from neoplasm.

ATYPICAL. The simple, straightforward definition would be
  "unusual," but "atypical" means much more than that. In a
  diagnosis, the use of the term atypical is a vague
  warning to the physician that the pathologist is worried
  about something, but not worried enough to say that the
  patient has cancer. For instance, lymphomas (cancers of
  the lymph nodes) are notoriously difficult to diagnose.
  Some lymph node biopsies are very disturbing but do not
  quite fulfil the criteria for cancer. Such a case may be
  diagnosed as "atypical lymphoid HYPERPLASIA." Other
  important atypical hyperplasias are those of the breast
  (atypical ductal hyperplasia and atypical lobular
  hyperplasia) and the lining of the uterus (atypical
  endometrial hyperplasia). Both of these conditions are
  thought to be precursor warning signs that the patient is
  at high risk of developing cancer of the respective organ
  (breast and uterus).

CARCINOMA.  A malignant NEOPLASM whose cells appear to be
  derived from EPITHELIUM. This word can be used by itself
  or as a suffix. Cancers composed of columnar epithelial
  cells are often called adenocarcinomas. Those of squamous
  cells are called squamous cell carcinomas. The type of
  cancer typically recapitulates the type of epithelium
  that normally lines the affected organ. For instance,
  almost all cancers of the colon are adenocarcinomas, and
  columnar epithelium is the normal lining of the colon.
  There are exceptions, however.

DYSPLASIA.  An ATYPICAL proliferation of cells. This may be
  loosely thought of as an intermediate category between
  HYPERPLASIA and NEOPLASIA. It finds its best use as a
  term to describe the phenomenon in which EPITHELIUM
  proliferates and develops the microscopic appearance of
  neoplastic tissue, but otherwise tends to "behave itself"
  and continues to line body surfaces without actually
  invading them, as a true malignant neoplasm would do. It
  may be convenient (but not totally accurate) to consider
  dysplasia as a "pre-cancer" or an incipient cancer.
  Probably the most commonly occurring type of dysplasia is
  that of the cervix of the uterus, where a progression
  from dysplasia to neoplasia can be clearly demonstrated.
  Other dysplasias, such as those of the breast and
  prostate, are more difficult to clearly relate to
  neoplasia at this time.

EPITHELIUM.  A specialized type of tissue that normally
  lines the surfaces and cavities of the body. There are
  three main types: 1) columnar epithelium, which lines the
  stomach, intestines, trachea and bronchi, salivary and
  other glands, pancreas, gallbladder, nasal cavity and
  sinuses, uterus (including inner cervix), Fallopian
  tubes, kidneys, testes, vasa deferentia, and other ductal
  structures, 2) stratified squamous epithelium, which
  lines the skin, oral cavity, throat, esophagus, anus,
  outer urethra, vagina, and outer cervix, and 3)
  transitional epithelium (urothelium), which lines the
  urine-collecting part of the kidneys, the ureters,
  bladder, and inside part of the urethra.

GRANULOMA.  A special type of INFLAMMATION characterized by
  accumulations of macrophages, some of which coalesce into
  "giant cells." Granulomatous inflammation is especially
  characteristic of tuberculosis, some deep fungal
  infections (like histoplasmosis and coccidioidomycosis),
  sarcoidosis (a disease of unknown cause), and reaction to
  foreign bodies.

HYPERPLASIA.  A proliferation of cells which is not
  NEOPLASTIC. In some cases, this may be a result of the
  body’s normal reaction to an imbalance or other stimulus,
  while in other cases the physiologic cause of the
  proliferation is not apparent. An example of the former
  process is the enlargement of lymph nodes in the neck as
  a result of reaction to a bacterial throat infection. The
  lymphocytes which make up the node divide and
  proliferate, taking up more volume in the node and
  causing it to expand. An example of hyperplasia in which
  the stimulus is not known is benign prostatic hyperplasia
  (BPH), in which the prostate gland enlarges in older men
  for no known reason. While hyperplasias do not invade
  other organs or METASTASIZE to other parts of the body,
  they can still cause problems because of their local
  physical expansion. For instance, in BPH, the enlarged
  prostate pinches off the urethra and interferes with the
  flow of urine. If untreated, permanent kidney damage can
  result.

INFLAMMATION.  A reaction, usually mediated by the immune
  system, to noxious stimuli, manifested clinically by
  swelling, pain, tenderness, redness, heat, and/or loss of
  function of the affected part. To a pathologist, however,
  inflammation means the infiltration of certain immune
  system cells into the tissue or organ being examined.
  These inflammatory cells include 1) neutrophils, which
  are the white blood cells that make up pus and are seen
  in acute or early inflammations, 2) lymphocytes, which
  are typically seen in more chronic or longstanding
  inflammations, and 3) macrophages (histiocytes), which
  are also seen in chronic inflammation. Some types of
  inflammation are readily diagnosable by the primary care
  physician, such as an infected skin wound that is tender,
  hot, and draining pus. Other types of inflammation are
  not so readily apparent clinically and require biopsy to
  distinguish them from neoplasms. The suffix "-itis" is
  appended to a root word to indicate "inflammation of
  _____." For example, cervicitis, pharyngitis, gastritis,
  and thyroiditis are inflammations of the cervix, pharynx
  (throat), stomach, and thyroid gland, respectively.

LESION.  This is a vague term meaning "the thing that is
  wrong with the patient." A lesion may be a TUMOR, an area
  of INFLAMMATION, or an invisible biochemical abnormality
  (like the abnormality of the sensitivity of the body’s
  cells to insulin in adult-onset diabetes).

METAPLASIA.  The phenomenon by which one type of tissue is
  replaced by another type. This often results from chronic
  irritation of an EPITHELIAL lining. A good example is the
  cervix, in which chronic irritation and INFLAMMATION
  causes the relatively delicate normal columnar epithelium
  to be replaced by tougher squamous epithelium (similar to
  that which normally lines the vagina, which is naturally
  "built tougher" for obvious reasons). This phenomenon is
  called "squamous metaplasia." In it’s pure state,
  metaplasia is not harmful, but some metaplasias are
  markers for increased risk of more serious diseases. For
  instance, a type of intestinal metaplasia of the stomach
  (in which columnar epithelium of the intestinal type
  replaces that of the gastric type) is considered a risk
  factor for the subsequent development of cancer of the
  stomach.

METASTATIC.  Of or pertaining to METASTASIS, or the process
  by which malignant NEOPLASMS can shed individual cells,
  which can travel through the lymph vessels or blood
  vessels, lodge in some distant organ, and grow into
  tumors in their own right. There are two major routes of
  metastasis, 1) hematogenous, in which the cells travel
  through the blood vessels, and 2) lymphogenous, in which
  the lymphatic vessels conduct the cancer cells. In the
  case of lymphogenous metastasis, the metastatic tumors
  can grow from cancers cells entrapped in the lymph nodes
  that collect the lymph draining from the organ where the
  original cancer has developed, causing the nodes to
  enlarge. In the case of breast cancer, the axillary
  (underarm) nodes are the first to become involved. In the
  case of cancer of the larynx (voice box), the nodes on
  either side of the neck (cervical nodes) are first.
  Hematogenous metastases tend to deposit in the lungs,
  liver, and brain. Many cancers metastasize both
  lymphogenously and hematogenously. Most cancer operations
  attempt to remove not only the cancerous organ, but also
  the lymph nodes that drain that organ. Some types of
  cancer, especially the most common ones (lung, breast,
  colon, and prostate cancers) tend to metastasize to lymph
  nodes first. Pathologic examination of these nodes is
  important in "staging" the cancer, which gives the
  patient and the doctor some idea as to the odds of curing
  the cancer and how to best treat it. A typical diagnosis
  of a specimen of a "radical" removal of a cancer may read
  like,

          Breast, left, mastectomy: infiltrating
          ductal cancinoma; three of fifteen
          axillary nodes contain metastatic
          carcinoma.

NECROSIS.  Death of tissue. Necrosis may be seen in
  inflammatory conditions, as well as in NEOPLASMS.

NEOPLASM, or NEOPLASIA.  A "new growth" of the body’s own
  cells, a proliferation of cells no longer under normal
  physiologic control. These may be "benign" or
  "malignant." Benign neoplasms are typically tumors (lumps
  or masses) that, if removed, never bother the patient
  again. Even if they are not removed, they are not capable
  of destroying adjacent organs or "seeding" out to other
  parts of the body. Malignant neoplasms, or "cancers," are
  those whose natural history (i.e., behavior if untreated)
  is to cause the death of the patient. Malignancy is
  expressed by 1) local invasion, in which the neoplasm
  extends into vital organs and interferes with their
  function, 2) METASTASIS, in which cells from the tumor
  seed out to other parts of the body and then grow into
  tumors themselves, and/or 3) paraneoplastic syndromes, in
  which the neoplasm secretes metabolic poisons or
  inappropriately large amounts of hormones that cause
  problems with functions of various body systems.

-OMA.  This suffix means "tumor" or "lump." It typically,
  but not invariably, refers to a NEOPLASM ("GRANULOMA" is
  an exception). In referring to neoplasms, benign ones are
  typically referred to by a word, the prefix of which
  refers to the organ or tissue of origin, followed by the
  suffix "-oma." For example, leiomyoma, osteoma,
  chondroma, adenoma, and hemangioma, refer to benign
  neoplasms of smooth muscle, bone, cartilage, glandular
  tissue, and blood vessel tissue, respectively. The
  analogous terms for malignant versions of these neoplasms
  are, leiomyoSARCOMA, osteosarcoma, chondrosarcoma,
  adenoCARCINOMA, and angiosarcoma.There are exceptions to
  these vocabulary rules. For instance, hepatomas and
  melanomas are all malignant. Other tumors, such as those
  of the adrenal glands, cannot be classified into benign
  or malignant categories based on pathologic appearance.
  Only their behavior in time shows their true colors. An
  example is pheochromocytoma (a tumor of the adrenal
  medulla), ten per cent of which are malignant, but we
  don’t know just by looking at the tumor if a given case
  will fall into that ten per cent.

POLYP.  A structure consisting of a rounded head attached to
  a surface by a stalk (also called a "pedicle" or
  "peduncle"). A mushroom growing from the soil is an
  excellent example of what a polyp looks like. Polyps my
  be HYPERPLASTIC, METAPLASTIC, NEOPLASTIC, INFLAMMATORY,
  or none of the above. The typical polyps removed from the
  colon of adults during colonoscopy are benign neoplasms
  called tubular adenomas or adenomatous polyps. The
  typical nasal polyps that develop in people with
  allergies are inflammatory. The common benign polyps
  removed from the cervix are of uncertain origin.

SARCOMA.  A malignant NEOPLASM whose cells appear to be
  derived from those other than EPITHELIUM. The connective
  tissues of the body (fibrous tissue, muscle, bone,
  cartilage, fat, and lining of joints) tend to give rise
  to sarcomas. In adults, CARCINOMAS are much more common
  than sarcomas. This makes sense, because as we age, our
  body linings are assaulted by one noxious substance after
  the other. So it is no surprise that those epithelial
  cells on the forefront of our battle with the environment
  are the first to lose control of their growth and
  development. In children, sarcomas make up a greater
  proportion of cancers. While the connective tissues of
  adults are rather stable and protected from environmental
  assault, those of children are still growing and
  developing, the cells dividing, raising the likelihood
  that something will go haywire and cause a cell to lose
  control over its growth.

SUPPURATION, SUPPURATIVE INFLAMMATION.  A type of acute
  INFLAMMATION characterized by infiltration of neutrophils
  at the microscopic level and formation of pus at the
  gross level. ABSCESS is special type of suppurative
  inflammation.

TUMOR.  A mass or lump that can be felt with the hand or
  seen with the naked eye. This may be a NEOPLASM,
  HYPERPLASIA, distention, swelling, or anything that
  causes a local increase in volume. The thing to remember
  is that not all tumors are cancers, and not all cancers
  are tumors.

________________________________________________________________________

An HTML version of this FAQ is available through the author’s home
page at:

               <http://www.neosoft.com/~uthman/>

Note: Please send all constructive comments regarding this
  FAQ to Ed Uthman, MD <uth…@neosoft.com>.

This article is provided as is without any express or implied warranties.
While every effort has been taken to ensure the accuracy of the
information, the author assumes no responsibility for errors or
omissions, or for damages resulting from use of the information herein.

Copyright (c) 1994-96, Edward O. Uthman. This material may be reformatted

and/or freely distributed via online services or other media, as long as
it is not substantively altered. Authors, educators, and others are
welcome to use any ideas presented herein, but I would ask for
acknowledgment in any published work derived therefrom.

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