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Stem2: A patient known to have hypothyroidism with a hard swelling in the inguinal region, the GP sent her for a biopsy. If the inguinal LNS was lymphoma what are the distinct types of lymphoma? SpoilerHodgkin Non-Hodgkin How malignant cells survive in LNSs SpoilerMalignant tumours release growth factors such as VEGF-C (vascular endothelial growth factor C) to induce lymphatic vessel expansion (lymph angiogenesis) in primary tumours and in draining sentinel LNs, thereby promoting LN metastasis Why is melanoma pigmented? SpoilerBecause of melanin Mention 4 types of melanoma? SpoilerLentigo maligna Superficial spreading Desmoplastic melanoma Acral melanoma Nodular melanomas A lesion under the toenail was found and the decision to amputate the toe and excise the LNs. What is the reason behind this decision? SpoilerTo prevent metastasis Safety margin Pain control What is epithelioid melanoma? SpoilerType of melanoma with cells resembling epithelium because of Abundant eosinophilic cytoplasm Enlarged round to oval shaped nuclei. Gene mutation in familial malignant melanoma? SpoilerBRAF gene Postoperatively the wound is red and swollen. Culture revealed diplococci give examples? SpoilerGram-negative diplococci Neisseria sp. Haemophilus Brucella Moraxella catarrhalis Acinetobacter Gram-positive diplococci SpoilerStreptococcus pneumoniae Enterococcus. Next the patient became toxic with rapid spread of infection what do you think the cause? SpoilerNecrotizing fasciitis

Stem 2 46-year-old man is referred by GP with a large 25 mm non-bleeding right arm skin ulcer. Punch biopsy is performed. From biopsy report, what are the criteria of malignancy? See 'Parotid tumours' station – Cytological features of malignant neoplasms Six months later, patient developed cervical lymphadenopathy. How does cancer spread to lymph nodes? See 'BCC' station and 'Parotid tumours' station Excision done but not enough, what you will do? See 'BCC' station What is the advantage of frozen section? See 'Peptic Ulcer Disease + Hyperparathyroidism' station Frozen section technique shortens the time to preliminary diagnosis significantly from traditional tissue biopsy preparation. What other alternatives to frozen section? SpoilerFine Needle Aspiration Cytology (FNAC) Imprint Cytology (IC) After excision and grafting, graft became infected and sloughed. Swab shows MRSA. What will you do? See 'BCC' station & 'Breast Cancer' station Define granulation tissue? SpoilerCombination of proliferating fibroblasts, loose connective tissue, new blood vessels and scattered chronic inflammatory cells, forms a type of tissue that is unique to healing wounds and is called granulation tissue. Fate of granulation tissue? SpoilerRemodelling - The connective tissue that has been deposited by fibroblasts is reorganized to produce the stable fibrous scar. This process begins 2 to 3 weeks after injury.

New questions: Ask about complications of diverticulitis: infects perforation obstruction

Stem 2 A 69-year-old male presented with 1 month history of bilateral groin lumps. O/E firm non-tender lumps with grey scales. Doppler ultrasound findings include diffuse testicular infiltration, enlargement with hypervascularity, or multifocal areas of hypoechoic, solid and hypervascular nodules within testes. Orchidectomy was done & testicles were found to be white tan pink & fleshy. Pathology report: Malignant cells are pleomorphic and non-cohesive, with large irregular nuclei and prominent nucleoli. There is vascular invasion and sclerosis of seminiferous tubules. No intratubular germ cell neoplasia. The neoplastic cells typically express CD20 In light of the pathology report given, what's the diagnosis? SpoilerLymphoma Talk about classification of testicular tumours & give an example for each? Germ Cell Tumour SpoilerSeminoma: classic, spermatocytic, anaplastic. Teratoma Choriocarcinoma Yolk sac Non-germ cell tumour SpoilerSex cord stromal:Non-seminoma: Leydig cell tumour Sertoli cell Others: metastasis and lymphoma Describe the microscopic morphology of testicular teratoma vs seminoma? Seminoma SpoilerSheet-like cord of cells separated by fibrous septa that contain lymphocytes. Large, prominent nucleoli Teratoma !Composed of various types of cells or organs component He presents with PE a year later & is found to have large mass at the region of para-aortic LNs compressing renal vessels. Debulking surgery done, but tumour can't be totally resected. Frozen section showed thyroid tissue. Why? SpoilerTeratoma has the 3 germ cell lines (mesoderm, endoderm, ectoderm) which can differentiate to any of its derivatives Whats name for a monodermal thyroid-predominant teratoma specifically in the ovary SpoilerIt is called struma ovarii Explain findings in adenocarcinoma SpoilerFailure of differentiation and subsequent malignant transformation of epithelial differentiation line. What's the composition of PE? SpoilerPlatelets Polymerized fibrin Admixed circulatory cells Which clotting factor allowing polymerization of fibrin? SpoilerActivated factor 8 Explain coagulation cascade Intrinsic Pathway SpoilerTrigger: Internal damage to the blood vessel wall (e.g. plaque rupture). Initiation: Exposure of negatively charged surfaces, such as collagen, activates factor XII (Hageman factor).Initiation: Cascade: A series of reactions involving factors XII, XI, IX, VIII, and X. Extrinsic Pathway SpoilerTrigger: External trauma causing tissue injury Initiation: Tissue factor (TF) is released from damaged cells, which activates factor VII Cascade: Cascade: Activated factor VII (VIIa) activates factor X. Activated factor X (Xa) joins the common pathway Common Pathway Convergence: Both the intrinsic and extrinsic pathways converge at the activation of factor X. Thrombin Formation: Factor Xa, along with factor V, calcium, and phospholipids, activates prothrombin to form thrombin. Fibrin Formation: Thrombin converts fibrinogen into fibrin, which forms a mesh-like structure that traps platelets and blood cells, forming a blood clot What is the cause of PE in this patient? Explain SpoilerVenous stasis (compression) Hypercoagulable state (tumour) Where could a β-hCG found in a normal male? SpoilerSeminal plasma

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1: "Adductor longus", 2: "Arterial branch of vastus medialis", 3: "Corona of glans penis", 4: "External oblique aponeurosis", 5: "Fascia lata (cut edge)", 6: "Femoral artery", 7: "Femoral nerve", 8: "Femoral vein", 9: "Grachis", 10: "Great saphenous vein", 11: "Iliopsoas", 12: "Ilioitibal tract", 13: "Inguinal ligament", 14: "Nerve to vastus medialis", 15: "Pectineus", 16: "Perforating branch of profunda femoris artery", 17: "Rectus femoris", 18: "Saphenous nerve", 19: "Sartorius", 20: "Subartorial fascia (thickened aponeurosis)", 21: "Spermatic cord", 22: "Superficial circumflex iliac vein", 23: "Superficial epigastric vein", 24: "Superficial external pudendal vein", 25: "Superficial inguinal ring", 26: "Tensor fasciae latae deep to fascia lata", 27: "Valvular bulge lie in vein", 28: "Vastus lateralis", 29: "Vastus medialis",