00:01
Welcome back.
00:02
Let's get into some additional information
about how malignancy causes pathology.
00:11
We've talked about paraneoplastic syndromes,
things related to molecules
that are secreted by tumors.
00:18
Now we're going to talk about local growth and
invasion and how the various ways that that
can actually cause disease, pathology, death.
00:29
What's shown here is a surgical
specimen of a bladder cancer.
00:33
It looks like there's a ring around
it, a black ring that was actually
the doing of the pathologist
to identify surgical margins,
so that when we look down the
slide after we sample this,
we will see black and know that
that's our surgical margin.
00:47
The main point to get out of this
is that the wall is the bladder,
inside that black ring is markedly thickened.
00:56
And that is an infiltrative tumor that is
completely replacing the normal wall structures.
01:02
A consequence of this tumor invading into the
wall is that we also had ureteral obstruction.
01:09
Ureters coming in were totally obliterated by
virtue of this tumor growing and squeezing them out.
01:15
And the upstream consequence in this
particular malignancy of the bladder tumor
is that we have massive
hydronephrosis with renal failure.
01:25
Now, this is a direct effect of
the tumor invading into the ureters
and then having pressure back up to
cause that profound hydronephrosis,
markedly dilated calyceal system in the
kidney, which compromises renal function.
01:39
Okay.
01:40
Another example, this is a portion of rectum.
01:44
On the right hand side, you
can see actually the anal skin,
and we have a tumor that has become deeply
invasive, into the wall of the of the rectum.
01:57
And you can see that, in that red area,
it has actually eroded into a blood vessel.
02:02
In this patient presented with massive hematochezia,
that is to say bright red blood per rectum,
as a result of the tumor eroding into a vessel.
02:14
Another example of direct invasion,
here's rectal cancer again,
and we're looking at a portion of the rectum
that has had tumor erode all the way through it.
02:24
We can see that because there's a probe in
the lower panel poking all the way through
and the tumor, has as a result of
that erosion, allowed fecal material,
bacteria, stool and things like that to get
into the peritoneal space around the rectum
and that is causing a peritonitis.
02:49
An example of a pathologic fracture.
02:50
So pathologic fractures occur
when a break in the bone occurs
with activity that should
not otherwise induce a break.
02:59
In this particular case, it's due
to this rather large chondrosarcoma,
and this happens to be in the humerus.
03:07
You can see the head of the humerus on the left
hand side and the shaft on the right hand side.
03:11
This comes from a middle aged woman who
was reaching into the trunk of her car to
pull out a gallon of milk and her humerus fractured.
03:21
This is due to the tumor, that kind
of grayish black mucoid looking thing
eroding through the bone,
disrupting the normal architecture.
03:31
And by direct invasion, we are getting loss of
bone and being prone to a pathologic fracture.
03:39
Mesothelioma.
03:41
So the rather voluminous amounts
of white material is tumor,
and that is growing on the surface of the
lung, and compressing the underlying lung.
03:53
In the lower left hand corner
is kind of that residual lung
and there was respiratory failure
due to the expansion of the tumor.
04:01
So a secondary consequence of tumor invasion locally.
04:06
This is a rather unusual tumor, it's
called a mucoepidermoid carcinoma,
and it per se is not particularly invasive.
04:16
But in this patient, it was in the
airways and was obstructing the bronchus.
04:23
It was kind of a one way valve.
04:25
The patient could breathe in and get air in and
couldn't get it back out behind that obstruction.
04:32
Also, they could have bacteria be inhaled,
that didn't come out with each exhalation.
04:38
So the lung behind this area of obstruction
is prone to recurrent pneumonias.
04:44
And that's actually why this was
taken out as a surgical specimen
and we were able then to identify
the mucoepidermoid carcinoma
that was causing that obstruction.
04:54
This is a cardiac fibroma,
an example of a benign tumor
that nevertheless caused the death of the patient.
05:04
So this was a pediatric patient who had a
rather large left ventricular wall fibroma.
05:10
You can see it as that white, rather
large mass and it didn't metastasize,
didn't go anywhere else but by compressing the
ventricle, the patient died of heart failure.
05:22
This was something where we
couldn't excise the tumor.
05:24
We knew it was there, but couldn't
excise it because it's largely
replacing a lot of the lateral
wall of the left ventricle.
05:33
Glioblastoma is just another example.
05:35
GBMs, Glioblastoma multiforme
are very invasive tumors,
and as they expand, they can have necrosis.
05:45
They can have areas of bleeding, but
they're also going to have effects
due to the expansion of of the tumor within
a confined space that is to say, the skull.
05:56
So you can see an artist's rendition
of a glioblastoma multiforme.
06:00
This would have been the right frontal lobe
of the patient if we were looking by an MRI,
and we are seeing kind of the equivalent
on the MRI scan on the right hand side.
06:14
And with that, we kind of talked about the
ways that tumors directly can impact their host.