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Flashcards in practical Deck (40):
1

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cerebral congestion(enghephalitis)

Definition: 

Congestion is the hyperemia which occurs through an arterial, active mechanism.

Morphology

Macroscopically:the aspect of the organ is:

larger

heavier

blood-red

warmer

pulsatile

painful 

Microscopically:

enlarged capillaries, filled with blood

Evolution:

The pattern may return to normal when the causative factors dissapear

Complications that may occur: edema and micro-hemorrhages

2

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Subdural hematoma

A hematoma is a well delineated collection of blood, which appears in different organs (e.g. frequently in the brain, skeletal muscle, but also in other organs)

Macroscopy of hematoma:    

nodular or oval, pushing the normal tissue 

With a slow change in color (gradually, from red to purple, then green and yellow, following the normal bilirubin breakdown) until its disappearance  

Microscopy of hematoma:

erythrocytes extravasate into the interstitium and release  hemoglobin. Under the action of inflammatory proteases, hemoglobin is gradually transformed into hemosiderin (brown color), then incorporated in macrophages (siderophages), which together with the lymph remove the hematoma

Evolution of hematoma:   

Complete resorbtion, in the case of small hematomas

Enclosure, in the case of large hematomas. They cannot be totally resorbed, but may be slowly surrounded and encased in connective tissue. A yellowish serous component remains usually in the center and hemosiderin and calcium may finally precipitate in the connective tissue which surrounds the old hematomas

Infection of the hematoma, if an infection develops in the proximity of the hematoma

Fibrosis of the entire hematoma – resulting in a small scar which, in some cases it may involve depositions of hemosiderin and calcium   

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Hemopericardium and cardiac tamponade

Hemopericardium refers to blood in the pericardial sac of the heart. It is clinically similar to a pericardial effusion, and, depending on the volume and rapidity with which it develops, may cause cardiac tamponade.

 

compression of the heart by an accumulation of fluid in the pericardial sac.

4

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Pulmonary artery thromboembolism

embolism is the mobilization and migration through the bloodstream of a structure named embolus, structure other than blood or aqueous solutions\ hydrosoluble fluids

pulmonary thrombembolism is still a frequent cause of death

5

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old arterial thrombus

What is THROMBOSIS? 

Definition: 

Thrombosis is the coagulation of blood inside blood vessels and the heart in a living organism.   

Predisposing factors for the formation of thrombus (the Virchow triad)    

Quallity of the vessel vall (endothelial lesions)

Nature of the blood flow (disorders of the circulation like stasis or turbulent flow)  

Composition of the blood (factors causing hyper coagulation) 

1. The lesions of the vascular wall may have a crucial role in the  thrombus formation, and may particularly appear in the following circumstances:    

in the arteries: atherosclerosis, HT, artheritis, action of chemical factors (nicotine)  

in the veins: sclerosing substances, hypoxia, neoplastic invasion 

in the capillaries: extreme temperatures (cold, warm)   

2. Disorder of the circulation:   

a. Stasis (decrease in the speed of the bloodstream)   

appears in: 

heart failure, bed-ridden patients, phenomena of local stasis   

effects: 

the contact between thrombocytes and endothelial cells, the local accumulation of activated factors of coagulation produced by endothelial cells (which are normally washed by the rapid bloodstream), and the hypoxia of the stasis affects the endothelial cells.    

b. The turbulent flow makes the blood elements to impact against the vascular wall which may cause endothelial lesions:   

aneurysms, hidrostatic varices   

at the site of vessel branching   

preexisting lesions that traumatize the vascular wall (atheroma, mural thrombi)   

vegetations or valvular verucae 

3. The hypercoagulation of blood can occur in:

some genetic diseases or 

under the action of some factors acquired during lifetime. 

Macroscopy of thrombus:

A. Differences between thrombus and postmortem clot:   

The thrombus is:   

adherent  

frail

undeformable   

dull

The clot is:   

non-adherent  

elastic    

deformable   

glossy 

Evolution of thrombus:

1. Autolysis (of small thrombi)    

the activation of fibrinolysis   

2. The organization in connective tissue (of larger thrombi): thrombus->granulation tissue->connective tissue scar    

-PMN penetrate into the thrombus and slowly remove the fibrin using hidrolytic enzymes   

- macrophages engulf the remaining fibrin and blood cells   

- myofibroblasts enter from the base of the thrombus and multiply inside the thrombus   

- from vasa vasorum, the endothelial cells multiply and enter the thrombus forming small capillaries, initially without basement membrane (it is formed later)  

-the mixture of myofibroblasts, macrophages, neutrophils, other inflammatory cells and the numerous new formed capillaries, form the granulation tissue- the first step in connective tissue scarring

- myofibroblasts produce collagen fibers that have contractile properties (the contraction of the thrombus)

- the capillaries lose their lumen and slowly disappear

- finally, the thrombus transforms in a connective tissue scar   

advantage: it fixes the thrombus to the wall (prevent thrombembolism)   

disadvantage: stays attached permanently, like a mass that deforms and obstructs the vessel

3. The recanalization of the thrombus (partial reestablishment of  the blood flow):   

partial lysis of the thrombus   

contraction of the myofibroblasts generates a space between the thrombus and the vascular wall    

the newly formed capillaries in the thrombus (angiogenesis) grow along the vascular axis, crossing the thrombus

4. The noninfectious (sterile) degradation of the thrombus:    

In large thrombi, that have a small connection with the walls of the veins, neutrophils enter and, with the help of their enzymes, melt the thrombus, liquefying its central core

5. The infective degeneration of the thrombus:     

Is encountered in thrombi colonized by bacteria, derived from an infectious source

Infected thrombi can generate emboli, further spreading the infection

6. The calcification of the thrombus:   

calcium  deposits may form inside venous thrombi (phlebolites) or on endocardial vegetations

7. The mobilization of thrombus:   

By partial desintergation of the thrombus and its dislodging, the fragments may enter the bloodstream

6

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cerebral Purpura

internal hemorrhage

the exit of blood outside the blood vessels in a living organism

rupture

erosion 

erythrodiapedesis 

7

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acute pulmonary edema

What is EDEMA? 

Definition:

the increase of fluids in the interstitial compartment    

Pathogenesis:    

Increase of hydrostatic pressure: hyperemia   

Decrease of the oncotic pressure: hypoproteinemia     

The retention of Na ions    

Disorders of lymphatic circulation: lymphedema

 Glotic edema:    

Definition:

the accumulation of liquid in the glotic mucosa

Etiopathology:   

-     acute respiratory infections    

-     immune reactions: angioedema (the Quincke edema)   

Evolution: 

death caused by asphixiation (suffocation) unless an emergency tracheostomy is performed

8

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cachexia

Atrophy by malnutrition 

occurs when the tissues and cells do not receive their basic energetic needs, in other words their normal nutritional requirements

Examples:

the lack of minimal nutritional intake (food deprivation)

the lack of nutrient absorption (GIT diseases)

loss of nutritional substances (vomit, diarrhea, etc.)

Terminology used in case of atrophy by malnutrition:

Tissue-wasting

Cachexia: extreme weight loss in adult

Athrepsia (or athrepsy): extreme weight loss in infants

9

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Left ventricular hypertrophia

Left ventricular hypertrophy is enlargement and thickening (hypertrophy) of the walls of your heart's main pumping chamber (left ventricle). Left ventricular hypertrophy can develop in response to some factor — such as high blood pressure or a heart condition — that causes the left ventricle to work harder.

hypertrophy is the increase in size and function of an organ which implies the increase in size and function of each constituent cell

The cells become bigger, with a larger nucleus and with more structural components (mitochondria, endoplasmic reticulum etc.)

Hypertrophy appears in permanent cells, particularly in muscle cells, but it can also appear in stable cells.

10

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Nodular hyperplasia of the prostate  urinary bladder hypertrophia

Benign prostatic hyperplasia (BPH) is an enlarged prostate gland . The prostate gland surrounds the urethra, the tube that carries urine from the bladder out of the body. As the prostate gets bigger, it may squeeze or partly block the urethra. This often causes problems with urinating

hyperplasia is the increase in size and function of an organ by the increase of the number of its constituent cells

Affects the labile cells, but can also appear in stable cells.

It may appeear simultaneously with hypertrophy

Hyperplasia and hypertrophy should be differentiated from hypergenesis, which involves the congenital overdevelopment of an organ

11

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Gangrene

The gangrene

gangrene is a particular type of necrosis and subsequent degradation of a tissue through an ischemic mechanism sometimes associated with a superposed bacterial infection. Most frequently it occurs at the limbs and in some internal organs.

 

 

Dry gangrene:

Definition: coagulative necrosis through an ischemic mechanism of tissues exposed directly to the air.

12

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Bedsores

are localized injuries to the skin and/or underlying tissue that usually occur over a bony prominence as a result of pressure, or pressure in combination with shear and/or friction. The most common sites are the skin overlying the sacrum, coccyx, heels or the hips, but other sites such as the elbows, knees, ankles or the back of the cranium can be affected.

13

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Bronchial squamus metaplasia

metaplasia is the replacement of a tissue with another type of tissue.

The metaplastic tissue is histologically normal, but its location is abnormal.

The young cells of a tissue proliferate and also change their type of differentiation

It does not occur in adult, mature or “differentiated” cells

n the bronchi (airways): the ciliated columnar pseudo-stratified epithelium is replaced with squamous epithelium. This process can be triggered by smoking, chronic bronchitis etc. The new type of epithelium has greater resistance to the aggressive agents, but it is the first step which makes possible the development of bronchial squamous carcinoma

n the bronchi (airways): the ciliated columnar pseudo-stratified epithelium is replaced with squamous epithelium. This process can be triggered by smoking, chronic bronchitis etc. The new type of epithelium has greater resistance to the aggressive agents, but it is the first step which makes possible the development of bronchial squamous carcinoma

14

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Gall stone cholesterol

lithiasis is the appearance of calculi in various areas of the body  

Calculi are precipitate phases in a solution situated in an excretory tract  

Pathogenesis:  

the increase of crystalloids in a secretion (eg : salts in the urine, bilirubin in the bile)  

the presence of a precipitation nucleus (i.e.: desquamated cells, microbes, foreign organisms)  

Stasis of secretion which favors the infection of the increased amount of secretion

15

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Serus pleurisy

Inflammation of the pleura, usually occurring as a complication of a disease such as pneumonia, accompanied byaccumulation of fluid in the pleural cavity, chills, fever, and painful breathing and coughing.

 

16

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vesicle(bulla)

vesicle (liquid deposit, less than 1 cm diameter)

bulla (liquid deposit, more than 1 cm diameter

Inflammations of the pavimentous epithelium: serous

17

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Fibrinus Pericarditis

Fibrinous pericarditis is an exudative inflammation. The visceral pericardium (epicardium) is infiltrated by the fibrinous exudate. This consists in fibrin strands and leukocytes. Fibrin describes an eosinophilic (pink) network, amorphous.

18

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Fibrinus peritonitis

 inflammation of the peritoneum, typically caused by bacterial infection either via the blood or after rupture of an abdominal organ.

19

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Purulent Peritonitis

Peritonitis is an inflammation of the peritoneum, the thin tissue that lines the inner wall of the abdomen and covers most of the abdominal organs. Peritonitis may be localized or generalized, and may result from infection (often due to rupture of a hollow abdominal organ

20

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purulent miningitis

 Meningitis is an acute inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges.The inflammation may be caused by infection with viruses, bacteria, or other microorganisms, and less commonly by certain drugs.Meningitis can be life-threatening because of the inflammation's proximity to the brain and spinal cord; therefore, the condition is classified as a medical emergency.

21

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Myocardial and pericardial abcess

circumscribed suppurative inflammation

Etiology: 

staphylococcus aurae (more frequent)

22

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Herpes virus vesicle

serous inflammation

On pavimentos epithelium (the tegument and mucous tissues)

23

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Pustula

The recent abscess (acute)

Macroscopic feature:

the area is well defined ; it is  round and yellow-whitish

Microscopic feature:

local PMN deposit, microbial colonies, cellular detritus

on the periphery of the abscess : congestion, xanthomatous → granulation tissue

Evolution:

healing (with AB treatment)

It becomes chronic

24

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Recent myocardial abcess

The recent abscess (acute)

Macroscopic feature:

the area is well defined ; it is  round and yellow-whitish

Microscopic feature:

local PMN deposit, microbial colonies, cellular detritus

on the periphery of the abscess : congestion, xanthomatous → granulation tissue

Evolution:

healing (with AB treatment)

It becomes chronic

25

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Primary tuberculosis Ranke complex

combination of a healed and calcified peripheral lung lesion with a calcified lymph node, due to previous infection from tuberculosis or histoplasmosis.

26

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late congenital syphilis

huntchisson teeth

Hutchinson's teeth[1] (also known as Hutchinson's incisor, Hutchinson's sign or Hutchinson-Boeck teeth) are a sign of congenital syphilis. Babies with this have teeth that are smaller and more widely spaced than normal and which have notches on their biting surfaces.

Congenital syphilis is syphilis present in utero and at birth, and occurs when a child is born to a mother with syphilis. Untreated early syphilis infections results in a high risk of poor pregnancy outcomes, including saddle nose, lower extremity abnormalities, miscarriages, premature births, stillbirths, or death in neonates.

27

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rhinoscleroma

Rhinoscleroma, or simply Scleroma, is a chronic granulomatous bacterial disease of the nose that can sometimes infect the upper respiratory tract.[1] It most commonly affects the nasal cavity—the nose is involved in 95-100 per cent of cases—however, it can also affect the nasopharynx, larynx, trachea, and bronchi. Slightly more females than males are affected and patients are usually 10 to 30 years of age. Rhinoscleroma is considered a tropical disease and is mostly endemic to Africa and Central America, less common in the United States.

28

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pseudomembranous Candidiasis is a fungal infection due to any type of Candida (a type of yeast).[1] When it affects the mouth, it is commonly called thrush.[1] Signs and symptoms include white patches on the tongue or other areas of the mouth and throat.[2] Other symptoms may include soreness and problems swallowing

29

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Granuloma[a] (plural granulomas or granulomata) is an inflammation found in many diseases. It is a collection of immune cellsknown as histiocytes.[1]

 

the granulomas of tuberculosis tend to contain necrosis ("caseating tubercules"), but non-necrotizing granulomas may also be present. Multinucleated giant cells with nuclei arranged like a horseshoe (Langhans giant cell) and foreign body giant cells [7]are often present, but are not specific for tuberculosis. A definitive diagnosis of tuberculosis requires identification of the causative organism by microbiologic culture

30

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candidosis in silver stain

WHAT IS CANDIDOSIS?

Definition: 

candidosis is an inflammation caused by a fungus

Etiology: 

Candida albicans which can be:

Saprophyte: in the oral cavity, in the digestive tract, in the respiratory tract, in the vagina, on the tegument

Pathogen: when the immune defense mechanism does not function

31

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squamus cell carcinoma

Definition: 

carcinomas (cc) are malignant tumors of the pavement, transitional and glandular epithelia. 

Age

It frequently appears at people over 50 years

It can also appear at children: hepato-carcinoma, rhino-pharyngeal cc., thyroid cc.

Sex :

Especially in men: pancreas cc., pulmonary cc., laryngeal cc.

Especially in women: mammary cc., gall bladder cc.

Macroscopically aspects:

Color: 

white-grayish

exceptions: hepato-carcinoma (green), cc of the renal cells (yellow) choriocarcinoma (red).

Consistancy: 

firm

exceptions: mucinous carcinoma of the stomach

Shape:

on the surface:  exophytic (vegetative), ulcerative, infiltrative (schirrous)

in the organs: nodular

Number: 

unique, rarely multiple

Dimenions: 

variable

 

Microscopically aspects:

Tumoral cells:

arranged in isles or chains (trabecular)

with atypical sizes, shapes, colors

typical and atypical mitosis

Stroma:

connective-vascular tissues

Secondary modifications:

haemorrhages, necroses, Ca deposits 

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basal cell carcinoma

Definition: 

carcinomas (cc) are malignant tumors of the pavement, transitional and glandular epithelia. 

Age

It frequently appears at people over 50 years

It can also appear at children: hepato-carcinoma, rhino-pharyngeal cc., thyroid cc.

Sex :

Especially in men: pancreas cc., pulmonary cc., laryngeal cc.

Especially in women: mammary cc., gall bladder cc.

Macroscopically aspects:

Color: 

white-grayish

exceptions: hepato-carcinoma (green), cc of the renal cells (yellow) choriocarcinoma (red).

Consistancy: 

firm

exceptions: mucinous carcinoma of the stomach

Shape:

on the surface:  exophytic (vegetative), ulcerative, infiltrative (schirrous)

in the organs: nodular

Number: 

unique, rarely multiple

Dimenions: 

variable

 

Microscopically aspects:

Tumoral cells:

arranged in isles or chains (trabecular)

with atypical sizes, shapes, colors

typical and atypical mitosis

Stroma:

connective-vascular tissues

Secondary modifications:

haemorrhages, necroses, Ca deposits 

33

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pigmented nevus

Nevi

The common acquired nevi

the most frequent melanic tumor in humans

their number grows with the age

frequent localization: head, throat, torso, limbs (they can appear everywhere on the body)

small dimension, under 6 mm

variable color : from takes the skin color up to black 

ordinary shapes : plaque, papule, polyp

34

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Malignant melanoma

high occurrence

de novo or on melanocytic lesions (acquired nevus, congenital nevus, displasic nevus)

at any age but especially in adults

Signs of malignization of a nevus:

the asymmetry of the lesion

irregular and random distribution of the pigment (brown, black, blue, red, depigmentated areas)

the lesion has irregular margins 

more than 6 mm diameter

Factors that favor the malignization:

preexsting melanic lesions 

solar radiations

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he invasive tumoral melanoma

a. The radial or orizontal growing phase (the nontumoral phase)

- with limited tumoral melanocytes in the epiderma (<> melanoma)

- with tumoral melanocytes in the epiderma and superficial derma (microinvasive melanoma)

- slow evolution (years)

- it does not metastasize

36

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esophagus cell squamus carcinoma

WHAT ARE CARCINOMAS ? 

Definition: 

carcinomas (cc) are malignant tumors of the pavement, transitional and glandular epithelia. 

Age

It frequently appears at people over 50 years

It can also appear at children: hepato-carcinoma, rhino-pharyngeal cc., thyroid cc.

Sex :

Especially in men: pancreas cc., pulmonary cc., laryngeal cc.

Especially in women: mammary cc., gall bladder cc.

Macroscopically aspects:

Color: 

white-grayish

exceptions: hepato-carcinoma (green), cc of the renal cells (yellow) choriocarcinoma (red).

Consistancy: 

firm

exceptions: mucinous carcinoma of the stomach

Shape:

on the surface:  exophytic (vegetative), ulcerative, infiltrative (schirrous)

in the organs: nodular

Number: 

unique, rarely multiple

Dimenions: 

variable

37

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rectal scirhous carcinoma

WHAT ARE CARCINOMAS ? 

Definition: 

carcinomas (cc) are malignant tumors of the pavement, transitional and glandular epithelia. 

Age

It frequently appears at people over 50 years

It can also appear at children: hepato-carcinoma, rhino-pharyngeal cc., thyroid cc.

Sex :

Especially in men: pancreas cc., pulmonary cc., laryngeal cc.

Especially in women: mammary cc., gall bladder cc.

Macroscopically aspects:

Color: 

white-grayish

exceptions: hepato-carcinoma (green), cc of the renal cells (yellow) choriocarcinoma (red).

Consistancy: 

firm

exceptions: mucinous carcinoma of the stomach

Shape:

on the surface:  exophytic (vegetative), ulcerative, infiltrative (schirrous)

in the organs: nodular

Number: 

unique, rarely multiple

Dimenions: 

variable

38

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WHAT ARE CARCINOMAS ? 

Definition: 

carcinomas (cc) are malignant tumors of the pavement, transitional and glandular epithelia. 

Age

It frequently appears at people over 50 years

It can also appear at children: hepato-carcinoma, rhino-pharyngeal cc., thyroid cc.

Sex :

Especially in men: pancreas cc., pulmonary cc., laryngeal cc.

Especially in women: mammary cc., gall bladder cc.

Macroscopically aspects:

Color: 

white-grayish

exceptions: hepato-carcinoma (green), cc of the renal cells (yellow) choriocarcinoma (red).

Consistancy: 

firm

exceptions: mucinous carcinoma of the stomach

Shape:

on the surface:  exophytic (vegetative), ulcerative, infiltrative (schirrous)

in the organs: nodular

Number: 

unique, rarely multiple

Dimenions: 

variable

39

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pigmented bsal cell carcinoma 

WHAT ARE CARCINOMAS ? 

Definition: 

carcinomas (cc) are malignant tumors of the pavement, transitional and glandular epithelia. 

Age

It frequently appears at people over 50 years

It can also appear at children: hepato-carcinoma, rhino-pharyngeal cc., thyroid cc.

Sex :

Especially in men: pancreas cc., pulmonary cc., laryngeal cc.

Especially in women: mammary cc., gall bladder cc.

Macroscopically aspects:

Color: 

white-grayish

exceptions: hepato-carcinoma (green), cc of the renal cells (yellow) choriocarcinoma (red).

Consistancy: 

firm

exceptions: mucinous carcinoma of the stomach

Shape:

on the surface:  exophytic (vegetative), ulcerative, infiltrative (schirrous)

in the organs: nodular

Number: 

unique, rarely multiple

Dimenions: 

variable

40

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nodular basal cell carcinoma

WHAT ARE CARCINOMAS ? 

Definition: 

carcinomas (cc) are malignant tumors of the pavement, transitional and glandular epithelia. 

Age

It frequently appears at people over 50 years

It can also appear at children: hepato-carcinoma, rhino-pharyngeal cc., thyroid cc.

Sex :

Especially in men: pancreas cc., pulmonary cc., laryngeal cc.

Especially in women: mammary cc., gall bladder cc.

Macroscopically aspects:

Color: 

white-grayish

exceptions: hepato-carcinoma (green), cc of the renal cells (yellow) choriocarcinoma (red).

Consistancy: 

firm

exceptions: mucinous carcinoma of the stomach

Shape:

on the surface:  exophytic (vegetative), ulcerative, infiltrative (schirrous)

in the organs: nodular

Number: 

unique, rarely multiple

Dimenions: 

variable