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Tumors And Tumor Like Lesions Of Infancy And Childhood

10:53 am by Admin in Cancer

Only 2% of all malignant tumors occur in infancy and childhood; nonetheless, cancer (including leukemia) is the leading cause of death from disease in the United States in children over the age of 4 and up to 14 years of age. Neoplastic disease accounts for approximately 9% of all deaths in this cohort; only accidents cause significantly more deaths. Benign tumors are even more common than cancers. Most benign tumors are of little concern, but on occasion they cause serious disease by virtue of their location or rapid increase in size. It is sometimes difficult to segregate, on morphologic grounds, true tumors or tissues that are present in abnormal locations. Examples of heterotopias include a rest of pancreatic tissue found in the wall of the stomach or small intestine or a small mass of adrenal cells found in the kidney, lungs, ovaries, or elsewhere. The heterotopic rests are usually of little significance, but they can be confused clinically with neoplasms. Rarely, they are sites of origin of true neoplasms, producing the paradox of an adrenal carcinoma arising in the overy.

The term hamartoma refers to an excessive but focal overgrowth of cells and tissues native to the organ in which it occurs. Although the cellular elements are mature and identical to those found in the remainder of the organ they do not reproduce the normal architecture of the surrounding tissue. Hamartomas can be thought of as the linkage between malformations and neoplasms the line of demarcation between a hamartoma and a benign neoplasm is frequently tenous and is variously interpreted. Hemangiomas; lymphagiomas; rhabdomyomas of the heart; adenomas of the liver; and developmental cysts with the kidneys, lungs, or pancreas are interpreted by some as hamartomas and by others as true neoplasms. The frequency of these lesions in infancy and childhood and their clinical behaviour give credence to the belief that many are developmental aberrations. Their unequivocally benign histology, however, does not preclude bothersome and rarely life-threatening clinical problems in some cases.

Benign tumors and tumor-like lesions

Reference has already been made to the difficulty in distinguishing benign tumors from hamartomas. Benign neoplasms are far more common in infancy and childhood than are cancers. Virtually any tumor may be encountered but within this wide array hemangiomas, lymphangiomas, fibrous lesions, and teratomas deserve special mention.

Hemangiomas

Hemangiomas are the most common tumors of infancy. Architecturally, they do not differ from those encountered in elder age. In children most are located in the skin, particularly on the face and scalp, where they produce flat-to-elevated, irregular, redblue masses; some of the flat, larger lesions(considered by some to represent vascular ectasias) are referred to as port-wine stains. Hemangiomas may enlarge along with the growth of the child, but in many instances they spontaneously regress. In addition to their cosmetic significance, they can represent one facet of the hereditarydisorder, von Hippel-Lindau disease. Rarely, vascular tumors, particularly those in the liver and soft tissues, become malignant.

Lympatic tumors

A wide variety of lesions are of lympatic origin. Some of them- lymphangiomas are hamartomatous or neoplastic in origin whereas other appear to represent abnormal dilations of preexisting lymph channels known as lymphangiectasis. The lymphangiomas are usually characterized by cystic and cavernous spaces. Lesions of this nature may occur on the skin but, more important are encountered in the deeper regions of the neck, axilla, mediastinum, tetroperitoneal tissue, and elsewhere. Although histologically benign they tend to increase in size after birt, both by the collection of fluid and by the budding of preexisting spaces. In this manner, they may encroach on vital structures, such as those in the mediastinum or nerve trunks in the axilla, to constitute clinical problems. Lymphangiectasis, in contrast , usually presents as a diffuse swelling of part or all of an extremity; considerable distortion and deformation may result as a consequence of the spongy, dilated subcutaneous and deeper lymphatics. The lesion is not progressive, however, and does not extend its original location. Nonetheless, it give rise to difficult corrective cosmetic problems.

Fibrous tumors

Fibrous tumors occuring in infants and children range from sparsely cellular proliferations of spindle-shaped cells (designated as fibromatosis) to richly cellular lesions indistinguishable from fibrosacomas occuring in elders. Biologic behavior cannot be predicted based on histology alone, however, because some of the lesions (including the cellular fibromatoses or infintile fibrosarcomas) may spontaneously regress. In some of these soft tissue fibrous lesions, a variable proportion of the cells acquire a moderate amount of pink cytoplasm and express muscle specific action. These myofibromatoses present in infants and younger children and although usually solitay they may be multifocal involving any organ. Solitary lesions are benign, but multifocal lesions may result in significant morbidity and mortality when they involve vital organs.

Teratomas

Teratomas illustrate the relationship of histologic maturity to biologic behavior. They may occur as benign, well-differentiated cystic lesions or as solid malignant (immature) teratomas. They exhibit two peaks in incidence: the first at approximately 2 years of age and the second in late adolescence or growing stage. Sacrococcygeal teratomas occur in 1 in 20,000 to 40,000 live births, four times more frequently in girls than in boys. Occasionally diagnosed by prenatal imaging studies, these tumors may be associated with nonimmune hydrops fetails or polyhydraminos and depending on their size, may necessiate cesarean section delivery. In view of the overlap in the mechanisms underlying teratogenesis and oncogenesis it is interesting that approximately 10% of sacrococcgeal teratomas are associated with congenital anomalies, primarily defects of the hindgut and cloacal region and other midline defects (meningocele, spina bifida) not believed to be due to the local effects of the tumor. Approximately 75% of these tumors are histologically mature with a benign course and about 12% are unmistakably malignant ( containing endodermal sinus tumor) and lethal. The remainder are designated as immature teratomas, and their malignant potential correlates with the amount of immature tissue elements present. Most of the benign teratomas are encountered in younger infants

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Pulmonary Tuberculosis

10:47 am by Admin in Tuberculosis

The overwhelming preponderance of tuberculous infections affect the lungs and begin there. Pulmonary involvement is still the major cause of tuberculosis morbidity and mortality. The prevention and control of these pulmonary infections account for tuberculosis being a relatively uncommon cause of death today in the United States. A further grim aspect of th eresurgence of tuberculosis is the emergence of highly drug-resistant strains.

Primary pulmonary tuberculosis

Except for the rare intestinal (bovine) tuberculosis and the even more uncommon skin, oropharyngeal, and lymphoidal primary sites, the lungs are the usual location of primary infections. The initial focus of primary infection is the Ghon complex which consists of (1) a parenchymal subpleural lesion, often just above or just below the interlobar fissure between the upper and the lower lobes, and (2) enlarged caseous lymph nodes draining the parenchymal focus.

The course and fate of this initial infection are variable, but in most cases patients are asymptomatic and the lesions undergo fibrosis and calcification. Exceptionally, particularly in infants and children or immunodeficient elders, progressive spread with cavitation, tuberculous pneumonia, or military tuberculosis may follow a primary infection.

Secondary (Reactivation) Pulmonary Tuberculosis

Most cases of secondary pulmonary tuberculosis represent reactivation of an old, possibily subclinical infection. During primary infection, bacilli may disseminate without producing symptoms and establish themselves in sites with high oxygen tension, particularly the lung apices Reactivation in such sites occurs in no more than 5 to 10% of the cases of primary infection. Secondary tuberculosis, however, tends to produce more damage to the lungs than does primary tuberculosis.

The secondary pulmonary tuberculous lesion is located in the apex of one or both. It begins as a small focus of consolidation, usually less than 3 cm in diameter. Less commonly, initial lesions may be located in other regions of the lung, particularly about the hilus. In almost every case of reinfection, the regional nodes develop foci of similar tuberculous activity. In favorable case, the initial parenchymal focus develops a small area of caseation necrosis that does not cavitate because it fails to communicate with a bronchus or bronchiole. The usual course is one of progressive fibrous encapsulation, leaving only fibrocalcific scars that depress and pucker the pleural surface and cause focal pleural adhesions. Sometimes, these fibrocalcific scars become secondarily blackened by anthracotic pigment.

Histologically, coalescent granulomas are present, composed of epithelioid cells surrounded by a zone of fibroblasts and lymphocytes that usually contains Langhans giant cells. Some necrosis (caseation) is ually present in the centers of these tubercies , the amount being entirely dependent on the sensitization of the patient and the virulence of the organisms.

As the lesions progress more tubercles coalesce to create a confluent area of consolidation. In the favorable case, either the entire area is eventually converted to a fibrocalcific scar or the residual caseous debris becomes totally and heavily walled off by hyaline collagenous connective tissue. In these late lesions, the multinucleate giant cells tend to disappear.

In cases of suspected tuberculous tissue changes the diagnosis is confirmed by histologic staining, smears, and cultures of acid-fast organisms. Tubercle bacilli can be demonstrated in the early exudative and caseous phases, but it is usually impossible to find them in the late fibrocalcific stages. Lesions with sparse organisms can be highly infective one can estimate that finding a single acid fast bacillus in a routine histologic sample granuloma indicates that a total of atleast 2000 organisms are present within the granuloma. Hence it can not be assumed that their absence in histologic sections is tantamount to their total destruction because in many of these instances culture of the lesions or inoculation of this material into guinea pigs yields the organisms.

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The Law of Attraction and Cancer

10:39 am by Admin in Cancer

Discussions involving the Law of Attraction or the Secret of Attraction predominately revolve around money and wealth. However, wealth is only one aspect of life. Health is of greater daily concern to us than is wealth but it does not appear to receive the same attention.

The Law of Attraction applies to all aspects of our lives including our health. We attract our state of health just as we attract our state of wealth. This attraction is, for most people, usually by default. While we are usually cognizant of attracting good health into our lives by our activities and philosophies, we are usually totally unaware of attracting disease into our lives. Very few patients with whom I have dealt have stated initially that they knew they created their disease.

Cancer is one of the areas where I spend a lot of time with patients, families and medical staff. As I ponder the Law of Attraction, I often think about the universal focus on cancer. Cancer is a hot topic. The treatment of cancer is a hot issue. The medications for cancer treatment are an expensive issue. Newspapers, radio stations and television stations regularly carry articles and programs about some aspect of cancer. Governments feed more money into cancer research and treatment. Pharmaceutical companies develop more expensive medications for its treatment and make more and more money. Physicians specialize in its diagnosis and treatment. Treatment teams are set up to work with the cancer patient and his family. Public forums are held and even court battles are fought over one type of cancer being given preferential treatment. And the incidence of cancer continues to escalate!

Why? Why, with all the focus on cancer and the enormous amounts of money being spent, does the incidence of cancer continue to rise? With all the expensive treatments, why do people continue to have recurrence of their cancer? Why do some families appear to be magnets for the disease while others appear to be immune?

Certainly, I believe, environmental issues play a large part in the development of cancer. Genetics play a part. Lifestyle, eating habits and smoking all play a part. But what about the Law of Attraction? Does it somehow explain the increasing incidence of cancer throughout the world.

The Law of Attraction requires three steps: ask, believe and receive. According to the Law of Attraction, the universe will give us exactly what we ask for. Is not the attention that we give to cancer in a way sending a message to the universe that we are asking for more (is not preparing for it asking for it?)? Is not the ongoing devotion to the business of cancer telling the universe that we believe we are ready to receive more of it. We are receiving it with open arms!

I am not suggesting that any individual wishes to have cancer. Nor am I suggesting that we should stop our research and treatment or our funding for such. That would be foolish. I do notice that very little emphasis is placed on prevention. As a society, if we were not ready to receive cancer, would we not be taking steps to get rid of the environmental and publicly promoted lifestyle and eating habits that we know contribute to cancer?

I believe the Law of Attraction adds a viable explanation to the increasing rates of cancer (as well as many other diseases) in our society. I believe it applies at both the macro level and the individual level. I expect little significant change will occur at the macro level and that it is up to each individual to apply the tenets of the Law of Attraction to their own lives to protect themselves. I do not believe our governments, industry or large institutions have the best interest of the individual in their focus. Thus we must learn to protect ourselves from these diseases by every means possible.

I work in a medical setting with people who span the spectrum from complete happiness to total despair. I have come to appreciate how people create their own reality but seldom ever take credit for it. This has led me to search for materials to help me understand the dynamics and to assist the people I help. And it has enabled me to change my thinking and lead a better more fulfilling and prosperous life. For more information on the Law of Attraction, visit my blog, the Secret of Attraction.

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