ADENOID CYSTIC CARCINOMA ALSO KNOWN AS: Cylindroma Adenocystic Carcinoma Adenocystic Basal Cell Caarcinoma Pseudoadenomatous Basal

Cell Carcinoma Basaloid Mixed Tumor What is Adenomatoid Cystic Carcinoma? Typically showing little cellular atypia and only rare mitotic figures, it pursues an unrelenting course that defies most therapeutic measures. Is a rare type of cancer that can exist in many different body sites. LOCATION 50%-70% occurs in minor salivary gland of the head and neck. Parotid gland is the most affected major salivary gland. but has also been reported in the: breast, lacrimal gland of the eye,Brain ,Bartholin gland, Trachea,Paranasal sinuses Age Predilection: 5th to 7th decades of life. Gender Predilection: No Gender Predilection. Clinical Features: It is a unilobular mass. Firm on palpation, occasionally with some pain or tenderness. Characterized by a slow growth rate. Present for several years before the patient seeks for treatment. Facial nerve weakness or paralysis may occasionally be the initial presenting symptom. A common feature of intraoral lesions particularly those arising on the palate, is the ulceration of the overlying mucosa. Histopathology 3 histological patterns: Tubular Cribriform Solid Cribriform Pattern The best recognized pattern.

Pseudocystic spaces contain mucopolysaccharides that are ultrastructurally characterized by multilayered or replicated basal lamina material. Solid Pattern Little duct formation and is composed of larger islands of small to medium sized cells with small dark nuclei. Tubular form Composed of smaller islands of cells with distinct duct like structures centrally. Treatment Parotid glands- wide resection in the form of a superficial parotidectomy or superficial and deep lobectomy is recommended. Intraorally- wide excision, often with the removal of the underlying bone. Radiation theraphy Chemotheraphy Radiotherapy for Adenoid Cystic Carcinoma The colored lines show varying degrees of radiation exposure. This image shows a cross-section of upper thoracic region where the trachea resection occurred. The radiation field marks are indicated by blue crosses taped to the mask. The mask ensures the patient does not move during radiotherapy. Another view of the radiation therapy room at the University of Virginia oncology center. This view of the radiation mask shows the projected radiation beam targets on the tape marked with blue. Prognosis Survival rates at 5 years approximate 70%; at 15 years the rate is only10%.

 

BASAL CELL ADENOCARCINOMA Is an uncommon epithelial neoplasm of the salivary gland most commonly arising in the parotid gland relatively rare slow growing tumor with an infiltrating growth pattern with vascular and neural invasion.

OTHER NAMES: Basaloid salivary carcinoma Carcinoma ex monomorphic adenoma Malignant basal cell tumor Basal cell carcinoma

OCCURENCE Accounts for less than 2% of all salivary gland tumor Very rare in minor salivary gland 90% involve the parotid gland

AGE

24 to 73 years  MEAN AGE 55 years old  CLINICAL FEATURES: Asymptomatic swelling Rarely present pain  HISTOLOGIC FEATURES: Composed of 2 cell types 1. 2.  Smaller cells with scant cytoplasm and dark nuclei Polygonal cell with eosinophilic to amphophilic cytoplasm and pale basophilic nuclei

DIVIDED INTO FOUR Trabecular Solid Membranous Tubular

DIFFERENCIAL DIAGNOSIS Basaloid cell adenoma Adenoid cystic carcinoma

TREATMENT Surgical excision with a wide margin to ensure complete PROGNOSIS 20% to 30%

Mucoepidermoid Carcinoma DEFINITION: epithelial mucin-producing tumors believed to arise from reserve cells in the interlobular and intralobular segments of the salivary duct system Mucous cells contains Neutral glycoproteins, acidic mucins and sulfomucins Epidermoid cells Keratin intermediate filaments MEC is capable of metastasis Location: MEC of the minor salivary gland.

Note the swelling on the right side of the floor of mouth which, on histopathological examination, proved to be mucoepidermoid carcinoma. Most common intraoral site: Palate Whitish mucous exuding from a muceopidermoid carcinoma AGE 3rd 5th decade of life GENDER equal gender predilection CLINICAL FEATURES: clinical manifestation is depended greatly on the grade of malignancy This particular tumor is entirely solid, without the cystic formations commonly seen in low-grade lesions. MEC in the mandible or maxilla appears radiolucent lesions within the M and PM region Mucoepidermoid carcinoma in posterior mandible with partly distinct borders and resorption of the roots of the first and second molars (arrows). The lesion resembles a cyst. HISTOPATHOLOGIC FEATURES Low-grade mucoepidermoid carcinoma with prominent mucous cells lacking nuclear atypia Intermediate-grade mucoepidermoid carcinoma with an increased number of epidermoid cells and mild nuclear atypia High-grade mucoepidermoid carcinoma with predominant epidermoid cells and moderate nuclear atypia TREATMENT Low Grade surgical procedure neck dissection is rarely performed High Grade surgery plus postoperative radiotherapy to primary site neck dissection is performed PROGNOSIS Low Grade excellent prognosis 95% survival rate High Grade

Fair prognosis 40% survival rate THANK YOU FOR LISTENING... AIDS What comes in to your mind when you hear the word AIDS? Acquired immune deficiency syndrome What Causes Aids? HIV or Human Immunodeficiency Virus (HIV) What is AIDS? This condition progressively reduces the effectiveness of the immune system and leaves individuals susceptible to opportunistic infections and tumors. The time between infection and the appearance of symptoms tends to be much longer, allowing more opportunities for these microorganisms to be transmitted to other hosts. The period between infection and the appearance of AIDS can take from 7 to 12 years. AIDS is now a pandemic. In 2007, an estimated 33.2 million people lived with the disease worldwide, and it killed an estimated 2.1 million people, including 330,000 childr History: Genetic research indicates that HIV originated in west-central Africa during the late nineteenth or early twentieth century. AIDS was first recognized by the U.S. Centers for Disease Control and Prevention in 1981 and its cause, HIV, identified in the early 1980s. Signs and Symptoms The symptoms of AIDS are primarily the result of conditions that do not normally develop in individuals with healthy immune systems Most of these conditions are infections caused by bacteria, viruses, fungi and parasites that are normally controlled by the elements of the immune system that HIV damages. A person may remain asymptomatic, feel, and appear healthy for even years even though he or she is infected with HIV. While he or she does not exhibit AIDS, the immune system starts to be impaired. The person may exhibit neurological symptoms such as memory loss, altered gait, depression, sleep disorders or chronic diarrhea. This set of symptoms is often called AIDS-related Complex (ARC) by clinicians. As the symptom progress, the patient becomes an AIDS patient. Minor Signs

Persistent Cough for one month Generalized pruritic dermatitis Recurrent herpes zoster

Oropharyngeal candidiasis Chronic disseminated herpes simplex Generalized lymphadenopathy Major Signs:

Loss of weight 10 percent of body weight Chronic diarrhea for more than one month Prolonged fever for one month Common Opportunistic Infections

Pneumocystis carinii pneumonia Oral candidiasis Toxoplasmosis of the CNS Chronic diarrhea/wasting syndrome Pulmonary/extra-pulmonary tuberculosis Cancers Kaposi s sarcoma affects small blood vessels and internal organs Cervical dysplasia and cancer. Researchers found out that women with HIV have higher rates of this type of cancer. Cervial carcinoma is associated with Human Papilloma Virus (HPV). Non-Hodgkin s lymphoma cancerous tumor of the lymph nodes. This is usually a late manifestation of HIV infection.

Mode of Transmission: Sexual intercourse Blood transfusion and sharing of infected syringes and needles among intravenous drug users Vertical or perinatal transmission (from a pregnant woman to the fetus during pregnancy, child delivery or breast-feeding) There are several ways of receiving infected blood: Blood transfusion Sharing of unsterilized syringes and needles used for intravenous injections Transmission during pregnancy Maybe transplacental 3

There is greater risk of transmission when mother has developed advanced AIDS

Organ donation Accidental exposure in hospitals or clinics

Diagnostic Examination: ELA or ELISA Enzyme link immunosorbent assay Particle agglutination (PA) test Western blot analysis confirmatory diagnostic test Immunofluorescent test Radio immuno-precipitation assay (RIPA) Nursing Management: Health education The healthcare worker must: Know the patient Avoid fear tactics Avoid judgmental and moralistic messages Be consistent and concise Use positive statement Give practical advice

Practice universal/standard precaution There is a need for a thorough medical handwashing after every contact with patient and after removing the gown and gloves, and before leaving the room of an AIDS suspect or known AIDS patient. Use of universal barrier or Personal Protective Equipment (PPE) e.g., cap, mask, gloves, CD gown, face shield/goggles are very necessary.

Prevention Care should be taken to avoid accidental pricks from sharp instruments contaminated with potentially infectious materials form AIDS patient. Gloves should be worn when handling blood specimens and other body secretions as well as surfaces, materials and objects exposed to them. Blood and other specimens should be labeled with special warning AIDS Precaution . Blood spills should be cleaned immediately using common household disinfectants, like chlorox . Needles should not be bent after use, but should be disposed into a puncture-resistant container.

Personal articles like razor or razor blades, toothbrush should not be shared with other members of the family. Razor blades may be disposed in the same manner as needles are disposed.

Diagnosis of AIDS

Patients with active AIDS should be isolated.

Less than 200 CD4+ T cells per cubic millimeter of blood, compared with about 1,000 CD4+ T cells for healthy people. CD4+T cells are white blood cells that play an important role in the body's immune system. These cells are destroyed by HIV. Even when a HIV-positive person feels well and is not experiencing any symptoms of the disease, CD4+ T cells are being infected by HIV.

CD4+ T cells accounting for less than 14 percent of all lymphocytes, a type of white blood cell.

One of more of the illnesses listed below: Candidiasis of bronchi, esophagus, trachea or lungs Cervical cancer that is invasive Coccidioidomycosis that has spread Cryptococcosis that affecting the body outside the lungs Cryptosporidiosis affecting the intestines and lasting more than a month Cytomegalovirus disease outside of the liver, spleen or lymph nodes Cytomegalovirus retinitis that occurs with vision loss Encephalopathy that is HIV-related Herpes simplex including ulcers lasting more than a month or bronchitis, pneumonitis or esophagitis Histoplasmosis that has spread Isosporiasis affecting the intestines and lasting more than a month month Kaposi sarcoma Lymphoma that is Burkitt type, immunoblastic or that is primary and affects the brain or central nervous system Mycobacterium avium complex or disease caused by M kansasii Mycobacterium tuberculosis in or outside the lungs Other species of mycobacterium that has spread Pneumocystis jiroveci, formerly called carinii, pneumonia Pneumonia that is recurrent Progressive multifocal leukoencephalopathy Salmonella septicemia that is recurrent Toxoplasmosis of the brain, also called encephalitis Wasting syndrome caused by HIV infection