The underlying tissue is what. Operations in the sequential and postpartum periods

Epithelial tissue, or epithelium, covers the outside of the body, lines the body cavities and internal organs, and also forms most of the glands.

Varieties of the epithelium have significant structural variations, which depend on the origin (epithelial tissue develops from all three germ layers) of the epithelium and its functions.

However, all species have common features that characterize epithelial tissue:

1. The epithelium is a layer of cells, due to which it can protect the underlying tissues from external influences and exchange between the external and internal environment; violation of the integrity of the reservoir leads to a weakening of its protective properties, to the possibility of infection.
2. Located on connective tissue (basement membrane), from which nutrients come to it.
3. Epithelial cells are polarized, i.e. parts of the cell (basal), lying closer to the basement membrane, have one structure, and the opposite part of the cell (apical) has another; different components of the cell are located in each part.
4. Possesses a high ability to regenerate (recover). Epithelial tissue does not contain or contains very little intercellular substance.

Epithelial tissue formation

Epithelial tissue is made up of epithelial cells that are tightly connected to each other and form a continuous layer.

Epithelial cells are always found on the basement membrane. It delimits them from loose connective tissue, which lies below, performing a barrier function, and prevents the germination of the epithelium.

The basement membrane plays an important role in the trophism of epithelial tissue. Since the epithelium is devoid of vessels, it receives nutrition through the basement membrane from the vessels of the connective tissue.

Classification by origin

Depending on the origin, the epithelium is divided into six types, each of which occupies a certain place in the body.

1. Cutaneous - develops from the ectoderm, localized in the area oral cavity, esophagus, cornea and so on.
2. Intestinal - develops from the endoderm, lines the stomach, the small and large intestine
3. Coelomic - develops from the ventral mesoderm, forms serous membranes.
4. Ependymoglial - develops from the neural tube, lines the brain cavity.
5. Angiodermal - develops from the mesenchyme (also called endothelium), lining the blood and lymph vessels.
6. Renal - develops from the intermediate mesoderm, occurs in the renal tubules.

Features of the structure of epithelial tissue

According to the shape and function of the cells, the epithelium is divided into flat, cubic, cylindrical (prismatic), ciliated (ciliated), as well as single-layer, consisting of one layer of cells, and multilayer, consisting of several layers.

Single layer

Single layer flat the epithelium is formed by a thin layer of cells with uneven edges, the surface of which is covered with microvilli. There are mononuclear cells, as well as with two or three nuclei.

Single layer cubic consists of cells with the same height and width, characteristic of the glands excretory duct. The single-layer columnar epithelium is divided into three types:

1. Bordered - occurs in the intestines, gallbladder, has adsorbing properties.
2. Ciliated - is characteristic of the oviducts, in the cells of which there are mobile cilia at the apical pole (they contribute to the movement of the egg).
3. Glandular - localized in the stomach, produces a mucous secret.

Single layer multi-row the epithelium lines the airways and contains three types of cells: ciliated, intercalated, goblet, and endocrine. Together they ensure the normal functioning of the respiratory system, protect against the ingress of foreign particles (for example, the movement of cilia and mucous secretions help to remove dust from the respiratory tract). Endocrine cells produce hormones for local regulation.

Multilayer

Multilayer flat non-keratinizing the epithelium is located in the cornea, anal rectum, etc. There are three layers:

• The basal layer is formed by cells in the form of a cylinder, they divide in a mitotic way, some of the cells belong to the stem;
• spinous layer - cells have processes that penetrate between the apical ends of the cells of the basal layer;
• a layer of flat cells - they are outside, constantly die off and peel off.

Multilayer flat keratinizing the epithelium covers the surface of the skin. There are five different layers:

1. Basal - formed by poorly differentiated stem cells, together with pigment - melanocytes.
2. The spinous layer together with the basal layer form the growth zone of the epidermis.
3. The granular layer is built of flat cells, in the cytoplasm of which the keratoglian protein is located.
4. The shiny layer got its name from its characteristic appearance during microscopic examination of histological preparations. It is a homogeneous shiny strip, which stands out due to the presence of elaidin in flat cells.
5. The stratum corneum consists of horny scales filled with keratin. The scales that are closer to the surface are susceptible to the action of lysosomal enzymes and lose their connection with the underlying cells, therefore they constantly peel off.

Transitional epithelium is in renal tissue, urinary tract, bladder. Has three layers:

• Basal - consists of cells with intense coloration;
• intermediate - with cells of various shapes;
• integumentary - has large cells with two to three nuclei.

It is common for the transitional epithelium to change shape depending on the state of the organ wall; they can flatten or acquire a pear-shaped shape.

Special types of epithelium

Aceto-white -it is an abnormal epithelium that becomes intensely white when exposed to acetic acid. Its appearance during colposcopic examination makes it possible to identify the pathological process in the early stages.

Buccal -collected from the inner surface of the cheek, is used for genetic examination and the establishment of family ties.

Functions of epithelial tissue

Located on the surface of the body and organs, the epithelium is a border tissue. This situation determines its protective function: protection of the underlying tissues from harmful mechanical, chemical and other influences. In addition, through the epithelium occur metabolic processes - absorption or release of various substances.

The epithelium, which is part of the glands, has the ability to form special substances - secrets, and also to release them into the blood and lymph or into the ducts of the glands. This epithelium is called secretory, or glandular.

Differences between loose fibrous connective tissue and epithelial

Epithelial and connective tissue perform different functions: protective and secretory in the epithelium, supporting and transport in connective tissue.

The cells of the epithelial tissue are tightly interconnected, there is practically no intercellular fluid. There is a large amount of intercellular substance in the connective tissue; the cells are not tightly connected to each other.

the cloth - is a phylogenetically developed system of cells and non-cellular structures, which has a common structure and is specialized in performing certain functions. Depending on this, epithelial, mesenchymal derivatives, muscle and nervous tissue are distinguished.

Epithelial tissue morphologically characterized by close association of cells into layers. Epithelium and mesothelium (a type of epithelium) line the surface of the body, serous membranes, the inner surface of hollow organs (alimentary canal, bladder and so on) and form most of the glands.

Distinguish between integumentary and glandular epithelium

Integumentary epithelium refers to the borderline, as it is located on the border of the internal and external environments and through it the metabolism (absorption and excretion) occurs. It also protects the underlying tissue from chemical, mechanical and other external influences.

Glandular epithelium possesses a secretory function, that is, the ability to synthesize and secrete secret substances that have a specific effect on the processes occurring in the body.

The epithelium is located on the basement membrane, under which lies a loose fibrous tissue. Depending on the ratio of cells to the basement membrane, a single-layer and stratified epithelium is distinguished.

The epithelium, all cells of which are associated with the basement membrane, is called monolayer.

In stratified epithelium, only the lower layer of cells is associated with the basement membrane.

Distinguish between single and multi-row monolayer epithelium. A single-row isomorphic epithelium is characterized by cells of the same shape with nuclei lying on the same level (in one row), and for multi-row, or anisomorphic, cells of various shapes with nuclei lying on different levels and in several rows.

The stratified epithelium, in which the cells of the upper layers turn into horny scales, is called multilayer keratinizing, and in the absence of keratinization, multilayer non-keratinizing.

A special form of stratified epithelium is transitional, characterized by the fact that its appearance changes depending on the stretching of the underlying tissue (walls of the renal pelvis, ureters, bladder, etc.).

Through a single-layer single-row epithelium, an exchange of substances occurs between the body and the external environment. For example, the monolayer epithelium of the alimentary canal provides absorption nutrients into the blood and lymph. The multilayer (skin epithelium), as well as the single-layer (bronchial) epithelium, performs mainly protective functions.

Tissue developing from the mesenchyme

Blood, lymph and connective tissue develop from one tissue rudiment - mesenchyme, therefore, they are combined into a group of supporting-trophic tissue.

Blood and lymph - a tissue consisting of a liquid intercellular substance and cells freely suspended in it. Blood and lymph perform a trophic function, transport oxygen and various substances from one organs to another, providing humoral communication of all organs and tissues.

Connective tissue subdivided into the proper connective, cartilaginous and bone. It is characterized by the presence of a large amount of fibrous intercellular substance. The connective tissue performs trophic, plastic, protective and supporting functions.

Muscle

Distinguish between non-striated (smooth) muscle tissue, consisting of cells elongated in length, and striated (striated), formed by muscle fibers that have a symplastic structure. Unstated muscle tissue develops from the mesenchyme, and striated muscle tissue develops from the mesoderm.

Nerve tissue

Nerve tissue consists of nerve cells, neurons, the main function of which is the perception and conduction of excitation, and neuroglia, organically associated with nerve cells and performing trophic, mechanical and protective functions. Rudiment nervous system on the early stage the developed embryo is isolated from the ectoderm, with the exception of microglia, originating from the mesenchyme.

Tissue development - norm and pathology

Associated with tissues are concepts such as proliferation, hyperplasia, metaplasia, dysplasia, anaplasia and regeneration.

Proliferation - all types of reproduction of cells and intracellular structures in health and disease. It underlies the growth and differentiation of tissues, ensures continuous renewal of cells and intracellular structures, as well as repair processes. The proliferation of cells that have lost the ability to differentiate leads to the formation of a tumor. Proliferation is at the heart of metaplasia. Different tissues have different proliferative capacities. Hematopoietic, connective, bone tissue, epidermis, mucosal epithelium, moderate - skeletal muscle, pancreatic epithelium, salivary glands and others. Low proliferative ability or its absence is characteristic of the tissue of the central nervous system and myocardium. When damaged, the function of these tissues is restored by intracellular proliferation. The proliferation of intracellular structures leads to an increase in the volume of cells, their hypertrophy. Hypertrophy of the organ as a whole can occur due to both cellular and intracellular proliferation.

Hyperplasia - an increase in the number of cells by their excessive neoplasm. It is carried out using direct (mitosis) and indirect division (amitosis).

With an increase in the number of cellular organelles (ribosomes, mitochondria, endoplasmic reticulum, etc.), one speaks of intracellular hyperplasia. Similar changes are observed in hypertrophy. Hyperplasia is part of proliferation, since the latter encompasses all types of cell proliferation in normal and pathological conditions. Hyperplasia develops due to various influences that stimulate cell multiplication, the result of which is the overproduction of cellular elements. In addition to an increase in the number of cells, hyperplasia is also characterized by some of their qualitative changes. The cells are larger in size than the original ones, their nuclei and the amount of cytoplasm evenly increase, as a result of which the nuclear-cytoplasmic ratio does not change. There may be nucleoli. Hyperplasia of cells with atypia is regarded as dysplasia.

Metaplasia - persistent transformation of one type of tissue into another with a change in its morphology and function. Metaplasia can be direct - a change in the type of tissue without an increase in the number of cellular elements (transformation of the connective tissue itself into bone without the participation of osteogenic elements) and indirect (tumor), which is characterized by cell proliferation and differentiation. Metaplasia can occur due to chronic inflammation, lack of retinol (vitamin A) in the body, hormonal disorders, etc.

The most common metaplasia of the epithelium, for example, metaplasia of the columnar epithelium in the flat (in the bronchi, salivary and sebaceous glands, bile ducts, intestines and other organs with glandular epithelium) or intestinal metaplasia (enterolization) of the epithelium of the gastric mucosa with gastritis.

The transitional epithelium of the urinary bladder in chronic inflammation can metaplastic in both flat and glandular. The squamous epithelium of the oral mucosa is metaplastic into the squamous keratinizing epithelium. There is no convincing evidence of the transformation of connective tissue into epithelial tissue.

Dysplasia - improper development of organs and tissues during embryogenesis and in the postnatal (postpartum) period, when the action of intrauterine factors is manifested after birth, even in an adult.

In oncology, the term "dysplasia" is used to define the precancerous state of tissues associated with impaired regeneration, which proceeds as hyperplasia (with excessive cell formation) and always with signs of atypia.

Depending on the severity of cell atypia, three degrees of dysplasia are distinguished:

• Lightweight;
• Moderate;
• Heavy.

Mild dysplasia characterized by the appearance in single cells of binucleation while maintaining a normal nuclear-cytoplasmic ratio in the remaining cells. In some cells, signs of dystrophy (vacuolar, fatty, etc.) may appear.

With moderate dysplasia in single cells, an increase in nuclei and the appearance of nucleoli in them are noted.

Severe dysplasia characterized by cell polymorphism, annocytosis, enlargement of nuclei, granular structure of chromatin in them, the appearance of multinucleated cells. Nucleoli are found in the nuclei. The nuclear-cytoplasmic ratio changes in favor of the nucleus. More pronounced degenerative changes appear in the cells. The arrangement of cells is chaotic. Cytologically, such dysplasia is difficult to distinguish from intraepithelial cancer. In cases of severe dysplasia, there are not as many atypical cells as in carcinoma in situ (pre-invasive cancer is a malignant tumor on initial stages development).

According to a number of researchers, mild to moderate dysplasia rarely progresses and in 20-50% of cases undergoes regression.

There are different points of view regarding severe dysplasia: some scientists believe that it can reverse development and transformation into cancer; for others, severe dysplasia is an irreversible condition that necessarily progresses to cancer. Dysplasia can also be observed with indirect metaplasia.

Anaplasia - a persistent violation of the maturation of malignant tumor cells with a change in their morphology and biological properties. Distinguish between biological, biochemical and morphological anaplasia.

Biological anaplasia is characterized by the loss of all functions of cells, except for the function of reproduction.

Biochemical anaplasia is manifested by the loss of part of the enzyme systems characteristic of the original cells by the cells.

Morphological anaplasia is characterized by a change in intracellular structures, as well as in the shape and size of cells.

18.02.2016, 01:35

Hello, Alexey Mikhailovich!

Please help to decipher the results of histology.
Diagnosis: severe cervical dysplasia. Uterine fibroids, subserous form. (Fibroids along the posterior wall of the uterus, 5.6x5.1x4.9 with signs of cystic degeneration)
01/21/16 was conducted electro excision of the cervix, diagnostic curettage of the cervical canal, uterine cavity.
Results of histological examination:
1. Cone - HSIL (CIN-3) with glandular involvement. Taper in the area of \u200b\u200bthe resection margin without HSIL elements.
2. Scraping cervical canal - HSIL (CIN-3) without underlying tissues, fragments of endocervical crypts.
3. Cavity - endometrium with proliferative glands.

I ask you very much to comment on the results of histology and recommend a further line and sequence of treatment.

A.M. Kind

18.02.2016, 09:20

Hello. if you are at a young reproductive age and plan to still give birth, and curettage of the cervical canal was performed before conization (this is not entirely correct, but explains the data of histological examination), then observation. if after conization, then after 2 months, repeated conization with the FOLLOWING curettage of the canal is shown and determination of a further plan based on the results. if your age is closer to menopause - the decision about the operation.

18.02.2016, 19:49

Thank you very much for your prompt reply! I am 42 years old, but I would not want to part with the uterus yet, so I plan to remove myoma laporoscopically in the future, but first I had to deal with the existing dysplasia.
The results of histology were given to me by the surgeon who operated on me. She said that everything was removed radically, scheduled a cytological examination every 3 months, ultrasound control of myoma. She said that after 3 months you can get pregnant), which for me, really,
no longer relevant, children are adults ... I was so glad that there was no oncology in the material studied, that I did not carefully read the conclusion then. At home I began to understand - there were contradictions. After all, the operation was performed in Gore. Onco dispensary, of course, according to all the rules, they had to perform curettage after conization. And it is very strange that the doctor did not say a word about re-conization, recommended to be observed by the oncogynecologist for 2 years, she said to remove the myoma not earlier than after 3-6 months, that is, it was already about some further measures, and not about the dangerous precancerous condition of the cervical canal, which is mentioned in the conclusion. So I think, maybe she read the conclusion inattentively? Or was it scraped out before conization? I decided that I would have to go to the dispensary again for explanations, because the situation is not clear to me ... how else to ask, "so as not to offend")?
But, if it nevertheless turns out that in the Central Committee of CIN-III, then, if everything is already in order in the vaginal part of the cervix, how deep should the excision deep into the Central Committee be? Are there any reliable methods that allow us to assume whether this second conization will already be radical, or amputation of the cervix is \u200b\u200balready needed? Or do surgeons have to act "blindly" every time in terms of the depth of excision - cut off - scraped out - looked? Is it necessary to do electro excision again, or is it possible already, since oncology is no longer reliably, to apply radio wave or laser? Or in general cryodestruction deep into the CC? And could you recommend, if everything is in order, what types of cytological studies are considered the most reliable for further monitoring of the state of cells. I heard, for example, about "liquid" cytology, I think, in paid laboratories, I will find this service.

1. Injured wound
Description... In the right half of the frontal region, at the border of the hairy part of the head, there is a "P" -shaped (when the edges are brought together) wound, with a side length of 2.9 cm, 2.4 cm and 2.7 cm. In the center of the wound, the skin is exfoliated in the form flap in the area of \u200b\u200b2.4 x 1.9 cm. The edges of the wound are uneven, sagged up to 0.3 cm wide, bruised. The ends of the wound are blunt. Gaps of 0.3 cm and 0.7 cm in length extend from the upper corners, penetrating to the subcutaneous base. At the base of the flap, there is a stripe-shaped abrasion, 0.7x2.5 cm in size. Taking into account this abrasion, the entire damage as a whole has a rectangular shape, 2.9x2.4 cm in size. The right and upper walls of the wound are beveled, and the left one is undermined. Tissue bridges are visible between the edges of the injury deep in the wound. Surrounding skin not changed. In the subcutaneous base around the wound, a hemorrhage of a dark red color, irregular oval shape, measuring 5.6x5 cm and 0.4 cm thick.
DIAGNOSIS
Contused wound of the right half of the frontal region.

2. Injured wound
Description... There are three wounds in the right parieto-temporal part, 174 cm from the plantar surface and 9 cm from the anterior midline, in the 15x10 cm area (conventionally designated 1,2,3).
The wound is 1. spindle-shaped, measuring 6.5 x 0.8 x 0.7 cm. When the edges are brought together, the wound acquires a rectilinear shape, 7 cm long. The ends of the wound are rounded, oriented at 3 and 9 of the conventional clock face.
The upper edge of the wound is covered with a width of up to 0.1-0.2 cm. The upper wall of the wound is beveled, the lower one is undermined. The wound in the middle part penetrates to the bone.
Wound 2, located 5 cm downward and 2 cm posterior to wound No. 1, has a star shape, with three rays oriented to 1.6 and 10 of the conventional clock face, 1.5 cm, 1.7 cm and 0 in length, 5 cm, respectively. The overall dimensions of the wound are 3.5x2 cm. The edges of the wound are sieged to the maximum width in the region of the anterior edge - up to 0.1 cm, the posterior edge - up to 1 cm. The ends of the wound are sharp. The front wall is undercut, the back is beveled.
Wound 3, similar in shape to wound N 2 and located 7 cm upward and 3 cm anterior to wound N 1. The length of the rays is 0.6, 0.9 and 1.5 cm. The overall dimensions of the wound are 3x1.8 cm. Edges the wounds were sieged to the maximum width in the front edge - up to 0.2 cm, the back - up to 0.4 cm.
All wounds have uneven, sagging, crushed, bruised edges, and tissue bridges in the ends. The outer boundaries of sedimentation are clear. The walls of the wounds are uneven, bruised, crushed, with intact hair follicles. The greatest depth of wounds in the center, up to 0.7 cm for wounds No. 1 and up to 0.5 cm for wounds No. 2 and 3. The bottom of wounds No. 2 and 3 is represented by crushed soft tissues. In the subcutaneous base around the wounds there is hemorrhage, irregular oval shape, measuring 7x3 cm for wounds No. 1 and 4 x 2.5 cm for wounds No. 2 and 3. The skin around the wounds (outside of the sedimentation of the edges) is not changed.
DIAGNOSIS
Three contused wounds on the right parietotemporal part of the head.

3. TORN WOUND
Description.On the right half of the forehead, 165 cm from the level of the plantar surface of the feet and 2 cm from the midline, there is a wound of an irregular fusiform shape, measuring 10.0 x 4.5 cm, with a maximum depth of 0.4 cm in the center. The length of the damage is located, respectively, 9-3 of the conventional clock face. When comparing the edges, the wound acquires an almost rectilinear shape, without a tissue defect, 11 cm long. The ends of the wound are sharp, the edges are uneven, without sediment. The skin along the edges of the wound is unevenly exfoliated from the underlying tissues to a width of up to: 0.3 cm - along the upper edge; 2 cm - along the bottom edge. In the resulting "pocket" is determined by a flat dark red blood clot. Hair along the edges of the wound and their follicles are not damaged. The walls of the wound are sheer uneven with small focal hemorrhages. There are tissue bridges between the edges of the wound in the area of \u200b\u200bits ends. The bottom of the wound is the partially exposed surface of the frontal bone scales. The length of the wound at the level of its bottom is 11.4 cm. Parallel to the length of the wound, the finely serrated edge of a fragment of the frontal bone, on which there are small focal hemorrhages, protrudes 0.5 cm into its lumen. No damage was found around the wound on the skin and in the underlying tissues.
DIAGNOSIS
Laceration of the right half of the forehead.

4. BITTED SKIN DAMAGE
Description. On the antero-outer surface of the upper third of the left shoulder in the area of \u200b\u200bthe shoulder joint, there is an unevenly pronounced red-brown annular sludge of irregular oval shape measuring 4x3.5 cm, consisting of two arcuate fragments: upper and lower.
The upper fragment of the sedimentation ring has dimensions of 3x2.2 cm and a radius of curvature of 2.5-3 cm. It consists of 6 banded irregularly expressed abrasions ranging in size from 1.2x0.9 cm to 0.4x0.3 cm, partially connected to each other. Central abrasions have the maximum size, and the minimum along the periphery of the sediment, especially at its upper end. The length of the abrasions is directed mainly from top to bottom (from the outer to the inner border of the semi-oval). The outer edge of the sedimentation is well expressed, looks like a broken line (step-like), the inner edge is winding, indistinct. The ends of sedimentation are U-shaped, the bottom is dense (due to drying out), with an uneven banded relief (in the form of ridges and furrows extending from the outer border of the semi-oval to the inner one). The sediments are deep (up to 0.1 cm) at the upper edge.
The lower fragment of the ring has dimensions of 2.5x1 cm and a radius of curvature of 1.5-2 cm.Its width is from 0.3 cm to 0.5 cm.The outer border of sedimentation is relatively flat and somewhat smoothed, the inner border is sinuous and more distinct, especially on the left side. Here the inner edge of the sedimentation has a steep or somewhat subdued character. The ends of the sedimentation are U-shaped. The bottom is dense, grooved, deepest at the left end of the sedimentation. The bottom relief is uneven, there are 6 sunken areas located in a chain along the course of the abrasion, irregular rectangular in size from 0.5 x 0.4 cm to 0.4 x 0.3 cm and a depth of 0.1-0.2 cm.
The distance between the inner boundaries of the upper and lower fragments of the "ring" of sedimentation is: on the right - 1.3 cm; in the center - 2 cm; on the left - 5 cm. The axes of symmetry of both semirings coincide with each other and correspond to the long axis of the limb. In the central zone of the annular sedimentation, a blue bruise of irregular oval shape measuring 2 x 1.3 cm with indistinct contours is determined.
DIAGNOSIS
Abrasions and bruising on the antero-outer surface of the upper third of the left shoulder.

5. CUT WOUND
Description.On the flexion surface of the lower third of the left forearm, 5 cm from the wrist joint, there is a wound (conventionally designated N 1) of an irregular spindle-shaped shape, measuring 6.5 x 0.8 cm, when the edges are brought together - 6.9 cm long. From the outer (left) at the end of the wound parallel to its length, there are 2 incisions, 0.8 cm long and 1 cm long, with smooth edges ending in sharp ends. 0.4 cm from the bottom edge of wound No. 2, parallel to its length, there is a superficial intermittent incision 8 cm long.The bottom of the wound at its inner (right) end has the greatest steepness and depth up to 0.5 cm.
2 cm down from the first wound there is a similar wound No. 2), measuring 7x1.2 cm. The length of the wound is oriented horizontally. When the edges are brought together, the wound acquires a rectilinear shape, 7.5 cm long. Its edges are wavy, without sedimentation and crushing. The walls are relatively even, the ends are sharp. At the inner (right) end of the wound, parallel to the length, there are 6 skin incisions with a length of 0.8 to 2.5 cm, at the outer one - 4 incisions, 0.8 to 3 cm long.The bottom is represented by dissected soft tissues and has the greatest steepness and the depth at the outer (left) end of the wound is up to 0.8 cm. In the depth of the wound, a vein is visible, on the outer wall of which there is a through damage of a fusiform shape, with dimensions of 0.3x0.2 cm.
In the tissues surrounding both wounds, in an oval-shaped area with dimensions of 7.5x5 cm, there are multiple dark-red hemorrhages merging with each other, irregular oval, sizes from 1x0.5 cm to 2x1.5 cm with uneven indistinct contours.
DIAGNOSIS
Two cut wounds the lower third of the left forearm.

6. PUNCH-CUT WOUND
Description.
On the left half of the back, 135 cm from the plantar surface of the feet, there is an irregular spindle-shaped wound with dimensions of 2.3 x 0.5 cm. The length of the wound is oriented at 3 and 9 of the conventional clock dial (subject to the correct vertical position of the body). After bringing the edges together, the wound has a rectilinear shape with a length of 2.5 cm. The edges of the wound are even, without sedimentation and bruising. The right end is U-shaped, 0.1 cm wide, the left in the form of an acute angle. The skin around the wound is free from damage and contamination.
On the posterior surface of the lower lobe of the left lung, 2.5 from its upper edge, a slit-like injury is horizontally located. When the edges are brought together, it acquires a rectilinear shape, 3.5 cm long. The edges of the damage are even, the ends are sharp. The lower wall of the damage is beveled, the upper one is undermined. On the inner surface of the upper lobe of the lung at the root, at 0.5 cm of the above-described damage, there is another (slit-like shape with smooth edges and sharp ends). There are hemorrhages along the wound channel.
Both injuries are connected by a single rectilinear wound canal, which has a direction from the back to the front and from the bottom up (subject to the correct vertical position of the body). The total length of the wound channel (from a wound on the back to damage to the upper lobe of the lung) is 22 cm.
DIAGNOSIS
Stab-cut blind wound of the left half of the chest, penetrating into the left pleural cavity, with through damage to the lung.

7. CHOPPED WOUND
Description. On the antero-inner surface of the lower third of the right thigh, 70 cm from the plantar surface of the feet, there is a gaping wound of an irregular fusiform shape, measuring 7.5x1 cm.After bringing the edges together, the wound takes a rectilinear shape, 8 cm long.The edges of the wound are smooth, sagging, bruising, the walls are relatively smooth. One end of the wound is U-shaped, 0.4 cm wide, the other in the form of an acute angle. The wound canal has a wedge-shaped shape and the greatest depth is up to 2.5 cm at its U-shaped end, ends in the muscles of the thigh. The direction of the wound channel from front to back, from top to bottom and from left to right (subject to the correct vertical position of the body) The walls of the wound channel are even, relatively smooth. In the muscles around the wound channel, hemorrhage of an irregular oval shape, measuring 6x2.5x2 cm.
On the front surface of the inner condyle of the right femur, the injury is wedge-shaped, measuring 4x0.4 cm and up to 1 cm deep, its longitudinal axis is oriented accordingly 1-7 of the conventional clock face (provided the bone is in the correct vertical position). The upper end of the lesion is U-shaped, 0.2 cm wide, the lower end is sharp. The edges of the lesion are even, the walls are smooth.
DIAGNOSIS
Chopped wound of the right thigh with a notch of the inner condyle of the femur.

8. BURN BY FLAME
Description.On the left half of the chest there is a red-brown wound surface, irregular oval in shape, measuring 36 x 20 cm. The area of \u200b\u200bthe burn surface, determined according to the rule of "palms", is 2% of the entire surface of the victim's body. The wound is covered in places with a brownish scab, which is dense to the touch. The edges of the wound are uneven, coarse and finely wavy, somewhat raised above the level of the surrounding skin and wound surface. The greatest depth of the lesion is in the center, the smallest - along the periphery. Most of the burn surface is represented by a bare subcutaneous base, which has a moist, shiny appearance. In some places, red small focal hemorrhages, oval in shape, measuring from 0.3 x 0.2 cm to 0.2 x 0.1 cm, as well as small thrombosed vessels, are determined. In the central part of the burn wound, there are separate areas covered with greenish-yellow pus-like overlays, which alternate with pinkish-red areas of young granulation tissue. In places on the wound surface, soot deposits are determined. Fluffy hairs in the wound area are shorter, their ends are "bulbous" swollen. When dissecting a burn wound in the underlying soft tissues pronounced edema is determined in the form of a gelatinous yellowish-gray mass, up to 3 cm thick in the center.
DIAGNOSIS
Thermal burn (flame) of the left half of the chest, III degree 2% of the body surface.

9. BURNING WITH HOT WATER
Description. On the front surface of the right thigh, there is a burn wound of an irregular oval shape, measuring 15x12 cm. The area of \u200b\u200bthe burn surface, determined according to the “palms” rule, is 1% of the entire surface of the victim's body. The main part of the burn surface is represented by a group of merging bubbles containing a cloudy yellowish-gray liquid. The bottom of the blisters is a uniform pink-red surface of the deep layers of the skin. Around the zone of blisters there are areas of skin with a soft, moist, pinkish-reddish surface, on the border of which there are zones of peeling of the epidermis with its filmy exfoliation up to 0.5 cm wide. The edges of the burn wound are large and small wavy, somewhat raised above the level of the surrounding skin, with "tongue-shaped" protrusions, especially from top to bottom (subject to the correct vertical position of the thigh). Fluffy hair in the wound area is not changed. When a burn wound is dissected in the underlying soft tissues, a pronounced edema is determined in the form of a gelatinous yellowish-grayish mass, up to 2 cm thick in the center.
DIAGNOSIS
Thermal burn with hot liquid on the front surface of the right thigh, II degree, 1% of the body surface.

10. THERMAL BURNING BY FLAME OF THE IV DEGREE
In the chest, abdomen, gluteal regions, external genitals and thighs, there is a continuous burn wound of irregular shape with wavy, uneven edges. Borders of the wound: on the left chest - subclavian region; on the right chest - costal arch; on the back on the left - the upper part of the scapular region; on the back on the right - the lumbar region; on the legs - the right knee and the middle third of the left thigh. The wound surface is dense, red-brown, in places black. On the border with intact skin, striped erythema up to 2 cm wide. Fluffy hair in the wound area is completely singed. On incisions in the underlying soft tissues, pronounced gelatinous yellow-gray edema up to 3 cm thick.

11. LIGHTNING BURNED
In the occipital region, in the center, there is a round dense light gray scar 4 cm in diameter with thinning of the skin, adhered to the bone. The borders of the scar are even, they rise in a roller-like manner during the transition to the intact skin. There is no hair in the area of \u200b\u200bthe scar. Internal examination: Scar thickness 2-3 mm. There is a round defect of the outer bone plate and spongy substance 5 cm in diameter with a flat, relatively flat and smooth surface, similar to a "polished" surface. The thickness of the bones of the cranial vault at the level of the cut is 0.4-0.7 cm, in the area of \u200b\u200bthe defect the thickness of the occipital bone is 2 mm, the inner bone plate is not changed.

Penetrating injuries, injuries penetrating into the cavity
12. PUNCH-CUT WOUND
Description. On the left half of the chest, along the midclavicular line in the 4th intercostal space, there is a longitudinally located wound, of an irregular fusiform shape, measuring 2.9x0.4 cm. Top part rectilinear wounds 2.4 cm long; lower - arched, 0.6 cm long. The edges of the wound are even, smooth. The upper end of the wound is U-shaped, 0.1 cm wide, the lower end is sharp.
The wound penetrates the pleural cavity with damage to the left lung. The total length of the wound channel is 7 cm, its direction: from front to back and slightly from top to bottom (with
condition of correct vertical position of the body). There are hemorrhages along the wound channel.
DIAGNOSIS
Stab and cut wound of the left half of the chest, penetrating into the left pleural cavity with damage to the lung.

13. FIRING THROUGH-THROUGH BULLET WOUND
On the chest, 129 cm from the level of the soles, 11 cm below and 3 cm to the left of the sternal notch, there is a 1.9 cm rounded wound with a tissue defect in the center and a circular slinging belt along the edge, up to 0.3 cm wide. uneven, scalloped, bottom wall slightly sloping gently, the upper one is undermined. In the bottom of the wound, the organs of the chest cavity are visible. Along the lower semicircle of the wound, the imposition of soot on a crescent-shaped area, up to 1.5 cm wide.On the back, 134 cm from the level of the soles, in the region of the third left rib, 2.5 cm from the line of the spinous processes of the vertebrae, there is a slit wound shape (without tissue defect) 1.5 cm long with uneven, finely patchwork edges, turned outward and rounded ends. A white plastic fragment of the cartridge container will stand from the bottom of the wound.

Examples of fracture injuries description:
14. FRACTURE OF THE RIB
There is an incomplete fracture on the 5th rib to the right between the angle and the tubercle, 5 cm from the articular head. On the inner surface, the fracture line is transverse, with smooth, well-matched edges, without damage to the adjacent compact substance; the fracture area gapes slightly (signs of stretching). Near the edges of the rib, this line bifurcates (in the area of \u200b\u200bthe upper edge at an angle of about 100 degrees, at the lower edge at an angle of about 110 degrees). The resulting branches pass to the outer surface of the rib and gradually, thinning, are interrupted near the edges. The edges of these lines are finely toothed and are not tightly comparable, the walls of the fracture in this place are slightly beveled (signs of compression.)

15. MULTIPLE FRACTURES OF THE RIB
2-9 ribs are broken along the left middle axillary line. Fractures are of the same type: on the outer surface, the fracture lines are transverse, the edges are even, tightly comparable, without damage to the adjacent compact (signs of stretching). On the inner surface, the fracture lines are oblique, with coarsely serrated edges and small splits and peak-like bends of the adjacent compact substance (signs of compression). From the zone of the main fracture along the edge of the ribs, there are longitudinal linear splits of the compact layer, which become hairy and come to naught. On the scapular line on the left, 3-8 ribs are broken with similar signs of compression on the outer surfaces and stretching on the inner surfaces described above.

Focal proliferates (including regeneration and metaplasia) with or without atrophy dysplasia I, II, III preinvasive cancer (Cis) invasive cancer - phase of local growth, phase of generalization of growth.

Uneven diffuse hyperplasia

Stages of tumor morphogenesis are normal

MORPHOGENESIS OF TUMORS

There are three types of tissue differentiation disorders (Fischer-Wazels 1927):

Congenital defects inthe form of heterotopy (for example, thyroid tissue
glands in the tongue, adrenal cortex in the kidney) or heteroplasia (for example, if
zygoma of the stomach in the Meckel diverticulum, cartilage in hypoplastic
noisy kidney). Sometimes ectopic tissue becomes a source of
of a true malignant tumor (insuloma from pancreatic tissue
glands in the wall of the stomach or intestines, cancer from breast tissue, ectopyro-
bath in the external genitals, etc.).

Metaplasia.

Dysplasia is a condition characterized by atypism of part of the epi
the telial layer (epithelial complex), loss of polarity and /
or layering in the absence of invasive growth.

Degreesdysplasia (depending on the severity of atypism):

easy(dysplasia I), in which atypism covers 1/3 of the epithelial layer (complex);

moderate(dysplasia II) - atypism covers 1/2 - 2/3 of the epithelial layer (complex);

heavy(dysplasia III) - atypism covers more than 2/3 of the epithelial layer (complex), but not all Dysplasia manifestations

In stratified squamous epithelium(growing from bottom to top) - focal proliferation with a violation of vertical anisomorphism (i.e. heterogeneity), basal cell hyperplasia, polymorphism, nuclear hyperchromatosis, an increase in the size of nuclei, an increase in P / N, hyper- and parakeratosis, an increase in MI.

In the glandular epithelium, dysplasia(it is more difficult to assess the degree of dysplasia than in stratified epithelium) - disorganization of glandular structures, atypism and chaotic arrangement of glands with an increase in branching and simplification of their structure, budding, papillary growths; polymorphism, hyperchromatosis of nuclei, basophilia of the cytoplasm, increase in P / N, displacement of nuclei to the lumen, multi-row, appearance of foci of keratinization, impaired secretion (appearance, strengthening, weakening). Dysplasia usually begins in the cambial zones of the glandular organs (in the stomach - in the necks and isthmuses of the glands; in the large intestine - in the superficial parts; in the lobules of the mammary gland - in the region of "growth buds", that is, at the place where the intralobular duct passes into the acinus; in liver - on the periphery of the lobules).

Often, dysplasia occurs against the background of regeneration, hyperplasia, and especially against the background of metaplasia (dysplasia against the background of enterolization of the gastric mucosa, dysplasia of epidermal glands or proliferating reserve cells in the cervix, dysplasia in adenomas of the stomach and intestines). At the same time, the probability of malignancy of the regenerating, hyperplastic, metaplastic epithelium is rather low, increasing when signs of dysplasia appear.

The reasons for the transformation of dysplasia into cancer are unclear. lThe essence of dysplasia- a reversible and, for the time being, controlled violation of the differentiation of the epithelium (or other tissue) of a precancerous nature as a result of the proliferation of cambial elements (stem cells, undifferentiated progenitor cells).

The author of the doctrine of progression, Fulds, figuratively considers dysplasia as an "imperfect cancer", and malignancy as one of the last stages of tumor progression. In dysplastic foci, the cellular composition is often more variegated than in tumors in the early stages.

Carcinoma in situ is a stage of cancer that does not show infiltrative growth.In this case, there is a complete replacement of the epithelial layer with atypical cells (in fact, tumor). The only difference from cancer is the preservation of the basement membrane and the absence of the introduction of tumor cells into the underlying tissues. At the same time, lymphoid-macrophage infiltration is often noted under the epithelium, sharply decreasing with the appearance of microinvasion, and especially with invasive cancer.

Early cancer- a fully formed cancerous tumor (there is invasion, but limited only by the mucous membrane, with the intrinsic muscle plate intact).

Superficial cancer- characterized by the disappearance of the basement membrane of the glands in certain areas of the mucous membrane.

and). At-risk groups- the categories and groups of people who have an increased risk of developing tumors compared to other groups or to the general population. For example: smoking and risk of developing lung cancer; infection with the herpes simplex virus type II and the risk of developing cervical cancer; the absence of pregnancy and childbirth and the risk of developing breast cancer, etc.

b). Background processes- a variety of pathological processes, against the background of which tumors occur more often than without them (atrophy, diffuse hyperplastic processes, malformations, chronic inflammatory processes, some dystrophic processes). The most important of the background processes, apparently, are such as diffuse hyperplasia or multiple foci of hyperplasia without atypism, characterized by a moderate increase in MI, the appearance of single pathological mitoses.

in). Actuallyprecancerous processes (dysplasia).

PRE-CANCER:

The common name for congenital and acquired dysplastic conditions
yanii, on the basis of which the development of cancer ( malignant tumors);

In the broad sense of the word, any condition preceding the development
cancer (malignant tumor).

TYPES OF PRECANCER:

Obligate- precancer, necessarily turning into cancer.

Optional- precancer, not necessarily turning into cancer. At the same time, facultative precancer is often divided into two options: facultative precancer in the broad sense of the word, which includes a variety of processes, against the background of which cancer develops more often than in the general population. However, this frequency is not statistically significant. An optional precancer in the narrow sense of the word refers to the processes against which cancer develops with a statistically significant probability.

Predictive valuedifferent phases of tumor morphogenesis are not the same.

Diffuse hyperplasia and focal proliferates areoptional precancer in the broadest sense of the word.

Dysplasia I-II degreeseen as optional precancer in the narrow sense of the word,although its specific meaning varies widely in different organs and depending on the background against which it arises.

Termsfor the development of cancer in this case - the continuation of the action of blastomogens, nonspecific stimulating factors, violation of nonspecific (normal killer cells, macrophages) and specific resistant ™ (T- and B-lymphocytes), hypoxia, circulatory disorders.

Dysplasia III- obligate precancer.

Ca in situ -it is already cancer The list of the main precancerous human diseases

Leukoplakia(Greek leukos - white; plakion - tile, plate) is a precancerous process characterized by focal acanthosis and keratinization of the non-keratinizing epithelium, manifested as white spots on the mucous membrane. Nicotine leukoplakia(nicotinic leukokeratosis) - leukoplakia of the mucous membrane of the palate in smokers in the form of white plaques with small red depressions corresponding to the excretory ducts of the salivary glands Erythroplasia,erythroplasia or Keira's disease (Greek erythros - red, plasis - formation) - carcinoma in situ of the glans penis, less often the mucous membranes of the oral cavity, pharynx, vulva, characterized by the appearance of foci of a pinkish-red color with a velvety flaky surface.

Pigmented xeroderma- an obligate precancer inherited in an autosomal dominant or autosomal recessive type, characterized by increased sensitivity of the skin to ultraviolet rays, manifested by redness, pigmentation, hyperkeratosis, edema and telangiectasias in areas exposed to solar radiation.

Congenital familial polyposis- Obligate precancer, characterized by hereditary polyposis of the small intestine or the entire intestine, often of the stomach.

Malignant lymphomatous polyposis(lymphomatous polyposis) - B-cell nodular lymphosarcoma, consisting mainly of small cells with split nuclei, characterized by multiple lesions of the small and large intestine with its polyposis, characterized by a tendency to rapid l "imphogenic generalization and transformation into leukemia.