Intestinal intussusception

Acute segmental infarction of kidney

Staging of colon cancer

Modified Duke Staging System
Modified Duke A
The tumor penetrates into the mucosa of the bowel wall but no further.
Modified Duke B
B1: tumor penetrates into, but not through the muscularis propria (the muscular layer) of the bowel wall.
B2: tumor penetrates into and through the muscularis propria of the bowel wall.
Modified Duke C
C1: tumor penetrates into, but not through the muscularis propria of the bowel wall; there is pathologic evidence of colon cancer in the lymph nodes.
C2: tumor penetrates into and through the muscularis propria of the bowel wall; there is pathologic evidence of colon cancer in the lymph nodes.
Modified Duke D
The tumor, which has spread beyond the confines of the lymph nodes (to organs such as the liver, lung or bone).
TNM Staging System (Tumor, Node, Metastisis)
Tumor
T1: Tumor invades submucosa.
T2: Tumor invades muscularis propria.
T3: Tumor invades through the muscularis propria into the subserosa, or into the pericolic or perirectal tissues.
T4: Tumor directly invades other organs or structures, and/or perforates.
Node
N0: No regional lymph node metastasis.
N1: Metastasis in 1 to 3 regional lymph nodes.
N2: Metastasis in 4 or more regional lymph nodes.
Metastasis
M0: No distant metastasis.
M1: Distant metastasis present.

Pharynx, anatomy and disease

Lateral pharyngeal pouch: At the level of valleculae
Superior - hyoid bone, middle constrictor muscle
Posterior - stylopharyngeus muscle, superior cornu of the thyroid cartilage
Anterior - thyrohyoid muscle and membrane
5% aspiration
Lateral pharyngeal diverticula: from tonsillar fossa or region of the thyrohyoid membrane
Persistent pouches or saccular collections of the region of the thyrohyoid membrane
Zenker's Diverticulum
Killian-Jamieson Pouches and Diverticula
Webs
Inflammatory disorder
Benign tumor
Malignant tumor

Von Hippel-Lindau Disorder

•Autosomal dominant disorder (Chroosome 3) with 1/35000-1/40000 incidence in America
•Most attacked in 2nd to 3rd decades
•M:F is about 1:1
Diagnostic Criteria
•> 1 hemangioblastoma of CNS
•1 hemangioblastoma + visceral manifestation
•1 manifestation + family history

Subclassification by NIH

•Type I: Renal + pancreatic cysts, high risk for RCC, no pheochromocytoma
•Type IIA: Pheochromocytoma, pancreatic islet cell tumor
•Type IIB: Pheochromocytoma + renal + pancreatic disease

Angiomatous lesions

- Retinal hemangioblastomas -> Von Hippel tumor
- CNS hemangioblastomas -> Lindau tumor
- Endolymphatic sac tumors
- Renal cell carcinoma - Pancreatic cysts and tumors
- Pheochromocytomas
- Epididymal cystadenomas

Groove pancreatitis

a form of segmental pancreatitis affecting the head of the pancreas, is localized within the "groove" between pancreas head, duodenum, and common bile duct. Differentiation between groove pancreatitis and pancreatic head carcinoma is often difficult.

Impact of protein plug over Santorini's duct may be the cause of groove pancreatitis

Image: a mass was detected in the head of the pancreas that involved the duodenum. Dynamic CT demonstrated a poorly enhancing lesion extending between the pancreatic head and the duodenum.

Bowler Hat Sign

For differienation of polyp and diverticulm of colon.
Bowler hat pointing toward center of cup showed a polyp and pointing away from center of cup showed a diverticulum
When the bowler hat is nearly parallel to long axis of bowel, it is impossible to determine whether it is a polyp or a diverticulum