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Malignancy

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MALIGNANCY (CELLULAR MORPHOLOGY)
Normal Tissue Present Firstly, normal tissues in the image are the ones on the right; the ones that appear lighter. Usually, staining (as performed in the image) helps to distinguish normal from cancerous tissue. From the image one can see that compared to the tissue that appears darker, the normal tissue is smaller (Koch 2010, pg. 18). The normal tissue cells are also consistent in their size and shape, unlike the cancerous tissue cells which appear to have very different shapes and sizes. Using the image only, those are the clear observations that can be made when describing the normal tissue. In addition, unlike the cancerous tissue cells which appear abnormal and distorted, normal tissue cells look smooth and regular. Deeper analysis focusing on the nucleus would have provided information that identifies and distinguishes normal from cancerous tissue.
Malignant tissue morphology suggesting cell/tissue origins The malignant tissue have large nucleus with irregular shape and size. In addition, the nucleoli are prominent; the cytoplasm is scarce and deeply colored or, on the opposite, is pale. The nucleus of malignant tissue plays, through its alterations, a big role in the evaluation of malignancy. Changes are associated with the surface, structure and homogeneity, the nucleus/cytoplasm ratio, volume, as well as shape and density. Ultra-structural features are associated with changes in chromatin (e.g. reduction in heterochromatin and increase of perichromatin and interchromatin granules, formation of inclusions, and increase of nuclear membrane pores), invaginations, and nucleus segmentation.

The nucleus is characterized by its movement towards the membrane, hypertrophy, numerical increase, development of intranuclear and canalicular systems between the nucleolus and the nuclear membrane, and macro and micro-segregation. Mitoses are also a regular feature of malignant tissue. Mitoses numerically increase, atypical mitosis forms with defects in the mitotic spindle develop, which produces dissymmetrical structures, triple or quadruple asters, and atypical forms of chromosomes. Nuclear changes justify genetic defects associated with these changes, and also explain the presence of different cell clones. In malignant tissue that are severely anaplastic, the presence of large nuclei and multinucleate cells shows abnormal divisions (Hermans 2006, pg. 27). The morphological features discussed here symbolize the changes happening at metabolic level, with the augmentation of structures in regards to the attenuation of structures related to other metabolisms, and cell division. Changes also occur in the cytoplasm, with new structures appearing or normal structures disappearing. The accumulation of messenger and ribosomal RNA makes the cytoplasm basophilic. Malignant tissues have a small cytoplasmic count, usually with vacuoles (Valavanis 2012, pg. 20).
Limited antibody staining panel which would advance my diagnostic certainty

Anti-S-100 Protein Antibody staining panel would be highly appropriate for advancing my diagnostic certainty. S-100 protein is a family of low-molecular-weight proteins that is commonly found in vertebrates. At neutral PH, they are completely soluble in ammonium sulfate (Harrison, Sessions, & Hong 2004, pg. 35). The family consists of over 20 types of S-100 proteins, which all contain a helix-loop-helix (HLH) domain and calcium-binding sites. S-100 proteins commonly occur in glial cells, melanocytes, and Schwann cells (Damjanov & Fan 2007, pg. 16). S-100 proteins can be used in numerous functions, from the inflammatory reaction to the control of calcium homeostasis. Some are markers for particular cancers and inflammatory diseases (Pories & Moses 2009 pg. 47).

Aggressiveness This type of tumor is commonly aggressive in its biological behavior. It is, in general, an aggressive tumor that grows quite rapidly. That is why the gravity of early detection is usually heavily stressed (Fleming 1997, pg. 33). This type of tumor is staged according to its size, existence of enlarged lymph nodes and evidence of metastasis to other parts of the body. The stages are usually 4, with stage I being the early diagnosed disease which has much higher success rates than the 3rd or 4th stages in which the tumor presents evidence of spread away from the original site. Due to its aggression, it typically metastasizes to the neck lymph nodes, and can also metastasize to the bones, lungs, or liver (Rykovich 2000, pg. 49). The metastasis to the neck lymph nodes is one of the most significant evidences of the aggressiveness of this tumor and lowers the prognosis by almost 50%.
Further Investigations a) Biopsy under local anesthesia b) Upper aero-digestive tract endoscopy c) Blood tests d) Ultrasound e) Needle aspiration cytology f) Further physical examination From the provided information, it is clear that this is a stage I tumor/cancer whose development can be arrested with faster diagnosis and treatment (Wakefield 2007, pg. 31). When these investigations are complete, staging can be done using the 'tumor, nodes, metastases' (TNM) staging system that is commonly employed in the staging of head and neck cancers. In this system, T is the degree of the primary tumor; N is the involvement of regional lymph nodes; and M is the evidence of metastases (Watson 2010 pg. 29). The extent of infiltration is indicative of prognosis.

References
Damjanov, I., & Fan, F. 2007, Cancer grading manual, Springer, New York.
Fleming, I. D. 1997, AJCC cancer staging manual (5th ed.), Lippincott-Raven, Philadelphia.
Harrison, L. B., Sessions, R. B., & Hong, W. K. 2004, Head and neck cancer: a multidisciplinary approach (2nd ed.), Lippincott Williams & Wilkins, Philadelphia.
Hermans, R. 2006, Head and neck cancer imaging, Springer, Berlin.
Koch, W. M. 2010, Head and neck cancer, Saunders/Elsevier, Philadelphia, PA.
Pories, S., & Moses, M. A. 2009, Cancer, Greenwood Press, Santa Barbara, Calif.
Rykovich, R. 2000, Diagnosis, cancer, CeShore, Pittsburgh.
Valavanis, A. 2012, Tumors, Springer, S.l.
Wakefield, L. 2007, Metastasis, IOS Press, Amsterdam.
Watson, M. S. 2010, Cancer care, Oxford University Press, Oxford.

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