1. SINUSES
A sinus is a blind tract usually lined with granulation tissue that leads from an epithelial surface into the surrounding tissue. e.g. pilonidal sinus
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2. FISTULA
It is a communicating track between two epithelial surfaces, commonly between a hollow viscus and the skin ( external fistula) or between two hollow viscera ( internal fistula) The track is lined with granulation tissue which is subsequently epithelialzed
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4. CLASSIFICATION
Congenital Acquired
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5. Pathological sinuses ACQUIRED 1. Pilonidal 2. Suture 3. Post-surgical
CONGENITAL
1. Preauricular
2. Umbilical
3. Urachal
4. Coccygeal
5. Sacral
ACQUIRED
1. Pilonidal
2. Suture
3. Post-surgical
4. Actinomycosis
5. Tuberculosis
6. Osteomyelitis
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6. Persistence of a sinus or fistula
F Foreign Body & Necrotic Tissue R Radiation I Immunosupression Infection Ischemia E Epithelization N Neoplasia D Drugs (eg: Steroids , Cytotoxic drugs) Distal Obstruction S Systemic Diseases (eg: AIDS)
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7. Clinical features
Asymptomatic Recurrent or persistent discharge Pain Infection
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8. Diagnosis
Assess the accurate direction, depth & presence of multiple tracts. Microbiological examination of discharge ( gut organism, actinomycosis, tuberculosis) Sinogram
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9. Management of Sinus
Complete excision of all sinus tract. Sinus is laid open or excised Biopsy of tissue is sent Removal of the cause
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13. Tumour

14. WHAT IS A TUMOUR?
a swelling inflammatory – abscess neoplasm - growth

15. NEOPLASM
Abnormal growth of cells which persists after initiating stimulus has been removed Cell growth has escaped from normal regulatory mechanisms Benign Malignant

16. Cells grow as a compact mass and remain at their site of origin
BENIGN NEOPLASM
Cells grow as a compact mass and remain at their site of origin

19. MALIGNANT NEOPLASM
Growth of cells is uncontrolled Cells can spread into surrounding tissue and spread to distant sites Cancer = a malignant growth

21. DIFFERENCES BETWEEN BENIGN AND MALIGNANT NEOPLASMS
Size Growth characteristics Vascularity/necrosis Function Invasion/metastasis

22. DIFFERENCES BETWEEN BENIGN AND MALIGNANT NEOPLASMS
BENIGN Nuclear variation in size and shape minimal Diploid Low mitotic count, normal mitosis Retention of specialisation
MALIGNANT Nuclear variation in size and shape minimal to marked, often variable Range of ploidy Low to high mitotic count, abnormal mitosis Loss of specialisation

23. DYSPLASIA
Premalignant condition Increased cell growth Cellular atypia Altered differentiation Can range from mild to severe Sites -cervix -bladder -stomach

24. IN-SITU MALIGNANCY
Epithelial neoplasm with features of malignancy altered cell growth cytological atypia altered differentiation BUT-no invasion through basement membrane