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[MOL] Educational Series/ Biopsy Report: Pls. save!


The Biopsy Report: A Patient's Guide

By Edward O. Uthman, MD. (uthman@riter.computize.com)
Diplomate, American Board of Pathology


Many medical conditions, including all cases of cancer, must be
diagnosed by removing a sample of
tissue from the patient and sending it to a pathologist for examination.
This procedure is called a
biopsy, a Greek-derived word that may be loosely translated as "view of
the living." Any organ in the
body can be biopsied using a variety of techniques, some of which
require major surgery (e.g.,
staging splenectomy for Hodgkin's disease), while others do not even
require local anesthesia (e.g.,
fine needle aspiration biopsy of thyroid, breast, lung, liver, etc).
After the biopsy specimen is
obtained by the doctor, it is sent for examination to another doctor,
the anatomical pathologist, who
prepares a written report with information designed to help the primary
doctor manage the patient's
condition properly.

The pathologist is a physician specializing in rendering medical
diagnoses by examination of tissues
and fluids removed from the body. To be a pathologist, a medical
graduate (M.D. or D.O.)
undertakes a five-year residency training program, after which he or she
is eligible to take the
examination given by the American Board of Pathology. On successful
completion of this exam, the
pathologist is "Board-certified." Almost all American pathologists
practicing in JCAHO-accredited
hospitals and in reputable commercial labs are either Board-certified or
Board-eligible (a term that
designates those who have recently completed residency but have not yet
passed the exam). There is
no qualitative difference between M.D.-pathologists and D.O.-
pathologists, as both study in the
same residency programs and take the same Board examinations.


   1.Excisional biopsy.

     A whole organ or a whole lump is removed (excised). These are less
common now, since the
     development of fine needle aspiration (see below). Some types of
tumors (such as lymphoma,
     a cancer of the lymphocyte blood cells) have to be examined whole
to allow an accurate
     diagnosis, so enlarged lymph nodes are good candidates for
excisional biopsies. Some
     surgeons prefer excisional biopsies of most breast lumps to ensure
the greatest diagnostic
     accuracy. Some organs, such as the spleen, are dangerous to cut
into without removing the
     whole organ, so excisional biopsies are preferred for these.

   2.Incisional biopsy.

     Only a portion of the lump is removed surgically. This type of
biopsy is most commonly used
     for tumors of the soft tissues (muscle, fat, connective tissue) to
distinguish benign conditions
     from malignant soft tissue tumors, called sarcomas.

   3.Endoscopic biopsy.

     This is probably the most commonly performed type of biopsy. It is
done through a fiberoptic
     endoscope the doctor inserts into the gastrointestinal tract
(alimentary tract endoscopy),
     urinary bladder (cystoscopy), abdominal cavity (laparoscopy), joint
cavity (arthroscopy),
     mid-portion of the chest (mediastinoscopy), or trachea and
bronchial system (laryngoscopy
     and bronchoscopy), either through a natural body orifice or a small
surgical incision. The
     endoscopist can directly visualize an abnormal area on the lining
of the organ in question and
     pinch off tiny bits of tissue with forceps attached to a long cable
that runs inside the

   4.Colposcopic biopsy.

     This is a gynecologic procedure that typically is used to evaluate
a patient who has had an
     abnormal Pap smear. The colposcope is actually a close- focusing
telescope that allows the
     physician to see in detail abnormal areas on the cervix of the
uterus, so that a good
     representation of the abnormal area can be removed and sent to the

   5.Fine needle aspiration

     (FNA) biopsy.This is an extremely simple technique that has been
used in Sweden for
     decades but has only been developed widely in the US over the last
ten years. A needle no
     wider than that typically used to give routine injections (about 22
gauge) is inserted into a lump
     (tumor), and a few tens to thousands of cells are drawn up
(aspirated) into a syringe. These
     are smeared on a slide, stained, and examined under a microscope by
the pathologist. A
     diagnosis can often be rendered in a few minutes. Tumors of deep,
hard-to-get-to structures
     (pancreas, lung, and liver, for instance) are especially good
candidates for FNA, as the only
     other way to sample them is with major surgery. Such FNA procedures
are typically done by
     a radiologist under guidance by ultrasound or computed tomography
(CT scan) and require
     no anesthesia, not even local anesthesia. Thyroid lumps are also
excellent candidates for

   6.Punch biopsy

     This technique is typically used by dermatologists to sample skin
rashes and small masses.
     After a local anesthetic is injected, a biopsy punch, which is
basically a small (3 or 4 mm in
     diameter) version of a cookie cutter, is used to cut out a
cylindrical piece of skin. The hole is
     typically closed with a suture and heals with minimal scarring.

   7.Bone marrow biopsy

     In cases of abnormal blood counts, such as unexplained anemia, high
white cell count, and
     low platelet count, it is necessary to examine the cells of the
bone marrow. In adults, the
     sample is usually taken from the pelvic bone, typically from the
posterior superior iliac spine.
     This is the prominence of bone on either side of the pelvis
underlying the "bikini dimples" on
     the lower back/upper buttocks. Hematologists do bone marrow
biopsies all the time, but most
     internists and pathologists and many family practitioners are also
trained to perform this

     With the patient lying on his/her stomach, the skin over the biopsy
site is deadened with a
     local anesthetic. The needle is then inserted deeper to deaden the
surface membrane covering
     the bone (the periosteum). A larger rigid needle with a very sharp
point is then introduced into
     the marrow space. A syringe is attached to the needle and suction
is applied. The marrow
     cells are then drawn into the syringe. This suction step is
occasionally uncomfortable, since it is
     impossible to deaden the inside of the bone. The contents of the
syringe, which to the naked
     eye looks like blood with tiny chunks of fat floating around in it,
is dropped onto a glass slide
     and smeared out. After staining, the cells are visible to the
examining pathologist or

     This part of procedure, the aspiration, is usually followed by the
core biopsy, in which a
     slightly larger needle is used to extract core of bone. The calcium
is removed from the bone to
     make it soft, the tissue is processed (see "Specimen Processing,"
below) and tissue sections
     are made. Even though the core biopsy procedure involves a bigger
needle, it is usually less
     painful than the aspiration.


After the specimen is removed from the patient, it is processed in one
or both of two major ways:

1. Histologic sections. This involves preparation of stained, thin (less
than 5 micrometers, or 0.005
millimeters) slices mounted on a glass slide, under a very thin pane of
glass called a coverslip. There
are two major techniques for preparation of histologic sections:

a. Permanent sections. This technique gives the best quality of specimen
for examination, at the
expense of time. The fresh specimen is immersed in a fluid called a
fixative for several hours (the
necessary time dependent on the size of the specimen). The fixative,
typically formalin (a 10%
solution of formaldehyde gas in buffered water), causes the proteins in
the cells to denature and
become hard and "fixed." Adequate fixation is probably the most
important technical aspect of
biopsy processing.

The fixed specimen is then placed in a machine that automatically goes
through an elaborate
overnight cycle that removes all the water from the specimen and
replaces it with paraffin wax. The
next morning, a technical professional, called a histologic technician,
or "histotech," removes the
paraffin-impregnated specimen and "embeds" it in a larger bloc of molten
paraffin. This is allowed to
solidify by chilling and is set in a cutting machine, called a
microtome. The histotech uses the
microtome to cut thin sections of the paraffin block containing the
biopsy specimen. These delicate
sections are floated out on a water bath and picked up on a glass slide.

The the paraffin is dissolved from the tissue on the slide. With a
series of solvents, water is restored
to the sections, and they are stained in a mixture of dyes. The most
common dyes used are
hematoxylin a natural product of the heartwood of the logwood tree,
Haematoxylon campechianum,
which is native to Central America, and eosin, an artifcial aniline dye.
The stain combination, casually
referred to by pathologists as "H and E" yields pink, orange, and blue
sections that make it easier for
us to distinguish different parts of cells. Typically, the nucleus of
cells stains dark blue, while the
cytoplasm stains pink or orange.

b. Frozen sections. This technique allows one to examine histologic
sections within a few minutes of
removing the specimen from the patient, but the price paid is that the
quality of the sections is not
nearly as good as those of the permanent section. Still, a skilled
pathologist and a knowledgeable
surgeon can work together to use the frozen section's rapid availability
to the patient's great benefit.

2. Smears. The specimen is a liquid, or small solid chunks suspended in
liquid. This material is
smeared on a microscope slide and is either allowed to dry in air or is
"fixed" by spraying or
immersion in a liquid. The fixed smears are then stained, coverslipped,
and examined under the

Like the frozen section, smear preparations can be examined within a few
minutes of the time the
biopsy was obtained. This is especially useful in FNA procedures (see
above), in which a radiologist
is using ultrasound or CT scan to find the area to be biopsied. He or
she can make one "pass" with
the needle and immediately give the specimen to the pathologist, who can
within a few minutes
determine if a diagnostic specimen was obtained. The procedure can be
terminated at that point,
sparing the patient the discomfort and inconvenience of repeated sticks.



The pathologist begins the examination of the specimen by dictating a
description of the specimen as
it looks to the naked eye. This is the "gross exam" or the "gross." Some
pathologists may refer to the
gross exam as the "macroscopic." Most biopsies are small, nondescript
bits of tissue, so the gross
description is brief and serves mostly as a way to code which biopsy
came from what area and to
use for troubleshooting if there is a question of specimen mislabeling.
A typical gross description of
an endoscopic colon biopsy follows:

     "Polyp of sigmoid colon." An ovoid, smooth- surfaced, firm, pale
tan nodule, measuring
     0.6 x 0.4 x 0.3 cm. Cassette 'A', all, bisected.

In the above example, the first item (in quotes) is an exact recitation
of how the specimen was
labeled by the doctor who took the biopsy. After that is a textual
description of what the specimen
looked like, followed by measurements indicating its size. The "Cassette
'A', all, bisected" phrase
indicates that the specimen was cut in half ("bisected"), submitted for
tissue processing in its entirety
("all") in a small container (cassette) labeled "A," which will
eventually be placed in the tissue

Larger organs removed as biopsies have correspondingly longer and more
detailed gross
descriptions. The following is the gross description of a spleen removed
to assess whether Hodgkin's
disease (a cancer of lymph tissues) has spread into it:

     "Spleen". An entire spleen, weighing 127 grams, and measuring 13.0
x 4.1 x 9.2 cm.
     The external surface is smooth, leathery, homogeneous, and dark
     There are no defects in the capsule. The blood vessels of the hilum
of the spleen are
     patent, with no thrombi or other abnormalities. The hilar soft
tissues contain a single,
     ovoid, 1.2-cm lymph node with a dark grey cut surface and no focal

     On section of the spleen at 2 to 3 mm intervals, there are three
well-defined pale-grey
     nodules on the cut surface, ranging from 0.5 to 1.1 cm in greatest
dimension. The
     remainder of the cut surface is homogeneous, dark purple, and firm.

     Summary of cassettes: 1, hilar blood vessels; 2, hilar lymph node,
entirely submitted; 3
     - 6 spleen nodules, entirely submitted; 7 - 8, spleen, away from

In the spleen described above, the pathologist found a few lumps
(nodules), representing the most
important data in this gross examination. These possibly represent the
tumors of Hodgkin's disease,
subject to confirmation by the microscopic examination. Much of the
remainder of the verbage
relates to "pertinent negatives," or things that were routinely looked
for but not found, such as a
rupture of the spleen capsule (suggesting an intraoperative accident),
blood clots ("thrombi") in the
vessels supplying the spleen, and evidence of an infection (in which
case the cut surface of the spleen
would be soft instead of firm). In addition, a lymph node was
serendipitously found adherent to the
spleen, and this was briefly described as having a normal appearance.

The last paragraph of the gross description gives the identifying
"codes" of the slices of the specimen
submitted for microscopic examination in cassettes. The microscope
slides prepared from the
processed samples will be labeled with the same numbers as the
cassettes, and the pathologist doing
the microscopic examination can, by referring to the typed gross
description, know from what part
of the specimen the tissue on the slide came.


The microscopic description, or the "micro" is a narrative description
of the findings gained from
examination of the glass slides under the microscope. The micro is
considered somewhat "optional"
in a written report. In such a case, the diagnosis (see below) is
considered to speak for itself. Here is
a the microscopic description on the report of the colon biopsy given

     Specimen A: The sections show a polypoid structure consisting of a
     fibrovascular core, surrounded by a mantle of mucosa showing an
     architecture with a predominantly tubular pattern. The tubules are
lined by tall columnar
     epithelium showing nuclear pseudostratification, hyperchromasia,
increased mitotic
     activity, and loss of cytoplasmic mucin. There is no evidence of
stromal invasion.

It can be readily seen that the language of microscopy is much more
arcane than that used for gross
descriptions. It is way beyond the scope of this monograph to cover the
nuances of descriptive
microscopic pathology. In general, microscopic descriptions are
communications between
pathologists for referral and quality assurances purposes.


This is analogous to the "bottom line" of a financial report. The
purpose of the gross examination, the
processing of the tissue, and the microscopic examination is to build a
logical argument toward a
terse assessment of what significance the biopsy has in regard to the
patient's health. Here is the
diagnosis for the colon biopsy, above:

     Colon, sigmoid, endoscopic biopsy: tubular adenoma (adenomatous

This format is widely used, but variations occur. The first term is the
organ or tissue involved
("colon"). The second term ("sigmoid") specifies the site in the colon
from which the biopsy was
obtained. The next term ("endoscopic biopsy") denotes the type of
surgical procedure used in
obtaining the biopsy. Then follows the diagnosis proper, in this case
"tubular adenoma," a common
benign tumor of the large intestine and rectum, which increases the risk
for developing colorectal
cancer in the future. In this particular case, an older synonym for
tubular adenoma, "adenomatous
polyp," follows in parentheses.


Finally, it may be useful to present a brief glossary of important terms
used in pathologic diagnoses.
Terms in the definition that are in ALL CAPS have their own entry.

     A closed pocket containing pus. Some abscesses are easily diagnosed
clinically, as they are
     painful and may "point out" such that pus becomes visible, but deep
and chronic abscesses
     may just look like a TUMOR clinically and require biopsy to
distinguish them from neoplasm.
     The simple, straightforward definition would be "unusual," but
"atypical" means much more
     than that. In a diagnosis, the use of the term atypical is a vague
warning to the physician that
     the pathologist is worried about something, but not worried enough
to say that the patient has
     cancer. For instance, lymphomas (cancers of the lymph nodes) are
notoriously difficult to
     diagnose. Some lymph node biopsies are very disturbing but do not
quite fulfil the criteria for
     cancer. Such a case may be diagnosed as "atypical lymphoid
     important atypical hyperplasias are those of the breast (atypical
ductal hyperplasia and
     atypical lobular hyperplasia) and the lining of the uterus
(atypical endometrial hyperplasia).
     Both of these conditions are thought to be precursor warning signs
that the patient is at high
     risk of developing cancer of the respective organ (breast and
     A malignant NEOPLASM whose cells appear to be derived from
     can be used by itself or as a suffix. Cancers composed of columnar
epithelial cells are often
     called adenocarcinomas. Those of squamous cells are called squamous
cell carcinomas. The
     type of cancer typically recapitulates the type of epithelium that
normally lines the affected
     organ. For instance, almost all cancers of the colon are
adenocarcinomas, and columnar
     epithelium is the normal lining of the colon. There are exceptions,
     An ATYPICAL proliferation of cells. This may be loosely thought of
as an intermediate
     category between HYPERPLASIA and NEOPLASIA. It finds its best use
as a term to
     describe the phenomenon in which EPITHELIUM proliferates and
develops the microscopic
     appearance of neoplastic tissue, but otherwise tends to "behave
itself" and continues to line
     body surfaces without actually invading them, as a true malignant
neoplasm would do. It may
     be convenient (but not totally accurate) to consider dysplasia as a
"pre-cancer" or an incipient
     cancer. Probably the most commonly occurring type of dysplasia is
that of the cervix of the
     uterus, where a progression from dysplasia to neoplasia can be
clearly demonstrated. Other
     dysplasias, such as those of the breast and prostate, are more
difficult to clearly relate to
     neoplasia at this time.
     A specialized type of tissue that normally lines the surfaces and
cavities of the body. There are
     three main types: 1) columnar epithelium, which lines the stomach,
intestines, trachea and
     bronchi, salivary and other glands, pancreas, gallbladder, nasal
cavity and sinuses, uterus
     (including inner cervix), Fallopian tubes, kidneys, testes, vasa
deferentia, and other ductal
     structures, 2) stratified squamous epithelium, which lines the
skin, oral cavity, throat,
     esophagus, anus, outer urethra, vagina, and outer cervix, and 3)
transitional epithelium
     (urothelium), which lines the urine-collecting part of the kidneys,
the ureters, bladder, and
     inside part of the urethra.
     A special type of INFLAMMATION characterized by accumulations of
macrophages, some
     of which coalesce into "giant cells." Granulomatous inflammation is
especially characteristic of
     tuberculosis, some deep fungal infections (like histoplasmosis and
     sarcoidosis (a disease of unknown cause), and reaction to foreign
     A proliferation of cells which is not NEOPLASTIC. In some cases,
this may be a result of the
     body's normal reaction to an imbalance or other stimulus, while in
other cases the physiologic
     cause of the proliferation is not apparent. An example of the
former process is the
     enlargement of lymph nodes in the neck as a result of reaction to a
bacterial throat infection.
     The lymphocytes which make up the node divide and proliferate,
taking up more volume in
     the node and causing it to expand. An example of hyperplasia in
which the stimulus is not
     known is benign prostatic hyperplasia (BPH), in which the prostate
gland enlarges in older
     men for no known reason. While hyperplasias do not invade other
organs or
     METASTASIZE to other parts of the body, they can still cause
problems because of their
     local physical expansion. For instance, in BPH, the enlarged
prostate pinches off the urethra
     and interferes with the flow of urine. If untreated, permanent
kidney damage can result.
     A reaction, usually mediated by the immune system, to noxious
stimuli, manifested clinically by
     swelling, pain, tenderness, redness, heat, and/or loss of function
of the affected part. To a
     pathologist, however, inflammation means the infiltration of
certain immune system cells into
     the tissue or organ being examined. These inflammatory cells
include 1) neutrophils, which are
     the white blood cells that make up pus and are seen in acute or
early inflammations, 2)
     lymphocytes, which are typically seen in more chronic or
longstanding inflammations, and 3)
     macrophages (histiocytes), which are also seen in chronic
inflammation. Some types of
     inflammation are readily diagnosable by the primary care physician,
such as an infected skin
     wound that is tender, hot, and draining pus. Other types of
inflammation are not so readily
     apparent clinically and require biopsy to distinguish them from
neoplasms. The suffix "-itis" is
     appended to a root word to indicate "inflammation of _____." For
example, cervicitis,
     pharyngitis, gastritis, and thyroiditis are inflammations of the
cervix, pharynx (throat), stomach,
     and thyroid gland, respectively.
     This is a vague term meaning "the thing that is wrong with the
patient." A lesion may be a
     TUMOR, an area of INFLAMMATION, or an invisible biochemical
abnormality (like the
     abnormality of the sensitivity of the body's cells to insulin in
adult-onset diabetes).
     The phenomenon by which one type of tissue is replaced by another
type. This often results
     from chronic irritation of an EPITHELIAL lining. A good example is
the cervix, in which
     chronic irritation and INFLAMMATION causes the relatively delicate
normal columnar
     epithelium to be replaced by tougher squamous epithelium (similar
to that which normally lines
     the vagina, which is naturally "built tougher" for obvious
reasons). This phenomenon is called
     "squamous metaplasia." In it's pure state, metaplasia is not
harmful, but some metaplasias are
     markers for increased risk of more serious diseases. For instance,
a type of intestinal
     metaplasia of the stomach (in which columnar epithelium of the
intestinal type replaces that of
     the gastric type) is considered a risk factor for the subsequent
development of cancer of the
     Of or pertaining to METASTASIS, or the process by which malignant
     shed individual cells, which can travel through the lymph vessels
or blood vessels, lodge in
     some distant organ, and grow into tumors in their own right. There
are two major routes of
     metastasis, 1) hematogenous, in which the cells travel through the
blood vessels, and 2)
     lymphogenous, in which the lymphatic vessels conduct the cancer
cells. In the case of
     lymphogenous metastasis, the metastatic tumors can grow from
cancers cells entrapped in the
     lymph nodes that collect the lymph draining from the organ where
the original cancer has
     developed, causing the nodes to enlarge. In the case of breast
cancer, the axillary (underarm)
     nodes are the first to become involved. In the case of cancer of
the larynx (voice box), the
     nodes on either side of the neck (cervical nodes) are first.
Hematogenous metastases tend to
     deposit in the lungs, liver, and brain. Many cancers metastasize
both lymphogenously and
     hematogenously. Most cancer operations attempt to remove not only
the cancerous organ,
     but also the lymph nodes that drain that organ. Some types of
cancer, especially the most
     common ones (lung, breast, colon, and prostate cancers) tend to
metastasize to lymph nodes
     first. Pathologic examination of these nodes is important in
"staging" the cancer, which gives
     the patient and the doctor some idea as to the odds of curing the
cancer and how to best treat
     it. A typical diagnosis of a specimen of a "radical" removal of a
cancer may read like,

          Breast, left, mastectomy: infiltrating ductal cancinoma; three
of fifteen axillary
          nodes contain metastatic carcinoma.

     Death of tissue. Necrosis may be seen in inflammatory conditions,
as well as in
     A "new growth" of the body's own cells, a proliferation of cells no
longer under normal
     physiologic control. These may be "benign" or "malignant." Benign
neoplasms are typically
     tumors (lumps or masses) that, if removed, never bother the patient
again. Even if they are not
     removed, they are not capable of destroying adjacent organs or
"seeding" out to other parts of
     the body. Malignant neoplasms, or "cancers," are those whose
natural history (i.e., behavior if
     untreated) is to cause the death of the patient. Malignancy is
expressed by 1) local invasion, in
     which the neoplasm extends into vital organs and interferes with
their function, 2)
     METASTASIS, in which cells from the tumor seed out to other parts
of the body and then
     grow into tumors themselves, and/or 3) paraneoplastic syndromes, in
which the neoplasm
     secretes metabolic poisons or inappropriately large amounts of
hormones that cause problems
     with functions of various body systems.
     This suffix means "tumor" or "lump." It typically, but not
invariably, refers to a NEOPLASM
     ("GRANULOMA" is an exception). In referring to neoplasms, benign
ones are typically
     referred to by a word, the prefix of which refers to the organ or
tissue of origin, followed by
     the suffix "-oma." For example, leiomyoma, osteoma, chondroma,
adenoma, and
     hemangioma, refer to benign neoplasms of smooth muscle, bone,
cartilage, glandular tissue,
     and blood vessel tissue, respectively. The analogous terms for
malignant versions of these
     neoplasms are, leiomyoSARCOMA, osteosarcoma, chondrosarcoma,
     adenoCARCINOMA, and angiosarcoma.There are exceptions to these
vocabulary rules. For
     instance, hepatomas and melanomas are all malignant. Other tumors,
such as those of the
     adrenal glands, cannot be classified into benign or malignant
categories based on pathologic
     appearance. Only their behavior in time shows their true colors. An
example is
     pheochromocytoma (a tumor of the adrenal medulla), ten per cent of
which are malignant, but
     we don't know just by looking at the tumor if a given case will
fall into that ten per cent.
     A structure consisting of a rounded head attached to a surface by a
stalk (also called a
     "pedicle" or "peduncle"). A mushroom growing from the soil is an
excellent example of what a
     polyp looks like. Polyps my be HYPERPLASTIC, METAPLASTIC,
     INFLAMMATORY, or none of the above. The typical polyps removed from
the colon of
     adults during colonoscopy are benign neoplasms called tubular
adenomas or adenomatous
     polyps. The typical nasal polyps that develop in people with
allergies are inflammatory. The
     common benign polyps removed from the cervix are of uncertain
     A malignant NEOPLASM whose cells appear to be derived from those
other than
     EPITHELIUM. The connective tissues of the body (fibrous tissue,
muscle, bone, cartilage,
     fat, and lining of joints) tend to give rise to sarcomas. In
adults, CARCINOMAS are much
     more common than sarcomas. This makes sense, because as we age, our
body linings are
     assaulted by one noxious substance after the other. So it is no
surprise that those epithelial
     cells on the forefront of our battle with the environment are the
first to lose control of their
     growth and development. In children, sarcomas make up a greater
proportion of cancers.
     While the connective tissues of adults are rather stable and
protected from environmental
     assault, those of children are still growing and developing, the
cells dividing, raising the
     likelihood that something will go haywire and cause a cell to lose
control over its growth.
     A type of acute INFLAMMATION characterized by infiltration of
neutrophils at the
     microscopic level and formation of pus at the gross level. ABSCESS
is special type of
     suppurative inflammation.
     A mass or lump that can be felt with the hand or seen with the
naked eye. This may be a
     NEOPLASM, HYPERPLASIA, distention, swelling, or anything that
causes a local increase
     in volume. The thing to remember is that not all tumors are
cancers, and not all cancers are
This CancerGuide Page By Edward O. Uthman, MD.

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