Definitions and Classificationsin Neoplasia

Folder: DefClass(NoTP)

Updated: February 11, 2015

Definitions in Oncology. (Part 1)Neoplasia: (“Plasia = Cells)Abnormal new cell proliferation of altered cells• Heritably Altered• Relative autonomous growth• Can be benign or malignant (See later)

Hyperplasia:• Abnormal proliferation of otherwise normal cells

Tumor:Solid mass, usually cellular (but not necessarily)• Can be neoplastic, non-neoplastic, or even non-cellular• "Tumor" usually means a neoplasm in common usage• Some free cell neoplasms can be non-tumorous

Definitions in Oncology. (part 2)Metaplasia:• Replacement of one type of normal adult

differentiated cell type that is normally present,• by another normal adult differentiated type that

belongs somewhere else. Usually in response to injury or irritation Reversible upon removal of the stimulus

See “Reversible squamous metaplasia”, next slide)

Dysplasia• Abnormal interaction of cells giving abnormal

tissue development• Can be pre-neoplastic

Reversible Squamous Metaplasia

Normal Secretory & Ciliated Epithelial CellsIllustrating functional effect of ciliated vs non-ciliated cells

Figure 16-19, ECB, 1998, p. 528RespCilia

Ciliated Epithelium ofHuman Respiratory Tract

Progressive Steps in Neoplastic Cell Development:Hyperplasia and Dysplasia

To Here Presentation 7, Feb. 3, 2015

Progressive Steps in Neoplastic Cell Development:Cancer In situ and Invasive Cancer

Figure 11.7 The Biology of Cancer (© Garland Science 2007)

Progression in Neoplastic Development: Weinberg, Chapter 11 on Multistep Tumorigenesis. Figure 11.7

CIS = carcinoma in situCIN = cervical intra-epithelial neoplasmDCIS = ductal carcinoma in situPIN = prostatic intra-epithelial neoplasm

Classifications of Cancers

Benign and Malignant Neoplasia

Benign Neoplasm Generally Encapsulated Non-invasive Highly Differentiated Few Mitotic Figures Slow Growth or No Net Growth Little Anaplasia Non-Metastatic (by definition)

Malignant Neoplasm Non-encapsulated Invasive Poorly Differentatied Mitotic Figures Common Can have rapid growth Relatively Anaplastic Metastatic or Capable of

becoming so

Definitions in Oncology. (part 3)Anaplasia:Irreversible loss of normal cell structure and function• Positional Anaplasia: Size, shape, arrangement, and

overall organization of cells in a tissue are altered• Cytological Anaplasia: Intra-cellular structures

(mitochondria, cytoskeletal elements, nuclear size and morphology) are altered

Cancer:• Mass of cells with potentially unlimited growth,• serves no useful function for the host,• deprives the host of nutrients necessary for survival,• expands locally by invasion and systemically by• lymphatic and hematogenous pathways,• untreated progresses to lethal condition in the host

Sites of Origin for Primary Clinical CancersCollection of 200 Different Clinical Diseases

(See Diversity of Cancers in Folder Title:"Clinical" and Two Graphics Following)

• Different Symptoms• Different Cell Type of Origin• Different Histology• Different Cell Products and Cell Markers• Different Prognoses• Different Therapy

Cancer Incidence 2002: 1,285,000. Cancer Deaths 555,000. 43% Death RateCancer Incidence 2009: 1,479,000. Cancer Deaths 562,000 38% Death RateCancer Incidence 2014: 1,665,540. Cancer Deaths 585,720 35% Death Rate

Why do we get cancers in these tissues & organs with these distributions? Why are cancers of some sites more deadly than cancers at other sites?

Normal Proliferative Human Cells & TissuesHematopoietic Pluripotent Stem Cells and Progenitor Cells

Form Blood Cells: Red Blood Cells, Leucocytes,Megacaryocytes/Platelets

Epithelial Linings• Respiratory epithelium• Gastro-intestinal linings• Genito-urinary tract

Glandular Linings• Mammary gland

SkinOvary and TestisBone MarrowMyoblastsFetal TissuesOrgan HypertrophyWound HealingNeurogenesisBrain Astrocytes/Glial Cells

Classification by Tissue Typefor Cell Type of Origin

(Histogenetic Classification)Connective Tissue

Hematopoietic Tissue

Nervous tissue

Germinal Tissue & Mixed Tissue Types

Epithelial Tissue

Sarcoma

Leukemia & Lymphoma

Neuroectodermal malignancies

Carcinoma

Classification of Cancer by Histogenetic Site of OriginPart 1: Connective Tissue Neoplasms

Tissue of OriginFibrous tissueCartilegeBoneFatSmooth MuscleSkeletal MuscleBlood Vessels

Benign NeoplasmFibromaChondromaOsteomaLipomaLeiomyomaRhabdomyomaHemangioma

Malignant NeoplasmFibrosarcomaChondrosarcomaOsteogenic SarcomaLiposarcomaLeiomyosarcomaRhabdomyosarcomaHemangiosarcoma

Sarcomas (Sarcomata) are malignant neoplasms of connective tissue origin.About 5% of all cancers in humans

Carcinomas:

Cancers of Epithelial Origin

Classification of Cancer by Histogenetic Site of OriginPart 2: Epithelial Neoplasms

Tissue of OriginEpidermisStomachAdrenal cortexSurface Epithelium(Non-glandular)Glandular EpitheliumColonBreastLung

Benign NeoplasmEpidermal papillomaGastric polypAdrenocortical adenomaPapilloma

Adenoma Colon adenoma Mammary adenoma Lung adenoma

Malignant NeoplasmEpidermal carcinomaGastric carcinomaAdrenocortical carcinomaSquamous carcinoma

Adenocarcinoma Colon carcinoma Mammary carcinoma Lung carcinoma

Carcinomas are malignant neoplasms of epithelial origin.About 85% of all cancers in humans!

Table 2.1 The Biology of Cancer (© Garland Science 2007) p. 30

Figure 2.4b Te Biology of Cancer

Figure 2.4c The Biology of Cancer (© Garland Science 2007)

Bronchiole of Lung

Columnar Epithelium (Gall Bladder)

Figure 2.6c The Biology of Cancer (© Garland Science 2007)Figure 2.6a The Biology of Cancer (© Garland Science 2007)

Squamous epitheliumUterine cervix

Skin

Glandular Epithelium (stomach)

Columnar Epithelium, Small Intestine

Goblet Cell(Mucous-secreting)

Figure 2.6d The Biology of Cancer (© Garland Science 2007)

Adenocarcinoma(Stomach)

Adenocarcinoma (Colon)

Glandular Epithelium Stomach

Neuroectodermal Malignancies

Cancers of the nervous system

Classification of Cancer by Histogenetic Site of OriginPart 4: Neoplasms of the Nervous System

Tissue of OriginBrain glial cells

MeningesNeuronsAdrenal

medullaRetina

Benign NeoplasmAstrocytomaOligodendrogliomaMeningiomaGanglioneuromaPheochromocytoma---

Malignant NeoplasmGlioblastoma multiforme

Meningeal sarcomaNeuroblastomaPheochromocytoma

Retinoblastoma

Neoplasms of the nervous system are generalized as Neuroectodermal malignancies comparable to carcinoma, sarcoma,

or leukemia groupings.Part of the remaining 5% of all cancers in humans

Table 2.4 The Biology of Cancer (© Garland Science 2007)p. 34

Figure 2.9a The Biology of Cancer (© Garland Science 2007)p. 35

Astrocytes (Glial Cells) Astrocytoma (Glioblastoma),Glioblastoma Multiforme

Neuroectodermal Neoplasm of Non-Neuronal Supporting Cells of Brain

Cancers of Hematopoietic Origin

Blood Cell Cancers; Leukemia, Lymphoma

Classification of Cancer by Histogenetic Site of OriginPart 3: Hematopoietic and immune system neoplasms

Tissue of OriginLymphoid tissueand Lymphocytes

ThymusGranulocytes

Plasma Cells1

Erythrocytes

Benign NeoplasmInfectious mononucleosisand other lymphoproliferative diseases

ThymomaGranulocytosis

Plasmacytoma (localized)Polycythemia vera

Malignant NeoplasmLymphoma (lymphosarcoma)Lymphocytic leukemia(B and T Cell Leukemias)Reticulum cell sarcomaHodgkin's DiseaseThymomaMyelogenous leukemia(Granulocytic leukemia)Multiple Myeloma (dispersed)Erythroleukemia

1 Antibody secreting B-cell. Neoplastic plasma cell secretes monoclonal antibodies or parts of monoclonal antibodies (Bence-Jones proteins)Leukemias and Lymphomas (Lymphosarcomas) About 5% of all cancers in humans

Table 2.3 The Biology of Cancer (© Garland Science 2007)p. 33

Different Forms of LeukemiasAcute (A) and Chronic (C)

3.4% of all forms of human cancers

Lymphocytic 54% (32% CLL; 22% ALL)Also called "lymphoblastic"

Myelocytic 37% (26% CML; 11% AML)Also called "granulocytic" or "myelocytic"

Monocytic 9% (All acute) Erythroleukemia Rare

Morphology &Staining ofBlood Cells

Kuby, 3rd Ed.Figure 3-1

Hematopoiesis (formation of blood cells)Fig 2-1, Kuby 4th Ed. p. 28

Pluripotent Stem Celland Lymphoid andMyeloid Lineages

(Fig 2-1, Kuby 4th Ed. p. 28

Myeloid Stem Cell

Lymphoid Lineage

Fig 2-1 Kuby 4th Ed

p. 28

MyeloidLineage(Kuby, Fig 2-1,4th Ed., p. 28)

Figure 8.32 The Biology of Cancer (© Garland Science 2007)

Disease Progression in Chronic Myelogenous Leukemia

p. 293

Classification of Cancers based on Tissue Type or Cell Type Source of Origin (Histogenic Classification)

Classification by Site of Origin

Slides 20 to 48

Benign and Malignant Neoplasia

Benign Neoplasm Generally Encapsulated Non-invasive Highly Differentiated Few Mitotic Figures Slow Growth or No Net Growth Little Anaplasia Non-Metastatic (by definition)

Malignant Neoplasm Non-encapsulated Invasive Poorly Differentatied Mitotic Figures Common Can have rapid growth Relatively Anaplastic Metastatic or Capable of

becoming so

Sites of Origin for Primary Clinical CancersCollection of 200 Different Clinical Diseases

(See Diversity of Cancers in Folder Title:"Clinical" and Two Graphics Following)

• Different Symptoms• Different Cell Type of Origin• Different Histology• Different Cell Products and Cell Markers• Different Prognoses• Different Therapy

Classification by Tissue Typefor Cell Type of Origin

(Histogenetic Classification)Connective Tissue

Hematopoietic Tissue

Nervous tissue

Germinal Tissue & Mixed Tissue Types

Epithelial Tissue

Sarcoma

Leukemia & Lymphoma

Neuroectodermal malignancies

Carcinoma

See Slides 14, 16, 20 for Benign vsMalignant

Diagnostic Pathobiology of Hodgkins Diseasevs

Non-Hodgkins Lymphoma

http://www.med-ed.virginia.edu/courses/path/innes/wcd/hodgkin.cfm(Right Click. Click on Open Hyperlink)

University of Virginia, School of Medicine;Pathology Trends

Derived from Lymphocyte, usually a B cell,Characterized by being binuclear.Presents “owl-like” appearance

Incidence

Early onset; 2nd age-related risk later in life

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PBS Series: secondopinion-tv.org

CML and Patient #9 in Gleevec Trial 1995Highlight. Right Click. Open Hyperlink

See episode 607

http://abcnews.go.com/Health/BreastCancerCenter/early-stage-breast-cancer-care/story?id=12870356

http://abcnews.go.com/Health/BreastCancerCenter/early-stage-breast-cancer-care/story?id=12870356

Surgical Excision of Regional Lymph Nodes in Breast Cancer(ABC News: February 8, 2011

(Copy & paste to Mozilla Firefox)

Neuroblastoma in a Little Boy(Viewed in Class in 501Intro)

William Bunn: 8-Year-old Police OfficerJuly, 2010 http://abclocal.go.com/wtvd/story?section=news/local&id=7531763  -  2 minutes and 32 seconds     http://www.msnbc.msn.com/id/26184891/vp/38084943#38084943   1 1/2 minutes - actual funeral Refers to Stem Cell Transplants and Chemotherapy for Neuroblastoma in final 5 seconds of clip

Also viewed story of Kuyler Van Nocker and Neuroblastoma

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1. I myself have been treated for a cancer.

2. One (or more) of my parents or step parents has been or is a cancer patient.

3. One (or more) of my grandparents has been or is a cancer patient.

4. One (or more) of my brothers or sisters (or a step-brother or sister) has been or is a cancer patient.

5. I have a child or a niece or nephew who is or has been a cancer patient.

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