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NeoplasiaNeoplasia NeoplasiaNeoplasia
DR EJAZ WARISDR EJAZ WARIS
ASSIS.PROF HISTOPATHOLOGYASSIS.PROF HISTOPATHOLOGY
FMHCFMHC
Objectives of the lecture
• Basics of neoplasia• Classification & nomenclature• Characteristics of tumors• Characteristics of malignant cells
(Literally: New growth) An abnormal tissue mass whose
growth exceeds and is uncoordinated with that of adjacent normal tissue and
persists after cessation of the stimuli that provoked it
Neoplastic growths are uncontrolled &
irreversible & non-neoplastic growths are controlled & reversible
Types of Tumors
– BENIGN NEOPLASM – A neoplasm that grows without invading adjacent
tissue of spreading to distant sites. • Usually well-circumscribed due to the lack of
invasion of surrounding tissues. – MALIGNANT NEOPLASM – A neoplasm that invades the surrounding normal
tissue. – Usually spreads to distant sites given sufficient time. – Usually is not well circumscribed.– Malignant tumor and cancer are synonyms
Benign tumors• Always end with the suffix – oma• e.g• Fibroma• Chondroma• Osteoma• Lipoma• Adenoma• Cystadenoma• Papillary cystadenoma
Malignant tumors• Carcinoma : Malignant tumor of epithelial origin e.g.squamous cell
carcinoma,adenocarcinoma,TCC,RCC
Sarcoma : Malignant tumor of mesenchymal origin e.g. fibrosarcoma,osteosarcoma,liposarcoma
ORIGIN BENIGN MALIGNANT
I. EPITHELIAL
Stratified squamous
Squamous cell papilloma
Squamous cell carcinoma
Basal cells of skin
Basal cell carcinoma
Epithelial lining from glands or ducts
Adenoma (e.g. of colon)
Adenocarcinoma (e.g. of colon)
Hepatocytes
Hepatocellular adenoma
Hepatocellular carcinoma (also called "hepatoma", a confusing Term that should be avoided)
Melanocytes
Nevus Melanoma (or malignant melanoma)
Renal Renal cell adenoma
Renal cell carcinoma
Transitional
Papilloma TCC
II. MESENCHYMAL
A. Connective Tissue
Bone Osteoma Osteosarcoma
Cartilage Chondroma Chondrosarcoma
Fibroblast Fibroma Fibrosarcoma
B. Hematopoietic
Erythroid Erythroid leukemia
Myeloid Myelogenous leukemia
Lymphoid Lymphocytic leukemiamalignant lymphoma
C. Muscle Smooth muscle
Leiomyoma Leiomyosarcoma
Striated (skeletal) muscle
Rhabdomyoma
Rhabdomyosarcoma
D. Vascular Hemangioma Angiosarcoma
III. GERM CELLS
Teratoma (dermoid)
teratocarcinoma
1)Differentiation– DIFFERENTIATION – The tissue type represented by the tumor.– Extent to which the tumor cell resemble
its parent cell– Ranges of differentiation :
well,moderately,poorly,undifferentiated – Well differentiated tumors resemble
identifiable tissue types.– Undifferentiated tumors doesnot resemble
Importance of differentiation
– Importance of differentiation • Site of origin in metastatic disease
– example: squamous carcinoma in a lymph node, sites of origin would include lungs, respiratory tract, gyn tract, skin
• Prognosis
– well differentiated often better prognosis than poorly differentiated
• Treatment • treatment varies, example adenocarcinoma vs
squamous
• Anaplasia : lack of differentiation of tumors• Dysplasia :Atypical proliferation of cells characterized
by nuclear enlargement and failure of differentiation which falls short of malignancy
– Dysplasia is recognized by alterations in the appearance of cells
– cell nuclei become hyperchromatic – nuclear membranes become irregular
• nuclear to cytoplasmic ratio increases • Dysplasia may regress, persist or progress
Carcinoma in situ• Full-thickness dysplasia extending from
the basement membrane to the surface of the epithelium. Applicable only to epithelial neoplasms. If the entire lesion is no more advanced than CIS, then the risk of metastasis is zero. This is because there are no blood vessels or lymphatics within the epithelium above the basement membrane
desmoplasia• The change that occurs in the stroma as
tumor invades is called desmoplasia. Desmoplasia refers to the stroma composed of connective tissue and blood vessels that surrounds the infiltrating tumor. The spindle shaped cells that make up the desmoplasia are not themselves neoplastic. Desmoplasia is a response to invasion of tissue by malignant tumor cells
2)Rate of growth
• Benign tumors are slow growing and show capsule formation
• Malignant tumors are rapid and fast growing,sometimes at an erratic pace to be diagnosed at a time when tumor has spread at distant sites
Local Invasion
• Growth into the surrounding tissue by direct extension/expansion
• Benign tumors never locally invade• Malignant tumors always invade
the souurounding tissues
Metastasis• Tumor implants discontinuous from
the primary tumor is metastasis
• Spread of tumor to distant sites by 1)lymphatic,
• 2)hematogenous routes, or• 3) seeding of body cavities.
Routes of spread• Seeding of body cavities and surfaces:
This occurs when a malignant neoplasm penetrates into a natural "open field" such as peritoneal cavity, pleural space, pericardial cavity, etc. Most common examples, ovarian carcinoma and mucin secreting ovarian and appendiceal carcinomas (pseudomyxoma peritonei).
Routes of spread• Lymphatic spread: This is the most common
pathway for dissemination of carcinomas (although sarcomas can also use this route). The pattern of lymph node involvement follows the natural routes of drainage.
• Hematogenous spread: This pathway is typical of sarcomas. Arteries are more difficult for tumor to penetrate than veins. With venous invasion, the blood-borne cells follow the venous flow draining the site of the tumor. Liver and lungs are frequently involved
Charateristics • Disturbed polarity and loss of
cohesiveness: nuclei oriented in different directions and are irregularly spaced. Cells become detached from one another.
• Pleomorphism: abnormal variation in size, shape
• Nuclear to cytoplasmic ratio increased. It increases from 1:4 to 1:1
Characteristics• Nuclear Chromatin shows irregular
clumping and hyperchromasia. • Prominent nucleoli• Irregular Nuclear membrane • Scanty more eosinophilic cytoplasm• Abnormal mitoses: may be present• Giant cells in anaplastic tumors
Grading of tumorsGrading of tumors Grade: The grade of a tumor is based on Grade: The grade of a tumor is based on
the degree of differentiation of the tumor the degree of differentiation of the tumor cells, the degree of cytologic atypia and cells, the degree of cytologic atypia and the number of mitoses within the tumor.the number of mitoses within the tumor.
In general, low grade tumors are well In general, low grade tumors are well differentiated, have minimal cytologic differentiated, have minimal cytologic atypia and low mitotic rates. High grade atypia and low mitotic rates. High grade tumors are poorly differentiated, have tumors are poorly differentiated, have marked cytologic atypia and high mitotic marked cytologic atypia and high mitotic rates.rates.
Staging of tumorsStaging of tumors
Stage: The stage of a tumor is Stage: The stage of a tumor is based on the size of the primary based on the size of the primary tumor, the extent of invasion into tumor, the extent of invasion into surrounding tissue, the spread to surrounding tissue, the spread to regional lymph nodes and the regional lymph nodes and the presence or absence of blood-presence or absence of blood-borne metastases. borne metastases.
Staging systemsStaging systems The staging system used here is the The staging system used here is the
American Joint Committee (AJC) on American Joint Committee (AJC) on Cancer Staging. The staging scheme Cancer Staging. The staging scheme varies by tumor site, but all tumors varies by tumor site, but all tumors are assigned a "T" stage referring to are assigned a "T" stage referring to tumor size, degree of penetration of tumor size, degree of penetration of surrounding tissue; a "N" indicative surrounding tissue; a "N" indicative of presence of lymph node of presence of lymph node involvement and a "M" which involvement and a "M" which indicates the existence of indicates the existence of metastasesmetastases
TNM STAGING SYSTEMTNM STAGING SYSTEM T" for tumor: T" for tumor: T1 might mean primary tumor is smaller than 1 cm T1 might mean primary tumor is smaller than 1 cm
in diameter in diameter T2 might mean primary tumor is larger than 1 cm T2 might mean primary tumor is larger than 1 cm
in diameter in diameter T3 might mean primary tumor is invading T3 might mean primary tumor is invading
something non-resectable something non-resectable "N" for regional lymph nodes: "N" for regional lymph nodes: N0 would mean no tumor in regional lymph nodes N0 would mean no tumor in regional lymph nodes N1 might mean tumor in a few nearby lymph nodes N1 might mean tumor in a few nearby lymph nodes N2 might mean many nodes, or some nodes farther N2 might mean many nodes, or some nodes farther
downstream, are involved downstream, are involved "M" for metastases: "M" for metastases: M0 would mean no distant metastases M0 would mean no distant metastases M1 would imply distant metastases, etcM1 would imply distant metastases, etc
Self Assessment Self Assessment Questions:Questions:
What is a neoplasm? Write two special What is a neoplasm? Write two special characters? characters?
What is a papilloma, adenomaWhat is a papilloma, adenoma What is dysplasia, Metaplasia, Anaplasia What is dysplasia, Metaplasia, Anaplasia
Hyperplasia? Mention examples?Hyperplasia? Mention examples? Mention major classes of neoplasms with Mention major classes of neoplasms with
five differentiating features? five differentiating features? Mention three features of malignant Mention three features of malignant
tumor?tumor?
Self Assessment Self Assessment Questions:Questions:
What is carcinoma-in-situ? What is carcinoma-in-situ? What is grading? And staging?What is grading? And staging? How are neoplasms named?How are neoplasms named? What is CIN? ClassifyWhat is CIN? Classify What are the common routes of What are the common routes of
cancer spread?cancer spread? How do we diagnose cancer?How do we diagnose cancer? Brief note of tumor markers?Brief note of tumor markers?
Benign Benign Malignant:Malignant:
Slow growing,Slow growing, capsulated, capsulated, Non-invasive Non-invasive do not do not
metastasize, metastasize, well well
differentiated, differentiated, suffix “oma” eg. suffix “oma” eg.
Fibroma.Fibroma.
Fast growing, Fast growing, non capsulated, non capsulated, Invasive & Invasive &
Infiltrate Infiltrate Metastasize. Metastasize. poorly poorly
differentiated, differentiated, Suffix Suffix
“Carcinoma” or “Carcinoma” or “Sarcoma”“Sarcoma”
Tumor Diagnosis:Tumor Diagnosis:
HistoryHistory and Clinical examinationand Clinical examination ImagingImaging - X-Ray, US, CT, MRI - X-Ray, US, CT, MRI Tumor markers Tumor markers Laboratory Laboratory
analysis analysis CytologyCytology –Pap –Pap smear, FNABsmear, FNAB BiopsyBiopsy - Histopathology, markers. - Histopathology, markers. MolecularMolecular TechTech – Gene detection. – Gene detection.