Neoplasma 1

NEOPLASMA I

Dr.Berti Nelwan,DFM,MSi,SpPA,SpF

NEOPLASMA I

DEFINISI & NOMENKLATUR KARAKTERISTIK NEOPLASMA JINAK & GANAS

• Diferensiasi & Anaplasia• Kecepatan Pertumbuhan• Invasi Lokal• Metastasis

Introduction:

• Inflammatory, Degenerative & Neoplastic• Growth – Increase in size due to

synthesis of tissue components.• Proliferation- Cell division.• Differentiation: functional and structural

maturity of cells.• Tumor – Swelling / new growth / mass

Introduction

• Why we have to learn about cancer/ tumor?• Cancer is the second leading cause of death• In the year 2000,

–10 million new cases of cancer –6 million cancer deaths worldwide.

• In the United States 2003, –Cancer caused 556,000 death/year –1500 cancer deaths per day.

Giant fibroadenoma mamma with malignant degeneration

DEFINISI NEOPLASMAPertumbuhan baru dimana terdapat diferensiasi sel, maturasi dan kontrol pertumbuhan yang abnormal

Suatu massa jaringan abnormal yang tumbuh berlebihan dan tidak teratur di sekitar jaringan normal yang akan berlangsung terus walaupun rangsangan penyebab sudah hilang dan mengakibatkan timbulnya perubahan.(1954, Ruppert Willis)

Characteristics of Neoplasia

Uncontrolled growth of Abnormal cells• 1. Benign• 2. Malignant• 3. Borderline

“Root words”• Neo- new• Plasia- growth• Plasm- substance• Trophy- size• +Oma- tumor• Statis- location

“Root words”• A- none• Ana- lack• Hyper- excessive• Meta- change• Dys- bad, deranged

Oncology defined

• Branch of medicine that deals with the study, detection, treatment and management of cancer and neoplasia

Non-Neoplastic Proliferation:

*Controlled & Reversible• Hypertrophy – Size

• Hyperplasia – Number

• Metaplasia – Change

• Dysplasia – Disordered

Neoplastic Proliferation:Uncontrolled & Irreversible*

• Benign– Localized, non-invasive.

• Malignant (Cancer)– Spreading, Invasive.

Neoplasia:• Progressive, Purposeless, Pathologic,

Proliferation of cells characterized by loss of control over cell division.

• DNA damage at growth control genes is central to development of neoplasm.

• Carcinogens – Chemical, physical & genetic DNA damage Neoplasm.

Pathogenesis of Neoplasia:

• Normal Hyperplasia Metaplasia (DNA damage) Dysplasia (DNA damage) (DNA damage) Anaplasia (DNA damage) Infiltration (DNA damage) Metastasis….

• Progressive DNA Damage – features of neoplasia.

Pathogenesis of Neoplasia:

• Non lethal DNA Damage leading to uncontrolled cell division.

Non-Neoplastic Neoplastic (Polyclonal) (Monoclonal)

Normal Adaptation Benign Malignant Mechanism of Neoplams

Loss of Normal Growth Control

Structure of Neoplasm:

• Neoplastic cells parenchyma.• Non-neoplastic - stroma (Connective

tissue & BV)

• Fast growth less stroma • Less stroma more necrosis

Biology of Neoplasm:

• Cell of origin• Rate of growth• Differentiation• Local Invasion• Metastasis

• Lung cancer• Grade - low, high• Well, Mod, P, Un.• Staging• Staging

Lung cancer:Squamus cell carcinoma.Poorly differentiated, high grade, stage 4, Liver+

Benign Malignant:• Slow growing,• capsulated, • Non-invasive • do not metastasize, • well differentiated, • suffix “oma” eg.

Fibroma.

• Fast growing, • non capsulated, • Invasive & Infiltrate • Metastasize. • poorly differentiated, • Suffix “Carcinoma” or

“Sarcoma”

What makes a neoplasm “malignant” ?

• The ability to invade and/or metastasize.

• Examples: Basal cell carcinoma ( a skin neoplasm) invades but rarely metastasizes.

• Malignant melanoma of the skin invades and can widely metastasize.

Language of Oncology

• Neoplasm: (meaning new growth that is “autonomous”); scientific term for a tumor.

• May be “malignant or benign”• Other “plasias”:

– Hyperplasia: an increase in cell number– Hypertrophy: an increase in cell size but not

number– Metaplasia: a reversible process where one cell

type changes into another cell type

What Is Cancer?

CANCER is a complex of diseases which occurs when normal cells mutate into abnormal cells that take over normal tissue, eventually harming and destroying the host

WHAT IS CANCER

A large group of diseases characterizedby:– Uncontrolled growth and spread of abnormal

cells– Proliferation (rapid reproduction by cell division)– Metastasis (spread or transfer of cancer cells

from one organ or part to another not directly connected)

KARSINOGEN (PENYEBAB KANKER)

• Bahan kimia • Nitrosamin kanker usus

• Virus• HPV kanker serviks• HCV, HBV kanker hati• Epstein Barr kanker nasofaring

• Radiasi• bom hiroshima kanker paru, • Chernobil kanker tiroid

• Hormon• Estrogen kanker payudara and

endometrium• Dll

FAKTOR PREDISPOSISI• Geografik/ Suku/ras

– Jepang banyak kanker lambung– Negro jarang kanker kulit

• Usia– >55 th

• Jenis kelamin– Man : paru, kolon dan prostat– Woman: paru, payudara dan kolon

• Hereditas– Kanker Payudara dan ovarium

• Kelainan neoplastik didapat– Hepatitis HCC (Hepatocellular carcinoma)

Nomenclature: Cell of origin + Suffix Suffix - oma• Fibroma • Osteoma• Adenoma• Papilloma • Chondroma

Carcinoma / Sarcoma• Fibrosarcoma• Osteosarcoma• Adencarcinoma• Squamous cell carcinoma• Chondrosarcoma

Exceptions: Leukemia, Lymphoma, Glioma,

Grading & Staging of Tumor

• Grading – Cellular Differentiation (Microscopic)

• Staging – Progression or Spread (clinical)

TNM: Staging of tumor:

Pathways of Spread:

• Direct Spread• Body cavities• Blood vessels• Lymphatic vessels

• Lungs – Systemic Venous blood• Liver – GIT venous return, nutrition.• Brain – End arteries.

Tumor Diagnosis:

• History and Clinical examination• Imaging - X-Ray, US, CT, MRI• Tumor markers Laboratory analysis • Cytology –Pap smear, FNAB• Biopsy - Histopathology, markers.• Molecular Tech – Gene detection.

NOMENKLATURTumor ada 2 komponen dasar:1. Parenkhim2. Stroma penunjang

parenchyma

supporting stroma

Nomenclature of Neoplasia

Tumor is named according to:1. Parenchyma, Organ or Cell• Hepatoma- liver• Osteoma- bone• Myoma- muscle


Tumor is named according to:2. Pattern and Structure, either

GROSS or MICROSCOPIC• Fluid-filled CYST• Glandular ADENO• Finger-like PAPILLO• Stalk POLYP


Tumor is named according to:3. Embryonic origin• Ectoderm ( usually gives rise to

epithelium)• Endoderm (usually gives rise to

glands)• Mesoderm (usually gives rise to

Connective tissues)

BENIGN TUMORS

• Suffix- “OMA” is used• Adipose tissue- LipOMA• Bone- osteOMA• Muscle- myOMA• Blood vessels- angiOMA• Fibrous tissue- fibrOMA

NOMENKLATUR

Tumor Ganas

Mesenkhim Sarkoma

Neoplasma ganas asal Epitelial Karsinoma

LIPOSARKOMAFIBROSARKOMAOSTEOSARKOMAADENOKARSINOMAKARSINOMA SEL SKUAMOUS

MALIGNANT TUMOR

• Named according to embryonic cell origin

1. Ectodermal, Endodermal, Glandular, Epithelial

• Use the suffix- “CARCINOMA”– Pancreatic AdenoCarcinoma– Squamos cell Carcinoma

MALIGNANT TUMOR

Named according to embryonic cell origin

2. Mesodermal, connective tissue origin

• Use the suffix “SARCOMA– FibroSarcoma– Myosarcoma– AngioSarcoma

EXCEPTS

1. “OMA” but Malignant– HepatOMA, lymphOMA, gliOMA, melanOMA

2. THREE germ layers– “TERATOMA”

3. Non-neoplastic but “OMA”– Choristoma– Hamatoma


BENIGN• Well-differentiated• Slow growth• Encapsulated • Non-invasive• Does NOT metastasize


MALIGNANT• Undifferentiated• Erratic and Uncontrolled Growth• Expansive and Invasive• Secretes abnormal proteins• METASTASIZES

PAPILLOMA Papilloma is benign epithelial neoplasm

Papilloma of the colon with finger-like projections into the lumen .

Benign tumor:Adenomatous polyp of the colon,

A, Gross appearance of several colonic polyps B, This benign glandular tumor (adenoma) is projecting into the colonic lumen and is attached to the mucosa by a distinct stalk

NOMENKLATUR

II. Lebih dari satu tipe sel neoplastik (Mixed tumor)Contoh: T. Kelenjar liur

III. Lebih satu tipe sel neoplastik dan merupakanderivat dari lebih satu lapisan germinativum (Teratogenous)Sel totipoten dalam gonad/ sisa embrionik berdiferensiasi kulit, otot, lemak, epitel usus, gigiContoh: Teratoma

Mixed Tumor/ Tumor Kelenjar Liur

This mixed tumor of the parotid gland contains epithelial cells forming ducts and myxoid stroma that resembles cartilage

Teratoma

Gross appearance of an opened cystic teratoma of the ovary. Note the presence of hair, sebaceous material, and tooth

KARATERISTIK TUMOR JINAK & GANAS

Kriteria membedakan Tumor jinak dan ganas1. Diferensiasi & Anaplasi2. Kecepatan Pertumbuhan3. Invasi Lokal4. Metastase

Diferensiasi & AnaplasiDiferensiasi menunjukkan seberapa banyak kemiripan sel parenkhim dibanding dengan sel normal (morfologi/ fungsional)

Baik Mirip sel matur normal asal jaringan neoplasma Dif. Sedang

Jelek/ tidak berdif. Sel primitif/ sel tidak spesifikT. Jinak umumnya berdiferensiasi baikT. Ganas berdiferensiasi jelek

Leiomyoma uteri, benign smooth muscle tumor

Leiomyoma of the uterus. This benign, well-differentiated tumor contains interlacing bundles of neoplastic smooth muscle cells that are virtually identical in appearance to normal smooth muscle cells in the myometrium

Benign tumor of thyroid gland

Benign tumor (adenoma) of the thyroid. Note the normal-looking (well-differentiated), colloid-filled thyroid follicles.

Normal thyroid


Anaplasi : Neoplasma ganas yang tidak berdiferensiasi Karakteristik : ● Sel dan inti pleomorfik, ● Inti hiperkromatik, ● tumor sel raksasa ● Gambaran mitosis, T. ganas atipik dan aneh ● Sel bentuk spindel dengan tripolar, kwadripolar/ multipolarDisplasia : Proliferasi yang tidak beraturan, tetapi bukan neoplasma (pleomorfik, hiperkromatik, mitosis)

Ringan

Displasia Sedang Berat = Ca. in situ/ Ka. Primitif

Note the marked cellular and nuclear pleomorphism, hyperchromatic nuclei, and tumor giant cells.

Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 11 November 2005 02:05 PM)© 2005 Elsevier

Anaplastic tumor of the skeletal muscle (rhabdomyosarcoma).

Anaplastic tumor showing cellular and nuclear variation in size and shape. The prominent cell in the center field has an abnormal mitotic tripolar spindle (arrow).

Gambaran skematik lesi prakanker/displasia dan karsinoma in situ pada serviks uteri.

I. DisplasiaSangatRingan

II. DisplasiaRingan

III. DisplasiaSedang

IV. DisplasiaBerat

V. KarsinomaIn Situ

I II III IV V

Derajat 1 Derajat 2 Derajat 3

Normal

Karsinoma mikroinvasif

Membrana basalis

Carcinoma In situ • A preinvasive stage of cancer referred to as carcinoma in situ. • Occurs in tumors of the skin, breast, uterine cervix• In situ epithelial cancers display the cytologic features of malignancy

(marked nuclear and cellular pleomorphism, and numerous mitotic figures extending toward the surface) without invasion of the basement membrane.


Kecepatan PertumbuhanT. Jinak tumbuh lambat, gambaran mitotik : jarang dan normalT. Ganas tumbuh lebih cepat, mitotik: banyak dan abnormalInvasi LokalT. Jinak : ● biasanya kohesif & ekspansif, ● massa berbatas tegas karena tidak ada invasi dan infiltrasi ke jaringan normal sekitarnya.

T. Ganas : ● invasi lokal dan infiltrasi ke jaringan normal sekitarnya, ● kadang-kadang kohesif & ekspansif dan

mendesak kedalam struktur sekitarnya yang normal.

FIBROUS CAPSULE in BENIGN TUMOR

A. Fibroadenoma of the breast. The tan-colored, encapsulated small tumor is sharply demarcated from the whiter breast tissue.

B. Microscopic view of fibroadenoma of the breast. The fibrous capsule (right) delimits the tumor from the surrounding tissue.

A. Cut section of an invasive ductal carcinoma of the breast. The lesion is retracted, infiltrating the surrounding breast substance, and would be stony hard on palpation.

B. The microscopic view of the breast carcinoma seen in A illustrates the invasion of breast stroma and fat by nests and cords of tumor cells. Note the absence of a well-defined capsule.

LOCAL INVASION


MetastasisMetastasis adalah suatu perpindahan tumor yang terpisah dengan tumor primernya T. ganas.

P. Darah

Kanker invasif penetrasi P. Limfe menyebar ke Organ tubuhCara MetastasisPenyebaran kanker terjadi melalui

1. Langsung rongga tubuh dan permukaan2. P. Limfe3. Hematogen


Melalui Rongga Tubuh dan Permukaan Terjadi pada neoplasma ganas yang menembus ke dalam tempat yang terbuka / rongga kavum peritonium, pleura, perikardial, subarachnoid dan rongga sendiContoh: Ka. Ovarium pseudomiksoma peritonei

Melalui Pembuluh LimfeTransportasi melalui limfatik cara utama penyebaran karsinoma.Contoh: Ka. Mammae

Penyebaran HematogenCara ini spesifik untuk sarkoma. Arteri dengan dinding lebih tebal kurang cepat penetrasi dari pada vena

Metastasis

Liver metastatic cancer from pancreatic adenocarcinoma

Comparison between a benign tumor of the myometrium (leiomyoma) and a malignant tumor of similar origin (leiomyosarcoma).

Benign and Malignant Tumor

Characteristic Benign Malignant

Differentiation Well differentiation, structure may be typical of tissue origin

Lack of differentiation/ anaplasiaStructure is often atypical

Rate of growth Usually progressive and slow growth,Mitotic figures are rare and normal

Erratic, may be slow to rapid,Abnormal and Numerous mitotic figure

Local invasion Usually well demarcated and no infiltration to the surrounding tissue

Locally invasive, infiltration to the surrounding tissue

Metastasis Absent Frequently present

TERIMA KASIH

Health & Medicine

Neoplasma 1