12 neoplasia I

8/7/2019 12 neoplasia I

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Neoplasia IIntroduction

Husni Maqboul, M.D.


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Terminology

Tumor : Pathologic disturbance of growth,

characterized by excessive and unnecessary

proliferation of cells

Galen (131 - 201 AD )

Swelling according to nature ( pregnancy )

Swelling exceeding nature ( Callus )

Swelling contrary to nature


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Terminology

Hamartoma : Excessive but focal

overgrowth of cells and tissues native to the

organ in which it occurs. Cellular elements

are mature, but do not produce normal

architecture

Hamartroma of lung

Angiomas

Pigmented nevi


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Terminology

Choristoma (Heterotopia) : Normal cells or tissues,

that are present in abnormal locations

Pancreatic cells in the wall of stomach or

intestine

Nests of adrenal cells in kidney , lung or ovaries


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Terminology

Neoplasms : Persistent , abnormal and

relatively autonomous proliferation of cells

occurring as a result of permanent cellular

defect that is passed to the progeny. Usually

develops due to a factor(s) , but once

developed , becomes independent of them.


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Types of neoplasms

Neoplasms

Parenchyma made up of neoplastic cells

Supporting host derived stroma

Benign: localized and amenable to surgicalremoval; patient usually survives

Malignant: invasive tumor capable ofdestroying structures and spread to distantsites (metastasis); may result in early deathof the patient


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Examples of benign tumors

Epithelial

Adenoma: benign glandular tumorPapilloma : benign surface epithelial tumors

Polyp : benign tumor projecting over mucosal

surface

Cystadenoma : benign epithelial tumor forming

hollow cystic mass


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Examples of benign tumors

Mesenchymal

Chondroma: benign cartilaginous tumor

Leiomyoma: benign smooth muscle tumor

lipoma: benign tumor of fat Fibroma: benign tumor of fibrous tissue

Mixed

Benign Mixed Tumor divergent differentiation of stem

cell (pleomorphic adenoma) Fibroadenoma neoplastic fibrous component

More than one germ cell layer

Benign teratoma mature components


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leiomyomas


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adenoma


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Examples of malignant tumors

Sarcoma (mesenchymal derivation: fibrosarcoma,

chondrosarcoma) Carcinoma (epithelial derivation: adenocarcinoma,

squamous cell carcinoma)

Squamous

Adeno Transitional

Lymphoma/leukemia


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adenocarcinoma


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carcinoma


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The terms benign and malignant

describe the biologic behavior of a tumor

The biologic behavior is characterized by

degree of differentiation of the tumor , rate

of growth (and rate of cell death) ,

infiltration of surrounding tissue, anddissemination to distant sites


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D

ifferentiation

Well-differentiated tumors contain cells that

resemble the normal cells of origin

Poorly-differentiated or undifferentiated

tumors contain cells that do not resemble

their normal counterparts (ancillary studies

may be needed to determine the cell oforigin)


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well-differentiated


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poorly-differentiated


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Benign tumors are composed of well-

differentiated cells.

Malignant tumors are characterized by a

wide range of cellular differentiation.

Anaplasia (cellular pleomorphism,

hyperchromatic nuclei, high N:C ratio, giantcells, bizarre nuclei) is a feature of

malignant tumors.

Differentiation


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anaplasia


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D

ysplasia denotes a loss of architectural organization

and a loss of cell uniformity in epithelium

pleomorphism and mitoses are moreprominent than in the normal

usually graded: mild, moderate, severe, and

carcinoma-in-situ mild to moderate dysplasia is potentially

reversible


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normal epithelium


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dysplasia


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D

ysplasia

Dysplasia is a non-neoplastic proliferation. Dysplasia may or may not progress to

cancer.


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R

ate of grow

th

In general, benign and well-differentiated

malignant tumors have a slower rate of

growth than moderately-differentiated and

poorly-differentiated malignant tumors.

There are exceptions. Blood supply, site,

and hormonal stimulation are factors thatcan affect the growth rate of tumors.


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I

nvasion

Benign tumors usually grow by slow

expansion.

Malignant tumors usually infiltrate and may

destroy surrounding tissue (cell surface and

the extracellular matrix play an important

role).


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F

unctional characteristics

Benign tumors are more likely to function

Epithelial tumors can produce mucin Hormonal production can be unregulated

Inappropriate production of hormones by

different type of cells Abnormal receptor and antigenic expression


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M

etastasis

indicates malignancy

a discontinuous spread of the tumor Methods of metastasis include: (1)seeding

of body cavities, (2) lymphatic spread, and

(3) hematogenous spread.


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metastatic ovarian carcinoma


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MRI: metastatic adenocarcinoma


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metastatic adenocarcinoma


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Grading and staging

Grading is based on the microscopic

features of the cells which compose a tumor

and is specific for the tumor type.

Staging is based on clinical, radiological,

and surgical criteria, such as, tumor size,

involvement of regional lymph nodes, andpresence of metastases. Staging usually has

more prognostic value.


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Morbidity and mortality

metastases

rupture into major vessels compression of vital organs

organ failure

infection


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meningioma


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basal cell carcinoma


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melanoma


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Diagnostic procedures

FNA (fine needle aspiration)

Cytological smears Biopsy

Frozen sections

Biochemical assays Molecular diagnosis

Flow cytometry


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cytology smear: adenocarcinoma


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Pap smearwith dysplasia


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frozen section


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staining a frozen section


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Ancillary studies

Immunohistochemistry

Cytogenetics Flow cytometry

Electron microscopy


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cytokeratin stain on a carcinoma


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AFPstain on a yolk sac tumor


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EM:neurosecretory granules


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EM: microvilli, tight junction in

an adenocarcinoma


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Biochemical assays

Tumor markers: sometimes diagnostic or

prognostic

Can be helpful in monitoring effectiveness

of therapy or in detecting

relapses/recurrences


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Summary

Neoplasia- an abnormal mass of tissue

which has lost its responsiveness to growth

controls

Benign neoplasms tend to be slow-growing,

well-differentiated tumors which lack the

ability to metastasize

Benign neoplasms, in general, remain

localized and are amenable to surgery


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Summary

Malignant neoplasms tend to be fast-

growing lesions which invade normal

structures

Malignant neoplasms vary in the degree of

differentiation and some show anaplasia

Malignant neoplasms are capable ofmetastasis


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Summary

The prognosis of a patient with any type of

neoplasm depends on a number of factors

including: the rate of growth of the tumor,

the size of the tumor, the tumor site, the cell

type and degree of differentiation, the

presence of metastasis, responsiveness totherapy, and the general health of the

patient.

12 neoplasia I

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