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Neoplasia

Dr. Phoo Pwint Maw Khine

Definition
A neoplasm is an abnormal mass of tissue, the growth of which exceeds and is uncoordinated with that of the normal tissues and persists in the same excessive manner after cessation of the stimuli which evoked the change Classification 1. Benign tumor 2. Malignant tumor

Nomenclature Benign Tumor


Suffix OMA denotes a benign neoplasm

Mesenchymal tumors
chrondroma: cartilaginous tumor fibroma: fibrous tumor osteoma: bone tumor

Epithelial tumor
adenoma: tumor forming glands papilloma: tumor with finger like projections papillary cystadenoma: papillalry and cystic tumor forming glands polyp: a tumor that projects above a mucosal surface

Pleomorphic adenoma of hard palate

Colonic polyp

Nomenclature Malignant Tumor


Sarcoma malignant tumor arising in Mesenchymal tissue (Sarc = fleshy) Carcinoma malignant neoplasm of Epithelial origin arising from any of the 3 germ layer (Ectoderm, Mesoderm, Endoderm) Simple tumor- one Parenchyma cell type derived from one germ layer Mixed tumor - more than one Neoplastic cell type Compound tumor {Teratoma} variety of parenchymal cell types representative of more than one germ layer, usually all 3 Exception: hepatoma: malignant liver tumor melanoma: malignant skin tumor seminoma: malignant testicular tumor lymphoma: malignant tumor of lymphocytes

Benign vs. Malignant Tumors


Tissue of Origin Benign Malignant Composed of One Parenchymal Cell Type

A. Mesenchymal Tumors 1. Connective tissue and derivatives

Fibroma Lipoma Chondroma Osteoma

Fibrosarcoma Liposarcoma Chondrosarcoma Osteosarcoma

2. Endothelial and related tissues


3.

Hemangioma Lymphangioma

Angiosarcoma Lymphangiosarcoma Leukemias

Blood cells
Muscle Leiomyoma Rhabdomyoma

3.

Leiomyosarcoma Rhabdomyosarcoma

Benign vs. Malignant Tumors


Tissue of Origin Benign Malignant Composed of One Parenchymal Cell Type

B. Epithelial Tumors 1. Stratified squamous 2. 3. 4.


5.

Squamous cell papilloma

Squamous cell carcinoma Basal cell carcinoma

Basal cell Glands or ducts Respiratory passages Neuroectoderm Renal epithelium Nevus Renal tubular adenoma Adenoma

Adenocarcinoma Bronchogenic carcinoma Malignant melanoma Renal cell carcinoma

6.

7.
8.

Liver cells
Urinary tract epithelium

Liver cell adenoma


Transitional cell papilloma

Hepatocellular carcinoma
Transitional cell carcinoma

Benign vs. Malignant Tumors


Tissue of Origin Benign Malignant

Composed of More Than One Neoplastic Cell Type (Mixed Tumors)

1. Salivary glands

Pleomorphic adenoma

Malignant mixed tumor of salivary gland

2. Breast

Fibroadenoma

Malignant cystosarcoma phyllodes

3. Renal Anlage

Wilms tumor

Benign vs. Malignant Tumors


Tissue of Origin Benign Malignant
Composed of More Than One Neoplastic Cell Type From More Than One Germ Layer - Teratogenous

1. Totipote ntial cells in gonads or in embryo nic rests

Mature teratoma, dermoid cyst

Immature teratoma, teratocarcino ma

Osteosarcoma

Squamous cell carcinoma of nose

Gastric cancer

Mouth cancer

Characteristics
1. Differentiation and Anaplasia
the extent to which parenchymal cells resemble comparable normal cells both morhologically and functionally Anaplasia : lack of differentiation (Hallmark of Malignancy)

2. Rate of growth 3. Mode of growth 4. Metastases local spread (invasion) and distant spread
Seeding of body cavities and surfaces Spread by transplantation Lymphatic spread Hematogenous spread

5. Effect of tumor

1. Differentiation and Anaplasia


Benign well differentiated Malignant variable range from well to poorly or undifferentiated Features of anaplasia
Cellular pleomorphism: variation in size and shape of cell Nuclear pleomorphism: variation in size and shape of nuclei Nuclear hyperchromatism: darkly stained nuclei d/t abundance of DNA and coarse clumped chromatin N:C ratio d/t larger nuclei, become 1:1 instead of normal 1:4 or 1:6 Presence of large nucleoli Mitoses and abnormal mitoses Tumor giant cell Loss of orientation: cells grow in disorganized, haphazard Abnormal karyotype

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

SCC (Well differentiated)

Carcinoma of lungs (Un differentiated)

Carcinoma in situ
Dysplasia : loss of uniformity of individual cells a/w/a loss in their architectural organization When dysplastic changes are marked and involve the entire thickness of epithelium, the lesion is considered a preinvasive neoplasm, referred to as Carcinoma in situ Features of anaplasia without invasion of basement membrane

2. Rate of growth
Benign grow slowly over a period of year Malignant grow rapidly, eventually spread and kill the host Some grow slowly and suddenly increase in size to disseminate and cause death Rate of growth is affected by
Hormone dependence Adequacy of blood supply

3. Mode of growth
Benign do not have capacity to infiltrate, invade or metastasize to distant sites Have fibrous capsule discrete, palpable, easily mobile mass that can be surgically nucleated Malignant progressive infiltration, invasion and destruction of surrounding tissue Poorly demarcated, lack of well defined cleavage plane and capsule Surgical resection difficult Exception : renal cell carcinoma (pseudocapsule)

4. Metastases
Benign do not metastasize Malignant discontinuous with Primary tumor

Metastasis disease of liver

Lymph node with metastatic adenocarcinoma

5. Effect of tumor
Location and impingement on adjacent structure Functional activity such as hormone production (Paraneoplastic syndrome) Superimposed complication (ulceration, bleeding and secondary infection) Benign malignant transformation Malignant metastasis to vital organ and malignant cachexia

PARA-Neoplastic Syndromes
Endocrine Nerve/Muscle, e.g., myasthenia w. lung ca. Skin: e.g., acanthosis nigricans, dermatomyositis Bone/Joint/Soft tissue: HPOA (Hypertrophic Pulmonary OsteoArthropathy) Vascular: Trousseau, Endocarditis Hematologic: Anemias Renal: e.g., Nephrotic Syndrome

ENDOCRINE
Cushing syndrome Small cell carcinoma of lung Pancreatic carcinoma Neural tumors Syndrome of inappropriate antidiuretic hormone secretion Hypercalcemia Small cell carcinoma of lung; intracranial neoplasms Squamous cell carcinoma of lung Breast carcinoma Renal carcinoma Antidiuretic hormone or atrial natriuretic hormones Parathyroid hormone-related protein (PTHRP), TGF-, TNF, IL-1 ACTH or ACTH-like substance

Adult T-cell leukemia/lymphoma


Ovarian carcinoma Hypoglycemia Fibrosarcoma Other mesenchymal sarcomas Hepatocellular carcinoma Insulin or insulin-like substance

Carcinoid syndrome

Bronchial adenoma (carcinoid)


Pancreatic carcinoma Gastric carcinoma

Serotonin, bradykinin

Polycythemia

Renal carcinoma Cerebellar hemangioma

Erythropoietin

Hepatocellular carcinoma

Pathways of metastases
1. Seeding of body cavities and surfaces
a. Transperitoneal spread: adenoCA stomach and colon implant anywhere in peritoneal cavity involve POD and both ovaries KRUKENBERG tumor Transpleural and transpericardial spread: CA lungs, CA breast

b.

2. Spread by transplantation
Needle tract following aspiration biopsy, surgical incision

3. Lymphatic spread
CA breast axillary LN, internal mammary LN CA lungs perihilar LN, tracheobronchial LN, mediastinal LN CA stomach Virchows LN

4. Hematogenous spread
Arterial spread Venous spread Bones, Brain, Kidney, Adrenal, Ovaries Liver, Lungs

Geographic & Environmental


Sun exposure Melanomas 6x incidence New Zealand vs Iceland Blacks have low incidence of melanoma, so do normally pigmented areas like areolae on white people Smoking and alcohol abuse Body mass Overweight = 50% increase in cancer Environmental vs racial factors Japanese immigrants to USA Viral exposure Human papilloma virus (HPV) and cervical cancer Hepatitis B virus (HBV) and liver cancer (Africa, Asia) Epstein-Barr Virus (EBV) and lymphoma

Age Most cancers occur in persons 55 years Childhood cancers


Leukemias & CNS neoplasms Bone tumors

Predisposing Factors for Cancer

Genetic predisposition Familial cancer syndromes


Early age at onset Two or more primary relatives with the cancer Multiple or bilateral tumors

Polymorphisms that metabolize procarcinogens, e.g., nitrites Nonhereditary predisposing conditions Chronic inflammation Precancerous conditions
Chronic ulcerative colitis Atrophic gastritis of pernicious anemia Leukoplakia of mucous membranes Immune collapse?

Grading and Staging of tumors


Grading: level of Differentiation Staging: spread of cancer within the patient Grading is based on no. of mitoses Cancer can be classified as Grade I to IV with increasing anaplasia Staging based on size of primary lesion, extent of spread to regional LN and +ce or ce of blood borne metastases

Diagnosis of tumor
1. 2. 3. 4. 5. 6. 7. 8. 9. Radiological support (X-ray, USG, CT, MRI, Mammogram) Laboratory diagnosis Histological diagnosis (Biopsy) Cytological diagnosis Haematological diagnosis Tumor markers Immunohistochemical techniques Immunocytochemistry DNA probe analysia DNA flow cytometry Hormone receptor assay

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