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Neoplasia-Connective tisue Malignancies,Hamartomas and Teratomas

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  1. 1. <ul><li>Neoplasia </li></ul><ul><li>Malignant connective tissue tumours, </li></ul><ul><li>Teratomas,Hamartomas </li></ul>
  2. 2. <ul><li>Malignant tumours of connective tissue origin (Sarcomata) </li></ul><ul><li>Not common as carcinomas, But can get at any age </li></ul><ul><li>prognosis worse compared to carcinomas. Spread through blood. </li></ul><ul><li>They form sheaths made up from merged neoplastic cells. They are inseparably merged in to stroma . </li></ul>
  3. 3. <ul><li>Eg: </li></ul><ul><li>Fibrosarcomas </li></ul><ul><li>Osteosarcomas </li></ul><ul><li>Rhabdomyosaecomas </li></ul><ul><li>Leiomyosarcomas </li></ul><ul><li>Liposarcomas. </li></ul>
  4. 4. Fibrosarcoma; <ul><li>Counter part of the benign tumour </li></ul><ul><li>Elongate large vesicular nucleus </li></ul><ul><li>Atypical mitosis </li></ul><ul><li>Giant cell commonly seen /collagen formation is scanty </li></ul><ul><li>nuclear pleomorphism hypercromatism </li></ul><ul><li>Haemorrege and necrosis is common </li></ul><ul><li>infiltration and metastasis </li></ul>
  5. 5. Osteosarcoma, <ul><li>Badly malignant (late chlidhood originate from osteoblasts), Osteoid formation in well dif types. </li></ul><ul><li>cell are pleomorphic/numerous giant cells </li></ul><ul><li>Some times cartilage formation </li></ul><ul><li>Growing tumour elevates the periosteum of the bone and form a feusiform swelling </li></ul><ul><li>Epiphysial plate forms resistance to spread. </li></ul><ul><li>Common in young age. </li></ul>
  6. 6. Leiomyosarcoma <ul><li>The tumour cells are spindle shaped. </li></ul><ul><li>Nuclear pleomorphism </li></ul><ul><li>Vesicular nuclei </li></ul><ul><li>Mitosis </li></ul><ul><li>Eosinophilic cytoplasm with fibrillar nature (myofibrils) </li></ul><ul><li>Eg: Stomach,Uterus </li></ul>
  7. 7. <ul><li>Teratoma ; Most of the tumours including mixed tumours arise from single germ layer. </li></ul><ul><li>Tumours consist of variety of parenchimal cell types representing more than one germ layer. </li></ul><ul><li>It is believed that they arise from totipotential cells of primitive cell rest and differentiate along different germ lines and produce different types of cells and there by different types of tissues. </li></ul><ul><li>Totipotent cells are encountered in gonads or rarely any where sequestered primitive cell rests are available </li></ul>
  8. 8. <ul><li>Teratomas are common in ovaries and testes </li></ul><ul><li>Other sites: mediastinum, retroperitoneal tissues </li></ul><ul><li>Endless verity of tissues: </li></ul><ul><li>Cartilage, Bone, Teeth, Hair, Epithelium </li></ul><ul><li>Specialised types of tissues: like Hepatic, Renal, Nervous, Occular etc--- </li></ul><ul><li>Teratomas may </li></ul><ul><li>Malignant </li></ul><ul><li>Benign </li></ul>
  9. 9. <ul><li>However some believe that teratomas arise from germ cells. (Commonly seen in gonads) </li></ul><ul><li>Definition. Tumour consist of multiple tissues chaotically arranged and foreign to the site to which it arises. </li></ul><ul><li>Teratomas consist of cells representative of all three germ layers but haphazardly arranged and incompletely differentiate. </li></ul>
  10. 11. <ul><li>Ovarian teratomas </li></ul><ul><li>Well differentiated, benign, (young or middle age women) </li></ul><ul><li>Histologically; Thin-walled cystic mass filled with sebaceous keratinous debris and matted hair. </li></ul><ul><li>Wall is usually stratified squamous epithelium . </li></ul><ul><li>In the eminence of the wall- Teeth, tongue like structure, even bone and cartilage, </li></ul><ul><li>Including other types of epithelia tissues respiratory, intestinal also can be seen in eminence. </li></ul>
  11. 12. <ul><li>Rarely entire teratoma has a one type of tissue eg Struma ovarii (Thyroid tissues) </li></ul><ul><li>Malignant changes are uncommon , </li></ul><ul><li>Malignant teratomas metastasis rapidly via blood and lymph. </li></ul><ul><li>Secondary lesion may be A mixture of tissues One type or </li></ul><ul><li>type which has not seen in primary </li></ul>
  12. 14. <ul><li>Testicular teratoma </li></ul><ul><li>Young middle aged males/ some in children </li></ul><ul><li>Majority highly malignant (undifferentiated) </li></ul><ul><li>Benign; Well differentiated and behave in a benign manner </li></ul><ul><li>Malignant intermediate; Both oraganoid formation and undifferentiated cells. </li></ul><ul><li>Malignant undifferentiated type; Anaplastic cells </li></ul><ul><li>Malignant trophoblastic type; Trophoblastic cells highly malignant. </li></ul>
  13. 15. <ul><li>Less malignant types are solid but often with cystic spaces. </li></ul><ul><li>Histologically - irregular gland like spaces lined with atypical cells which may resemble squamous respiratory and intestinal epithelium in different places. </li></ul><ul><li>Masses of cartilage bones and muscles etc inter-spread with epithelial elements and supported by connective tissue stroma. </li></ul><ul><li>Highly malignant types- consist of anaplastic sheets of cells sometimes with glandular patterns and papillary formation </li></ul>
  14. 16. <ul><li>Hamartomas; </li></ul><ul><li>Tumour like malformation. </li></ul><ul><li>Tissues of the particular part of the body are haphazardly arranged with an excess of one or more of its components. </li></ul><ul><li>Eg Hamartoma in lung tissue </li></ul><ul><li>Hyaline cartilage is similar to found in the bronchi </li></ul><ul><li>There are clefts lined with respiratory epithelium </li></ul><ul><li>In the middle smooth muscle and connective tissues. </li></ul>
  15. 17. Haemangioma: Cavernous type Capillary type
  16. 18. <ul><li>Tumours of nerve sheath origin </li></ul><ul><li>Both schwannomas and neurofibromas are nerve sheeth tumours. </li></ul><ul><li>Schwannomas Arise from Schwann cells. </li></ul><ul><li>Neurofibromas arise from Perinural cells and fibroblasts. </li></ul><ul><li>However, it is believed these lesions are two entities of the same spectrum. </li></ul>
  17. 19. Neurofibroma <ul><li>Cutaneous neurofibroma/ </li></ul><ul><li>Solitary form in a periperal nerve. </li></ul><ul><li>Plexiform neuroma </li></ul>
  18. 20. <ul><li>Neurofibroma: </li></ul><ul><li>Slow growing, Benign, Well circumscribe </li></ul><ul><li>Not encapsulated. </li></ul><ul><li>Lesions may be multiple & solitary </li></ul><ul><li>Histology: Mixed population of </li></ul><ul><li>Schwann cells </li></ul><ul><li>Fibroblasts </li></ul><ul><li>Histology </li></ul><ul><li>Spindle shaped cells with ill defined cell margins. </li></ul><ul><li>Nuclei are ovoid or elongated but uniform. </li></ul><ul><li>Cells dispersed in a connective tissue matrix which has collagen and fibroblasts. Myxomatous changes and nerve fibrous can be seen in the matrix. </li></ul>
  19. 22. Plexiform neuroma <ul><li>Large/multiple </li></ul><ul><li>Pendulous/Flabby </li></ul><ul><li>Consist of thicken tortuous and small nerves. </li></ul><ul><li>Schwann cells/fibroblasts </li></ul><ul><li>Schwann cells produced myxoid connective tissue which expands each nerve. </li></ul>
  20. 23. <ul><li>Schwannoma(Neurilemmoma); </li></ul><ul><li>Cranial/spinal/peripheral nerves can de affected. </li></ul><ul><li>Encapsulated and appears to arise focally on the nerve trunk. </li></ul><ul><li>So nerve stretched over the tumour. </li></ul><ul><li>Microscopically tumour composed of elongated cells disposal in one of these two patterns. </li></ul><ul><li>Antoni type A - Arranged in an organised impact manner. Palisading of nuclei, and pink area between two palisadings (Varocay Body) </li></ul><ul><li>Antoni type B- cells are lossely arranged and scattered in the matrix. </li></ul>