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Neoplasia-Connective tisue Malignancies,Hamartomas and Teratomas

Neoplasia-Connective tisue Malignancies,Hamartomas and Teratomas

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    Cancer Cancer Presentation Transcript

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