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Neoplasia-Connective tisue Malignancies,Hamartomas and Teratomas

Neoplasia-Connective tisue Malignancies,Hamartomas and Teratomas

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  • 1.
    • Neoplasia
    • Malignant connective tissue tumours,
    • Teratomas,Hamartomas
  • 2.
    • 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 .
  • 3.
    • Eg:
    • Fibrosarcomas
    • Osteosarcomas
    • Rhabdomyosaecomas
    • Leiomyosarcomas
    • Liposarcomas.
  • 4. 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
  • 5. 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.
  • 6. Leiomyosarcoma
    • The tumour cells are spindle shaped.
    • Nuclear pleomorphism
    • Vesicular nuclei
    • Mitosis
    • Eosinophilic cytoplasm with fibrillar nature (myofibrils)
    • Eg: Stomach,Uterus
  • 7.
    • 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
  • 8.
    • 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
  • 9.
    • 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.
  • 10.  
  • 11.
    • 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.
  • 12.
    • 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
  • 13.  
  • 14.
    • 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.
  • 15.
    • 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
  • 16.
    • 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.
  • 17. Haemangioma: Cavernous type Capillary type
  • 18.
    • 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.
  • 19. Neurofibroma
    • Cutaneous neurofibroma/
    • Solitary form in a periperal nerve.
    • Plexiform neuroma
  • 20.
    • 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.
  • 21.  
  • 22. 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.
  • 23.
    • 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.
  • 24.