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  1. 1. <ul><li>Neoplasia I </li></ul>
  2. 2. <ul><li>Tumour </li></ul><ul><li>Cancer (Malignant) </li></ul><ul><li>Carcinoma/s </li></ul><ul><li>Carcinogenesis; Process involved in development of all types of malignant neoplasm . </li></ul><ul><li>Oncology; </li></ul><ul><li>Oncogenesis; Changes involved in the development of any kind of neoplasm. </li></ul><ul><li>Neoplasia: is a result of pathological proliferation of cells . </li></ul>
  3. 3. <ul><li>Definition: </li></ul><ul><li>The purpose less excessive proliferation which continue indefinitely (irreversible) even after removing the initial stimuli with an un coordinated manner to the requirement of the surrounding tissues or the individual. </li></ul><ul><li>Autonomous growth : un control growth </li></ul><ul><li>BUT Nutrition and HOST Stromal tissue </li></ul><ul><li>Parasitic in behaviour </li></ul>
  4. 4. <ul><li>Tumours vary mostly in structure and behavior </li></ul><ul><li>This variation depend on, </li></ul><ul><li>Type of cells from which neoplasm developed </li></ul><ul><li>Degree of differentiation achieved </li></ul><ul><li>Whether the neoplasm is Malignant or benign </li></ul>
  5. 5. <ul><li>Tumours - Benign ; </li></ul><ul><li>No propensity to metastasis </li></ul><ul><li>Localized, slow growing </li></ul><ul><li>Symptom less (pressure,Hormonal) </li></ul><ul><li>No invasion/Can excised completely </li></ul><ul><li>Few mitosis but normal </li></ul><ul><li>Encapsulated/ No metastasis </li></ul><ul><li>Mimic the structure of the parent organ, </li></ul><ul><li>resembles the cells of origin </li></ul><ul><li>(uniform cells) (Well differentiated). </li></ul><ul><li> </li></ul>
  6. 6. <ul><li>Malignant : </li></ul><ul><li>Rapidly growing </li></ul><ul><li>Invasive (margins are not clear) </li></ul><ul><li>Vary in size and shape (cells/nuclei) </li></ul><ul><li>Frequent and abnormal mitosis. </li></ul><ul><li>Bear little resemblance to the mother tissue </li></ul><ul><li>(Less well differentiated) </li></ul><ul><li>Metastatic - Loss of adherence </li></ul><ul><li>Spread through blood and lymph </li></ul>
  7. 7. <ul><li>Differentiation: </li></ul><ul><li>Extent of resemblance to the mother tissue or </li></ul><ul><li>adult cells of the tissue of origin both in Morphology (Cell-cell, Cell to stroma) </li></ul><ul><li>Functionally </li></ul><ul><li>Well differentiated </li></ul><ul><li>Moderately differentiated. </li></ul><ul><li>Poorly differentiated . </li></ul><ul><li>Anaplasia; </li></ul><ul><li>Complete loss of resemblance to the mother tissue </li></ul><ul><li>(Lack of differentiation). </li></ul>
  8. 8. Degree of differentiation is assessed by using cellular atypia. <ul><li>Degree of differentiation is assessed by using cellular atypia. </li></ul><ul><li>Size shape/ of the cell (Pleomorphism) </li></ul><ul><li>Arrangement in relation to one another/stroma/bld </li></ul><ul><li>Disorganized growth of groups or sheets of cells. </li></ul><ul><li>large distorted nuclei/ multi nucleated </li></ul><ul><li>High nuclear/cytoplasm ratio </li></ul><ul><li>Hyperchromatism </li></ul><ul><li>Abnormal mitosis/ increase mitosis </li></ul>
  9. 9. Dysplasia <ul><li>Group of changes that can be seen principally in epithelia which would lead to disorganise the tissues </li></ul><ul><li>both in cellular level </li></ul><ul><li>organisation level </li></ul><ul><li>Histopathological description of epithelium in which cellular atypia present </li></ul>
  10. 10. <ul><li>Dysplastic changes: </li></ul><ul><li>Cellular changes which characterize in malignant and premalignant lesions. </li></ul><ul><li>Neuclear /cellular pleomorphism </li></ul><ul><li>Altered neuclear cytoplasm ratio. </li></ul><ul><li>Hyperchromatism </li></ul><ul><li>Abnormal mitoses/ more mitoses </li></ul><ul><li>Loss of polarity/ loss of stratification </li></ul><ul><li>Individual cell keratinisation </li></ul><ul><li>Basel cell hyperplasia. </li></ul><ul><li>Drop shaped rete pegs </li></ul>
  11. 11. <ul><li>How does neoplasia differ from hyperplasia </li></ul><ul><li>Spontaneous growth </li></ul><ul><li>Growth is not related to the degree of stimulus and once it starts proceeds irrespective of the stimulus. </li></ul><ul><li>Once stimulus removes the lesion progress </li></ul>
  12. 12. Classification of tumours <ul><li>Naked eye appearance: </li></ul><ul><li>eg; Annular, Fungating, Scirrhus tumours </li></ul><ul><li>Aetiological : </li></ul><ul><li>Unknown agents </li></ul><ul><li>Single agent –different types of tumours </li></ul><ul><li>Different types of agents –Single tumours </li></ul><ul><li>Functional: Insulinoma, Glucagonoma </li></ul>
  13. 13. <ul><li>Behavior: </li></ul><ul><li>Benign, Malignant </li></ul><ul><li>Intermediate: Locally aggressive </li></ul><ul><li>No metastasis </li></ul><ul><li>Low metastasis </li></ul><ul><li>Metastasized but progress slow </li></ul><ul><li>Eg; Basal cell Carcinoma Ameloblastoma </li></ul>
  14. 14. <ul><li>Spontaneous regression; </li></ul><ul><li>Malignant melanomas, Choriocarcinoma, </li></ul><ul><li>Clear cell carcinoma of the kidny, Neuroblastoma, </li></ul><ul><li>Burkitt lymphomas (small dose of cytotoxic agents) </li></ul><ul><li>Latent cancer ; Proliferating mass of cell has all the histological features of malignancy even invasion of blood and lymph, However , they are clinically silent with no metastasis. </li></ul><ul><li>Dormant cancer: Late appearance of metastatic tumour after successful removal of the primary tumour. </li></ul><ul><li>No local recurrence </li></ul><ul><li>Patient is quite well in between </li></ul><ul><li>Tumour comes out with a serious illness.- </li></ul>
  15. 15. <ul><li>Histogenetic ; </li></ul><ul><li>Based on the type of tissue origin </li></ul><ul><li>Tumours of epithelial Epithelial Tumours of connective tissue </li></ul><ul><li>Problems </li></ul><ul><li>Tumours arising from endothelium or mesothelium resemble the tumours of epithelial in origin. </li></ul><ul><li>eg mesotheliomata adenocarcinoma of the lung. </li></ul><ul><li>Undifferentiated tumours </li></ul><ul><li>Tumour metaplasia </li></ul><ul><li>Tumours arising from embryonic tissues. Certain tumours arising from cells that are present in development but disappears in the adult life . </li></ul>
  16. 16. <ul><li>Histologic classification: </li></ul><ul><li>Tumour metaplasia </li></ul><ul><li>Anaplasia </li></ul><ul><li>Undifferentiated salivary tumours which have no glandular appearance will name as polygonal spheroidal, </li></ul><ul><li>Carcinoma simplex. The anaplasia is so great that it is uncertain whether the origin is epithelial or connective tissue. </li></ul>
  17. 17. In new Classifications <ul><li>Behavior, </li></ul><ul><li>Tissue of origin </li></ul><ul><li>supplemented with histological description. </li></ul>
  18. 18. <ul><li>Nomenclature : </li></ul><ul><li>Epithelial, (Benign or Malignant) </li></ul><ul><li>Mesenchymal (Benign or Malignant) </li></ul><ul><li>Neoplasia - </li></ul><ul><li>Parenchyma (Neoplastic cells) (Nature) </li></ul><ul><li>Stroma (Growth/ evolution) </li></ul><ul><li>Eg: Flashy tumours (scanty stroma) </li></ul><ul><li>Scirrhous tumour of the breast Desmoplasia(abundant stromal reaction) </li></ul>
  19. 19. <ul><li>The nomenclature of benign mesenchymal tumours: </li></ul><ul><li>parenchymal component is named histologically </li></ul><ul><li>Chondro, osteo, lipo, fibro, etc </li></ul><ul><li>OMA - Benign tumours </li></ul>
  20. 20. <ul><li>Benign mesenchymal tumours are named histogenetically according to parenchymal cell type </li></ul><ul><li>Muscle = leiomyoma, </li></ul><ul><li>rhabdomyoma </li></ul><ul><li>Bone = osteoma </li></ul><ul><li>cartilage = chondroma </li></ul><ul><li>fat = lipoma </li></ul><ul><li>vessel = angioma </li></ul><ul><li>fibrous tissue = fibroma </li></ul>
  21. 21. <ul><li>Benign epithelial tumours Microscopic, Macroscopic, Histogenecity </li></ul><ul><li>Neoplasm arising from benign epithelium containing microscopic or microscopic finger like or papillary projections </li></ul><ul><li>Papilloma . </li></ul><ul><li>Neoplasm arising from benign epithelium which forms a glandular pattern or directly arising from glandular tissues(not necessarily look like glands). </li></ul><ul><li>Adenomas </li></ul><ul><li> (renal tubular adenomas) </li></ul>
  22. 22. <ul><li>Degree of differentiation is assessed by using cellular atypia. </li></ul>
  23. 23. <ul><li>Malignant tumours; </li></ul><ul><li>Tumours arising from mesenchimal tissues with malignant nature “Sarcoma” </li></ul><ul><li>Muscle = Leiomyoma, Liomyosarcoma Rhabdomyoma Rhabdomyosarcoma </li></ul><ul><li>Bone = osteoma Osteo sarcoma </li></ul><ul><li>cartilage = chondroma Chondrosarcoma </li></ul><ul><li>fat = lipoma Liposarcoma </li></ul><ul><li>vessel = angioma Angiosarcoma </li></ul><ul><li>fibrous tissue = fibroma Fibrosarcoma </li></ul>
  24. 24. <ul><li>Malignant neoplasms of epithelial cell origin (derived from any of the germ layers) “Carcinoma” </li></ul><ul><li>eg; Epidermis, GIT, Renal tubular </li></ul><ul><li>The carcinomas will be further specified as adenocarcinoma, squamous cell carcinoma </li></ul><ul><li>Further specify eg renal cell adeno carcinomas, bronchogenic SCC. </li></ul>
  25. 25. <ul><li>Mixed tumours ; </li></ul><ul><li>Benign or malignant cells in tumours resembles to each other to a certain extant.(as they arise from one cell) </li></ul><ul><li>But sometimes divergent differentiations in a single line of cells have been observed. The result will be mass of cells with different types of tissues. However, most of these tumours represent single germ layer. (Pluripotential cell) </li></ul><ul><li>They will be named as “ mixed ” Eg; pleomorphic adenoma (epithelial or myoepithelial cells of the salivary origin) </li></ul>
  26. 26. <ul><li>Teratoma ; Most of the tumours including mixd tumours arise from single germ layer. </li></ul><ul><li>Teratomas: </li></ul><ul><li>consist of variety of parenchymal 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>
  27. 27. <ul><li>Totipotential cells differentiates alone various germ layers produce different types of tissues such as Skin, Muscle, Fat, Gut Epithelium, teeth etc-- </li></ul><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 part from which its arises. </li></ul>
  28. 28. <ul><li>Hamatomas: </li></ul><ul><li>Hamartoma is a tumour like malformation in which the tissues of a particular part of the body are arranged haphazardly usually with an excess of one or more of its component. </li></ul><ul><li>Differentiation is aberrant </li></ul><ul><li>Arrangement is disorganised </li></ul><ul><li>Cells are mature and indigenous to the site </li></ul><ul><li>Eg 1: Haemangioma, </li></ul><ul><li>2: 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>
  29. 29. <ul><li>Differ from teratomas. </li></ul><ul><li>The tissues specific to the site/No capsule </li></ul><ul><li>No tendency towards excessive growth </li></ul>
  30. 30. <ul><li>Comparison </li></ul><ul><li>Benign </li></ul><ul><li>Circumscribed </li></ul><ul><li>Encapsulated </li></ul><ul><li>Not </li></ul><ul><li>Slow/ stops latter </li></ul><ul><li>Compress the normal surrounding tissue </li></ul><ul><li>Structurally and functionally well differentiated </li></ul><ul><li>Malignant </li></ul><ul><li>Irregular in shape </li></ul><ul><li>Not encapsulated </li></ul><ul><li>Ulceration an haemorrhage is common </li></ul><ul><li>Growth is rapid </li></ul><ul><li>Invade and destruct the normal tissue </li></ul><ul><li>Less well differentiated or anaplastic </li></ul>
  31. 31. <ul><li>Death- due to pressure effects/hormonal effects/obstructions </li></ul><ul><li>Function –Maintains </li></ul><ul><li>Expansive growth </li></ul><ul><li>No </li></ul><ul><li>Regular </li></ul><ul><li>Little increase/normal </li></ul><ul><li>Normal </li></ul><ul><li>Little tendency </li></ul><ul><li>Small size </li></ul><ul><li>Death- due to destructive effects/blood loss/ infections/starvation/malnutrition/anaemia </li></ul><ul><li>altered </li></ul><ul><li>Infiltration, invasion, </li></ul><ul><li>Metastasis </li></ul><ul><li>Nuclear and cellular atypia </li></ul><ul><li>Increase mitosis/abnormal </li></ul><ul><li>Cellular adhesion is weak </li></ul><ul><li>Necrosis common </li></ul><ul><li>Large size </li></ul>
  32. 32. <ul><li>Sarcoma </li></ul><ul><li>Less common </li></ul><ul><li>Young people </li></ul><ul><li>The parenchymal cells arranged in diffuse sheets and integrated with stroma </li></ul><ul><li>Poorly formed stroma </li></ul><ul><li>Haemorrhage/necrosis extensive </li></ul><ul><li>Fast growing </li></ul><ul><li>Lympahtic spread uncommon </li></ul><ul><li>Very early blood borne metastasis </li></ul><ul><li>Radioresistant </li></ul><ul><li>Carcinoma </li></ul><ul><li>Common </li></ul><ul><li>Middle/Old aged </li></ul><ul><li>Parenchymal cells arranged in groups or columns </li></ul><ul><li>Well formed stroma </li></ul><ul><li>Haemorrhage/necrosis less extensive </li></ul><ul><li>Comparatively slow </li></ul><ul><li>Early lymphatic spread is common </li></ul><ul><li>Little late </li></ul><ul><li>Radiosensitive </li></ul>
  33. 34. <ul><li>Ovarian teratomas: </li></ul><ul><li>Well differentiated, benign, seen 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, other types of epithelia and nerves tissues. </li></ul><ul><li>Rarely entire teratoma has a one type of tissue eg Struma ovarii (Thyroid tissues) </li></ul>
  34. 35. <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>Rarely described a solid type which is malignant. </li></ul><ul><li>Testicular teratoma </li></ul><ul><li>Young middle aged males/ some in children (benign) . </li></ul><ul><li>Majority highly malignant </li></ul><ul><li>In malignant variety - Malignant intermediate Malignant undifferentiated </li></ul>
  35. 36. <ul><li>The less malignant types consists irregular gland like spaces lined with atypical cells which may resemble squmamous respiratory and intestinal epithelium in different places. </li></ul><ul><li>Masses of cartilage bones muscles etc seen </li></ul><ul><li>All is supported by connective tissue stroma. </li></ul><ul><li>Highly malignant types glandular pattern with papillary convolusions </li></ul><ul><li>Malignant tropoblastic types has tropoblast cells in addition to other types of cells. </li></ul>