Neoplasia basics ! first lecture !

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Neoplasia basics ! first lecture !

  1. 1. Neoplasia DR EJAZ WARIS ASSIS.PROF HISTOPATHOLOGY FMHC
  2. 2. Objectives of the lecture <ul><li>Basics of neoplasia </li></ul><ul><li>Classification & nomenclature </li></ul><ul><li>Characteristics of tumors </li></ul><ul><li>Characteristics of malignant cells </li></ul>
  3. 3. What is a Neoplasm ?
  4. 4. ( Literally: New growth) An abnormal tissue mass whose growth exceeds and is uncoordinated with that of adjacent normal tissue and persists after cessation of the stimuli that provoked it
  5. 6. Whats the main difference between a neoplastic & a nonneoplastic growth?
  6. 7. Neoplastic growths are uncontrolled & irreversible & non-neoplastic growths are controlled & reversible
  7. 8. Components of a tumor <ul><li>Parenchyma : composed of tumor cells </li></ul><ul><li>Stroma : supportive tissue </li></ul>
  8. 9. Types of Tumors <ul><ul><li>BENIGN NEOPLASM </li></ul></ul><ul><ul><li>A neoplasm that grows without invading adjacent tissue of spreading to distant sites. </li></ul></ul><ul><li>Usually well-circumscribed due to the lack of invasion of surrounding tissues . </li></ul><ul><ul><li>MALIGNANT NEOPLASM </li></ul></ul><ul><ul><li>A neoplasm that invades the surrounding normal tissue. </li></ul></ul><ul><ul><li>Usually spreads to distant sites given sufficient time. </li></ul></ul><ul><ul><li>Usually is not well circumscribed. </li></ul></ul><ul><ul><li>Malignant tumor and cancer are synonyms </li></ul></ul>
  9. 10. Benign tumors <ul><li>Always end with the suffix – oma </li></ul><ul><li>e.g </li></ul><ul><li>Fibroma </li></ul><ul><li>Chondroma </li></ul><ul><li>Osteoma </li></ul><ul><li>Lipoma </li></ul><ul><li>Adenoma </li></ul><ul><li>Cystadenoma </li></ul><ul><li>Papillary cystadenoma </li></ul>
  10. 17. Malignant tumors <ul><li>Carcinoma : </li></ul><ul><li>Malignant tumor of epithelial origin </li></ul><ul><li>e.g.squamous cell carcinoma,adenocarcinoma,TCC,RCC </li></ul><ul><li>Sarcoma : </li></ul><ul><li>Malignant tumor of mesenchymal origin </li></ul><ul><li>e.g. fibrosarcoma,osteosarcoma,liposarcoma </li></ul>
  11. 25. Naming of neoplasms
  12. 26. ORIGIN BENIGN MALIGNANT I. EPITHELIAL Stratified squamous Squamous cell papilloma Squamous cell carcinoma Basal cells of skin Basal cell carcinoma Epithelial lining from glands or ducts Adenoma (e.g. of colon) Adenocarcinoma (e.g. of colon) Hepatocytes Hepatocellular adenoma Hepatocellular carcinoma (also called &quot;hepatoma&quot;, a confusing Term that should be avoided) Melanocytes Nevus Melanoma (or malignant melanoma) Renal Renal cell adenoma Renal cell carcinoma Transitional Papilloma TCC
  13. 27. II. MESENCHYMAL A. Connective Tissue Bone Osteoma Osteosarcoma Cartilage Chondroma Chondrosarcoma Fibroblast Fibroma Fibrosarcoma B. Hematopoietic Erythroid Erythroid leukemia Myeloid Myelogenous leukemia Lymphoid Lymphocytic leukemia malignant lymphoma C. Muscle Smooth muscle Leiomyoma Leiomyosarcoma Striated (skeletal) muscle Rhabdomyoma Rhabdomyosarcoma D. Vascular Hemangioma Angiosarcoma III. GERM CELLS Teratoma (dermoid) teratocarcinoma
  14. 28. Other terms <ul><li>Choristoma </li></ul><ul><li>Hemartoma </li></ul><ul><li>Pleomorphic adenoma </li></ul><ul><li>teratoma </li></ul>
  15. 29. Characteristics of tumors
  16. 30. 1)Differentiation <ul><ul><li>DIFFERENTIATION </li></ul></ul><ul><ul><li>The tissue type represented by the tumor. </li></ul></ul><ul><ul><li>Extent to which the tumor cell resemble its parent cell </li></ul></ul><ul><ul><li>Ranges of differentiation : well,moderately,poorly,undifferentiated </li></ul></ul><ul><ul><li>Well differentiated tumors resemble identifiable tissue types. </li></ul></ul><ul><ul><li>Undifferentiated tumors doesnot resemble </li></ul></ul>
  17. 31. Importance of differentiation <ul><ul><li>Importance of differentiation </li></ul></ul><ul><ul><ul><li>Site of origin in metastatic disease </li></ul></ul></ul><ul><ul><li>example: squamous carcinoma in a lymph node, sites of origin would include lungs, respiratory tract, gyn tract, skin </li></ul></ul><ul><ul><ul><li>Prognosis </li></ul></ul></ul><ul><ul><li>well differentiated often better prognosis than poorly differentiated </li></ul></ul><ul><ul><ul><li>Treatment </li></ul></ul></ul><ul><ul><ul><li>treatment varies, example adenocarcinoma vs squamous </li></ul></ul></ul>
  18. 33. <ul><li>Anaplasia : lack of differentiation of tumors </li></ul><ul><li>Dysplasia :Atypical proliferation of cells characterized by nuclear enlargement and failure of differentiation which falls short of malignancy </li></ul><ul><ul><ul><ul><li>Dysplasia is recognized by alterations in the appearance of cells </li></ul></ul></ul></ul><ul><ul><ul><ul><li>cell nuclei become hyperchromatic </li></ul></ul></ul></ul><ul><ul><ul><ul><li>nuclear membranes become irregular </li></ul></ul></ul></ul><ul><ul><ul><li>nuclear to cytoplasmic ratio increases </li></ul></ul></ul><ul><ul><ul><li>Dysplasia may regress, persist or progress </li></ul></ul></ul>
  19. 36. Carcinoma in situ <ul><li>Full-thickness dysplasia extending from the basement membrane to the surface of the epithelium. Applicable only to epithelial neoplasms. If the entire lesion is no more advanced than CIS, then the risk of metastasis is zero. This is because there are no blood vessels or lymphatics within the epithelium above the basement membrane </li></ul>
  20. 39. desmoplasia <ul><li>The change that occurs in the stroma as tumor invades is called desmoplasia. Desmoplasia refers to the stroma composed of connective tissue and blood vessels that surrounds the infiltrating tumor. The spindle shaped cells that make up the desmoplasia are not themselves neoplastic. Desmoplasia is a response to invasion of tissue by malignant tumor cells </li></ul>
  21. 40. 2)Rate of growth <ul><li>Benign tumors are slow growing and show capsule formation </li></ul><ul><li>Malignant tumors are rapid and fast growing,sometimes at an erratic pace to be diagnosed at a time when tumor has spread at distant sites </li></ul>
  22. 41. Local Invasion <ul><li>Growth into the surrounding tissue by direct extension/expansion </li></ul><ul><li>Benign tumors never locally invade </li></ul><ul><li>Malignant tumors always invade the souurounding tissues </li></ul>
  23. 42. Metastasis <ul><li>Tumor implants discontinuous from the primary tumor is metastasis </li></ul><ul><li>Spread of tumor to distant sites by 1)lymphatic, </li></ul><ul><li>2)hematogenous routes, or </li></ul><ul><li>3) seeding of body cavities. </li></ul>
  24. 43. Routes of spread <ul><li>Seeding of body cavities and surfaces: This occurs when a malignant neoplasm penetrates into a natural &quot;open field&quot; such as peritoneal cavity, pleural space, pericardial cavity, etc. Most common examples, ovarian carcinoma and mucin secreting ovarian and appendiceal carcinomas (pseudomyxoma peritonei). </li></ul>
  25. 44. Routes of spread <ul><li>Lymphatic spread: This is the most common pathway for dissemination of carcinomas (although sarcomas can also use this route). The pattern of lymph node involvement follows the natural routes of drainage. </li></ul><ul><li>Hematogenous spread: This pathway is typical of sarcomas. Arteries are more difficult for tumor to penetrate than veins. With venous invasion, the blood-borne cells follow the venous flow draining the site of the tumor. Liver and lungs are frequently involved </li></ul>
  26. 47. Malignant cell
  27. 48. Charateristics <ul><li>Disturbed polarity and loss of cohesiveness : nuclei oriented in different directions and are irregularly spaced. Cells become detached from one another. </li></ul><ul><li>Pleomorphism : abnormal variation in size, shape </li></ul><ul><li>Nuclear to cytoplasmic ratio increased . It increases from 1:4 to 1:1 </li></ul>
  28. 49. Characteristics <ul><li>Nuclear Chromatin shows irregular clumping and hyperchromasia. </li></ul><ul><li>Prominent nucleoli </li></ul><ul><li>Irregular Nuclear membrane </li></ul><ul><li>Scanty more eosinophilic cytoplasm </li></ul><ul><li>Abnormal mitoses : may be present </li></ul><ul><li>Giant cells in anaplastic tumors </li></ul>
  29. 65. GRADING AND STAGING OF TUMORS
  30. 66. Grading of tumors <ul><li>Grade: The grade of a tumor is based on the degree of differentiation of the tumor cells, the degree of cytologic atypia and the number of mitoses within the tumor. </li></ul><ul><li>In general, low grade tumors are well differentiated, have minimal cytologic atypia and low mitotic rates. High grade tumors are poorly differentiated, have marked cytologic atypia and high mitotic rates. </li></ul>
  31. 67. Staging of tumors <ul><li>Stage: The stage of a tumor is based on the size of the primary tumor, the extent of invasion into surrounding tissue, the spread to regional lymph nodes and the presence or absence of blood-borne metastases. </li></ul>
  32. 68. Staging systems <ul><li>The staging system used here is the American Joint Committee (AJC) on Cancer Staging. The staging scheme varies by tumor site, but all tumors are assigned a &quot;T&quot; stage referring to tumor size, degree of penetration of surrounding tissue; a &quot;N&quot; indicative of presence of lymph node involvement and a &quot;M&quot; which indicates the existence of metastases </li></ul>
  33. 69. TNM STAGING SYSTEM <ul><li>T&quot; for tumor: </li></ul><ul><li>T1 might mean primary tumor is smaller than 1 cm in diameter </li></ul><ul><li>T2 might mean primary tumor is larger than 1 cm in diameter </li></ul><ul><li>T3 might mean primary tumor is invading something non-resectable </li></ul><ul><li>&quot;N&quot; for regional lymph nodes: </li></ul><ul><li>N0 would mean no tumor in regional lymph nodes </li></ul><ul><li>N1 might mean tumor in a few nearby lymph nodes </li></ul><ul><li>N2 might mean many nodes, or some nodes farther downstream, are involved </li></ul><ul><li>&quot;M&quot; for metastases: </li></ul><ul><li>M0 would mean no distant metastases </li></ul><ul><li>M1 would imply distant metastases, etc </li></ul>
  34. 70. Self Assessment Questions: <ul><li>What is a neoplasm? Write two special characters? </li></ul><ul><li>What is a papilloma, adenoma </li></ul><ul><li>What is dysplasia, Metaplasia, Anaplasia Hyperplasia? Mention examples? </li></ul><ul><li>Mention major classes of neoplasms with five differentiating features? </li></ul><ul><li>Mention three features of malignant tumor? </li></ul>
  35. 71. Self Assessment Questions: <ul><li>What is carcinoma-in-situ? </li></ul><ul><li>What is grading? And staging? </li></ul><ul><li>How are neoplasms named? </li></ul><ul><li>What is CIN? Classify </li></ul><ul><li>What are the common routes of cancer spread? </li></ul><ul><li>How do we diagnose cancer? </li></ul><ul><li>Brief note of tumor markers? </li></ul>
  36. 72. Benign Malignant: <ul><li>Slow growing, </li></ul><ul><li>capsulated, </li></ul><ul><li>Non-invasive </li></ul><ul><li>do not metastasize, </li></ul><ul><li>well differentiated, </li></ul><ul><li>suffix “oma” eg. Fibroma. </li></ul><ul><li>Fast growing, </li></ul><ul><li>non capsulated, </li></ul><ul><li>Invasive & Infiltrate </li></ul><ul><li>Metastasize. </li></ul><ul><li>poorly differentiated, </li></ul><ul><li>Suffix “Carcinoma” or “Sarcoma” </li></ul>
  37. 74. Tumor Diagnosis: <ul><li>History and Clinical examination </li></ul><ul><li>Imaging - X-Ray, US, CT, MRI </li></ul><ul><li>Tumor markers Laboratory analysis </li></ul><ul><li>Cytology –Pap smear, FNAB </li></ul><ul><li>Biopsy - Histopathology, markers. </li></ul><ul><li>Molecular Tech – Gene detection. </li></ul>
  38. 75. Bilateral Cystadenoma Ovary:
  39. 76. Lipoma Intestine:
  40. 77. meningioma
  41. 78. Lung carcinoma
  42. 79. Hepatic Adenoma:
  43. 81. Carcinoma Breast:
  44. 82. Carcinoma Lung:
  45. 83. Osteo - sarcoma:
  46. 84. Biopsy – Slide preparation

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