Neoplasma 1


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Neoplasma 1

  1. 1. NEOPLASMA I Dr.Berti Nelwan,DFM,MSi,SpPA,SpF
  2. 2. NEOPLASMA I DEFINISI & NOMENKLATUR KARAKTERISTIK NEOPLASMA JINAK & GANAS • Diferensiasi & Anaplasia • Kecepatan Pertumbuhan • Invasi Lokal • Metastasis
  3. 3. Introduction:• Inflammatory, Degenerative & Neoplastic• Growth – Increase in size due to synthesis of tissue components.• Proliferation- Cell division.• Differentiation: functional and structural maturity of cells.• Tumor – Swelling / new growth / mass
  4. 4. Introduction• Why we have to learn about cancer/ tumor? • Cancer is the second leading cause of death • In the year 2000, –10 million new cases of cancer –6 million cancer deaths worldwide. • In the United States 2003, –Cancer caused 556,000 death/year –1500 cancer deaths per day.
  5. 5. Giant fibroadenoma mamma with malignant degeneration
  6. 6. DEFINISI NEOPLASMAPertumbuhan baru dimana terdapat diferensiasi sel, maturasi dan kontrolpertumbuhan yang abnormalSuatu massa jaringan abnormal yang tumbuh berlebihan dan tidak teratur disekitar jaringan normal yang akan berlangsung terus walaupun rangsanganpenyebab sudah hilang dan mengakibatkan timbulnya perubahan.(1954, RuppertWillis)
  7. 7. Characteristics of NeoplasiaUncontrolled growth of Abnormal cells• 1. Benign• 2. Malignant• 3. Borderline
  8. 8. “Root words”• Neo- new• Plasia- growth• Plasm- substance• Trophy- size• +Oma- tumor• Statis- location
  9. 9. “Root words”• A- none• Ana- lack• Hyper- excessive• Meta- change• Dys- bad, deranged
  10. 10. Oncology defined• Branch of medicine that deals with the study, detection, treatment and management of cancer and neoplasia
  11. 11. Non-Neoplastic Proliferation: *Controlled & Reversible• Hypertrophy – Size• Hyperplasia – Number• Metaplasia – Change• Dysplasia – Disordered
  12. 12. Neoplastic Proliferation: Uncontrolled & Irreversible*• Benign – Localized, non-invasive.• Malignant (Cancer) – Spreading, Invasive.
  13. 13. Neoplasia:• Progressive, Purposeless, Pathologic, Proliferation of cells characterized by loss of control over cell division.• DNA damage at growth control genes is central to development of neoplasm.• Carcinogens – Chemical, physical & genetic  DNA damage  Neoplasm.
  14. 14. Pathogenesis of Neoplasia:• Normal  Hyperplasia  Metaplasia (DNA damage)  Dysplasia  (DNA damage)  (DNA damage) Anaplasia (DNA damage) Infiltration  (DNA damage)  Metastasis….• Progressive DNA Damage – features of neoplasia.
  15. 15. Pathogenesis of Neoplasia:• Non lethal DNA Damage leading to uncontrolled cell division.
  16. 16. Mechanism of NeoplamsNormal Adaptation Benign MalignantNon-Neoplastic Neoplastic (Polyclonal) (Monoclonal)
  17. 17. Loss of Normal Growth Control
  18. 18. Structure of Neoplasm:• Neoplastic cells parenchyma.• Non-neoplastic - stroma (Connective tissue & BV)• Fast growth  less stroma• Less stroma  more necrosis
  19. 19. Biology of Neoplasm:• Cell of origin • Lung cancer• Rate of growth • Grade - low, high• Differentiation • Well, Mod, P, Un.• Local Invasion • Staging• Metastasis • Staging Lung cancer: Squamus cell carcinoma. Poorly differentiated, high grade, stage 4, Liver+
  20. 20. Benign Malignant:• Slow growing, • Fast growing,• capsulated, • non capsulated,• Non-invasive • Invasive & Infiltrate• do not metastasize, • Metastasize.• well differentiated, • poorly differentiated,• suffix “oma” eg. • Suffix “Carcinoma” or Fibroma. “Sarcoma”
  21. 21. What makes a neoplasm “malignant” ?• The ability to invade and/or metastasize.• Examples: Basal cell carcinoma ( a skin neoplasm) invades but rarely metastasizes.• Malignant melanoma of the skin invades and can widely metastasize.
  22. 22. Language of Oncology• Neoplasm: (meaning new growth that is “autonomous”); scientific term for a tumor.• May be “malignant or benign”• Other “plasias”: – Hyperplasia: an increase in cell number – Hypertrophy: an increase in cell size but not number – Metaplasia: a reversible process where one cell type changes into another cell type
  23. 23. What Is Cancer?CANCER is a complex of diseases which occurs when normal cells mutate into abnormal cells that take over normal tissue, eventually harming and destroying the host
  24. 24. WHAT IS CANCERA large group of diseases characterizedby:– Uncontrolled growth and spread of abnormal cells– Proliferation (rapid reproduction by cell division)– Metastasis (spread or transfer of cancer cells from one organ or part to another not directly connected)
  25. 25. KARSINOGEN (PENYEBAB KANKER) • Bahan kimia • Nitrosamin kanker usus • Virus • HPV kanker serviks • HCV, HBV kanker hati • Epstein Barr kanker nasofaring • Radiasi • bom hiroshima kanker paru, • Chernobil kanker tiroid • Hormon • Estrogen kanker payudara and endometrium • Dll
  26. 26. FAKTOR PREDISPOSISI• Geografik/ Suku/ras – Jepang banyak kanker lambung – Negro jarang kanker kulit• Usia – >55 th• Jenis kelamin – Man : paru, kolon dan prostat – Woman: paru, payudara dan kolon• Hereditas – Kanker Payudara dan ovarium• Kelainan neoplastik didapat – Hepatitis HCC (Hepatocellular carcinoma)
  27. 27. Nomenclature: Cell of origin + SuffixSuffix - oma Carcinoma / Sarcoma• Fibroma • Fibrosarcoma• Osteoma • Osteosarcoma• Adenoma • Adencarcinoma• Papilloma • Squamous cell carcinoma• Chondroma • ChondrosarcomaExceptions: Leukemia, Lymphoma, Glioma,
  28. 28. Grading & Staging of Tumor• Grading – Cellular Differentiation (Microscopic)• Staging – Progression or Spread (clinical)
  29. 29. TNM: Staging of tumor:
  30. 30. Pathways of Spread:• Direct Spread• Body cavities• Blood vessels• Lymphatic vessels• Lungs – Systemic Venous blood• Liver – GIT venous return, nutrition.• Brain – End arteries.
  31. 31. Tumor Diagnosis:• History and Clinical examination• Imaging - X-Ray, US, CT, MRI• Tumor markers Laboratory analysis• Cytology –Pap smear, FNAB• Biopsy - Histopathology, markers.• Molecular Tech – Gene detection.
  32. 32.  NOMENKLATUR Tumor ada 2 komponen dasar: 1. Parenkhim 2. Stroma penunjang parenchyma supporting stroma
  33. 33. Nomenclature of NeoplasiaTumor is named according to:1. Parenchyma, Organ or Cell• Hepatoma- liver• Osteoma- bone• Myoma- muscle
  34. 34. Nomenclature of Neoplasia Tumor is named according to: 2. Pattern and Structure, either GROSS or MICROSCOPIC • Fluid-filled CYST • Glandular ADENO • Finger-like PAPILLO • Stalk POLYP
  35. 35. Nomenclature of NeoplasiaTumor is named according to:3. Embryonic origin• Ectoderm ( usually gives rise to epithelium)• Endoderm (usually gives rise to glands)• Mesoderm (usually gives rise to Connective tissues)
  36. 36. BENIGN TUMORS• Suffix- “OMA” is used• Adipose tissue- LipOMA• Bone- osteOMA• Muscle- myOMA• Blood vessels- angiOMA• Fibrous tissue- fibrOMA
  38. 38. MALIGNANT TUMOR• Named according to embryonic cell origin1. Ectodermal, Endodermal, Glandular, Epithelial• Use the suffix- “CARCINOMA” – Pancreatic AdenoCarcinoma – Squamos cell Carcinoma
  39. 39. MALIGNANT TUMORNamed according to embryonic cell origin2. Mesodermal, connective tissue origin• Use the suffix “SARCOMA – FibroSarcoma – Myosarcoma – AngioSarcoma
  40. 40. EXCEPTS1. “OMA” but Malignant – HepatOMA, lymphOMA, gliOMA, melanOMA2. THREE germ layers – “TERATOMA”3. Non-neoplastic but “OMA” – Choristoma – Hamatoma
  41. 41. Characteristics of NeoplasiaBENIGN• Well-differentiated• Slow growth• Encapsulated• Non-invasive• Does NOT metastasize
  42. 42. Characteristics of NeoplasiaMALIGNANT• Undifferentiated• Erratic and Uncontrolled Growth• Expansive and Invasive• Secretes abnormal proteins• METASTASIZES
  43. 43. PAPILLOMA Papilloma is benign epithelial neoplasmPapilloma of the colon with finger-like projections into the lumen .
  44. 44. Benign tumor:Adenomatous polyp of the colon,A, Gross appearance of several colonic polyps B, This benign glandular tumor(adenoma) is projecting into the colonic lumen and is attached to the mucosa bya distinct stalk
  45. 45. NOMENKLATURII. Lebih dari satu tipe sel neoplastik (Mixed tumor) Contoh: T. Kelenjar liurIII. Lebih satu tipe sel neoplastik dan merupakan derivat dari lebih satu lapisan germinativum (Teratogenous) Sel totipoten dalam gonad/ sisa embrionik berdiferensiasi kulit, otot, lemak, epitel usus, gigi Contoh: Teratoma
  46. 46. Mixed Tumor/ Tumor Kelenjar LiurThis mixed tumor of the parotid gland contains epithelial cells formingducts and myxoid stroma that resembles cartilage
  47. 47. TeratomaGross appearance of an opened cystic teratoma of the ovary. Note thepresence of hair, sebaceous material, and tooth
  48. 48. KARATERISTIK TUMOR JINAK & GANASKriteria membedakan Tumor jinak dan ganas 1. Diferensiasi & Anaplasi 2. Kecepatan Pertumbuhan 3. Invasi Lokal 4. MetastaseDiferensiasi & AnaplasiDiferensiasi menunjukkan seberapa banyak kemiripan sel parenkhimdibanding dengan sel normal (morfologi/ fungsional) Baik Mirip sel matur normal asal jaringan neoplasmaDif. Sedang Jelek/ tidak berdif. Sel primitif/ sel tidak spesifik T. Jinak umumnya berdiferensiasi baik T. Ganas berdiferensiasi jelek
  49. 49. Leiomyoma uteri, benign smooth muscle tumorLeiomyoma of the uterus. This benign, well-differentiated tumorcontains interlacing bundles of neoplastic smooth muscle cellsthat are virtually identical in appearance to normal smoothmuscle cells in the myometrium
  50. 50. Benign tumor of thyroid gland Normal thyroidBenign tumor (adenoma) of the thyroid. Note the normal-looking (well-differentiated), colloid-filled thyroid follicles.
  51. 51. KARATERISTIK TUMOR JINAK & GANASAnaplasi : Neoplasma ganas yang tidak berdiferensiasi Karakteristik : Sel dan inti pleomorfik, Inti hiperkromatik, tumor sel raksasa Gambaran mitosis, T. ganas atipik dan aneh Sel bentuk spindel dengan tripolar, kwadripolar/ multipolarDisplasia : Proliferasi yang tidak beraturan, tetapi bukan neoplasma (pleomorfik, hiperkromatik, mitosis) RinganDisplasia Sedang Berat = Ca. in situ/ Ka. Primitif
  52. 52. Anaplastic tumor of the skeletal muscle (rhabdomyosarcoma).Note the marked cellular and nuclear pleomorphism,hyperchromatic nuclei, and tumor giant cells. Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 11 November 2005 02:05 PM) © 2005 Elsevier
  53. 53. Anaplastic tumor showing cellular and nuclear variation in size and shape.The prominent cell in the center field has an abnormal mitotic tripolarspindle (arrow).
  54. 54. Gambaran skematik lesi prakanker/displasia dan karsinoma in situ pada serviks uteri.I. Displasia Derajat 1 Derajat 2 Derajat 3Sangat Normal I II III IV VRinganII. DisplasiaRinganIII. DisplasiaSedangIV. DisplasiaBerat Membrana basalisV. KarsinomaIn Situ Karsinoma mikroinvasif
  55. 55. Carcinoma In situ• A preinvasive stage of cancer referred to as carcinoma in situ.• Occurs in tumors of the skin, breast, uterine cervix• In situ epithelial cancers display the cytologic features of malignancy (marked nuclear and cellular pleomorphism, and numerous mitotic figures extending toward the surface) without invasion of the basement membrane.
  56. 56. KARATERISTIK TUMOR JINAK & GANASKecepatan PertumbuhanT. Jinak tumbuh lambat, gambaran mitotik : jarang dan normalT. Ganas tumbuh lebih cepat, mitotik: banyak dan abnormalInvasi LokalT. Jinak : biasanya kohesif & ekspansif, massa berbatas tegas karena tidak ada invasi dan infiltrasi ke jaringan normal sekitarnya.T. Ganas : invasi lokal dan infiltrasi ke jaringan normal sekitarnya, kadang-kadang kohesif & ekspansif dan mendesak kedalam struktur sekitarnya yang normal.
  57. 57. FIBROUS CAPSULE in BENIGN TUMOR A. Fibroadenoma of the breast. The tan-colored, encapsulated small tumor is sharply demarcated from the whiter breast tissue. B. Microscopic view of fibroadenoma of the breast. The fibrous capsule (right) delimits the tumor from the surrounding tissue.
  58. 58. LOCAL INVASION A. Cut section of an invasive ductal carcinoma of the breast. The lesion is retracted, infiltrating the surrounding breast substance, and would be stony hard on palpation. B. The microscopic view of the breast carcinoma seen in A illustrates the invasion of breast stroma and fat by nests and cords of tumor cells. Note the absence of a well-defined capsule.
  59. 59. KARATERISTIK TUMOR JINAK & GANASMetastasisMetastasis adalah suatu perpindahan tumor yang terpisahdengan tumor primernya T. ganas. P. DarahKanker invasif penetrasi P. Limfe menyebar ke Organ tubuhCara MetastasisPenyebaran kanker terjadi melalui 1. Langsung rongga tubuh dan permukaan 2. P. Limfe 3. Hematogen
  60. 60. KARATERISTIK TUMOR JINAK & GANASMelalui Rongga Tubuh dan PermukaanTerjadi pada neoplasma ganas yang menembus ke dalamtempat yang terbuka / rongga kavum peritonium, pleura,perikardial, subarachnoid dan rongga sendiContoh: Ka. Ovarium pseudomiksoma peritoneiMelalui Pembuluh LimfeTransportasi melalui limfatik cara utama penyebarankarsinoma.Contoh: Ka. MammaePenyebaran HematogenCara ini spesifik untuk sarkoma.Arteri dengan dinding lebih tebal kurang cepat penetrasi daripada vena
  61. 61. Metastasis Liver metastatic cancer from pancreatic adenocarcinoma
  62. 62. Comparison between a benign tumor of the myometrium (leiomyoma)and a malignant tumor of similar origin (leiomyosarcoma).
  63. 63.  Benign and Malignant TumorCharacteristic Benign MalignantDifferentiation Well differentiation, structure Lack of differentiation/ may be typical of tissue origin anaplasia Structure is often atypicalRate of growth Usually progressive and slow Erratic, may be slow to growth, rapid, Mitotic figures are rare and Abnormal and normal Numerous mitotic figureLocal invasion Usually well demarcated and Locally invasive, no infiltration to the infiltration to the surrounding tissue surrounding tissueMetastasis Absent Frequently present
  64. 64. TERIMA KASIH