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Neoplasia - Patholgy

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Neoplasia
Dr. Ananda Dyuti Heera
Khulna Medical College

Published in: Health & Medicine
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Neoplasia - Patholgy

  1. 1. Neoplasia Dr. Ananda Dyuti Hira MBBS; M.Phil(Path)
  2. 2. Neoplasia means “new growth” and a new growth is called a neoplasm. Oncology (Greek oncos = tumor) is the study of tumors or neoplasms.
  3. 3. According to British eminent Oncologist, Sir Rupert Willis “A neoplasm is an abnormal mass of tissue, the growth of which exceeds and is uncoordinated with that of the normal tissues and persists in the same excessive manner after cessation of the stimuli which evoked the change”.
  4. 4. Classification of tumor Tumor may be classified as- 1) Naked eye appearance 2) Histogenetic(including embryological considerations) 3) Histological 4) Behavioural 5) Aetiological 6) Functional
  5. 5. • Naked eye appearance- -Annular -Fungating(cauliflower) -Schirrhous(hard due tolarge amounts of fibrous tissue)
  6. 6. • Histogenetic classification- 1) Tumors of epithelial origin(e.g squamous cell papilloma) 2) Tumors of connective tissue origin(fibroma, Lipoma)
  7. 7. • Carcinoma- Malignant tumor of epithelial origin.(e.g squamous cell carcinoma, adenocarcinoma). • Sarcoma-Malignant tumor of connective tissue origin(e.g Fibrosarcoma, liposarcoma, chodrosarcoma)
  8. 8. Histological classification- 1) Well differentiated 2) Moderately differentiated 3) Poorly differentiated 4) Undifferentiated
  9. 9. Behavioural classification 1) Benign tumor(papilloma, adenoma, fibroma, lipoma, osteoma, chondroma, leiomyoma). 2) Malignant tumor(papillary carcinoma, adenocarcinoma, fibrosarcoma, liposarcoma, osteosarcoma, chondrosarcoma, leiomyosarcoma). 3) Tumors of intermediate malignancy/locally malignant tumor
  10. 10. 4) Latent cancer 5) Dormant cancer 6) Carcinoma in situ 7) Spontaneous regressions
  11. 11. Benign tumor • A tumor is said to be benign when its microscopic and gross characteristics are considered relatively innocent, implying that it will remain localized, it cannot spread to other sites, and it is generally amenable to local surgical removal; the patient generally survives.
  12. 12. e.g papilloma, adenoma, fibroma, lipoma, osteoma, chondroma, leiomyoma. Adenoma : Benign epithelial neoplasm derived from glands, although they may or may not form glandular structures.
  13. 13. Malignant tumors are collectively referred to as cancers, derived from the Latin word for crab, because they adhere to any part that they seize on in an obstinate manner, similar to a crab. Malignant, as applied to a neoplasm, implies that the lesion can invade and destroy adjacent structures and spread to distant sites (metastasize) to cause death. Not all cancers pursue so deadly a course. Some are discovered early and are treated successfully, but the designation malignant always raises a red flag.
  14. 14. Locally malignant tumor/ tumors of intermediate malignancy These tumors do not fit either into benign/ malignant group. These are locally invasive tumor but show little/ no tendency to metastasize. e.g Basal cell carcinoma, Ameloblastoma, carcinoid tumor, Giant cell tumor, pleomorphic tumor of salivary gland.
  15. 15. • Carcinoma in situ- preinvasive proliferation of the epithelium that has cytological features of malignancy.
  16. 16. • Spontaneous regressions- malignant melanoma, clear cell carcinoma of kidney, neuroblastoma, choriocarcinoma.
  17. 17. • All tumors, benign and malignant, have two basic components: (1) clonal neoplastic cells that constitute their parenchyma and (2) reactive stroma made up of connective tissue, blood vessels, and variable numbers of macrophages and lymphocytes.
  18. 18. • Mixed tumor- more than one neoplastic cell usually derived from one germ layer. e.g.Pleomorphic adenoma of salivary gland, fibroadenoma of breast.
  19. 19. Teratoma, which contains recognizable mature or immature cells or tissues representative of more than one germ cell layer and sometimes all three. Originate from totipotential cells. Such cells have the capacity to differentiate into any of the cell types found in the adult body. Benign (mature) teratoma : When all the component parts are well differentiated,  Malignant teratoma: It is when less well differentiated, it is an immature, potentially or overtly.
  20. 20. FIGURE: A, Gross appearance of an opened cystic teratoma of the ovary. Note the presence of hair, sebaceous material, and tooth. B, A microscopic view of a similar tumor shows skin, sebaceous glands, fat cells, and a tract of neural tissue (arrow).
  21. 21. Characteristics of Benign & Malignant Neoplasms  DIFFERENTIATION AND ANAPLASIA  Differentiation: Extent to which neoplastic parenchymal cells resemble the corresponding normal parenchymal cells, both morphologically and functionally.  Anaplasia: Lack of differentiation. Pleomorphism - variation in size and shape. Abnormal nuclear morphology -the nuclei contain abundant chromatin and are dark staining (hyperchromatic). - Nuclear-to-cytoplasm ratio may approach 1 : 1 instead of the normal 1 : 4 or 1 : 6.
  22. 22. Nuclear shape is variable and often irregular, and the chromatin is often coarsely clumped and distributed along the nuclear membrane. - Large nucleoli are usually present in these nuclei. - Mitoses - large numbers of mitoses, reflecting the higher proliferative activity of the parenchymal cells,atypical, bizarre mitotic figures, sometimes producing tripolar, quadripolar, or multipolar spindles.
  23. 23. • - Loss of polarity- Sheets or large masses of tumor cells grow in an anarchic, disorganized fashion. • - Other changes- formation of tumor giant cells, some possessing only a single huge polymorphic nucleus and others having two or more large, hyperchromatic nuclei.
  24. 24. FIGURE : Anaplastic tumor of the skeletal muscle (rhabdomyosarcoma). Note the marked cellular and nuclear pleomorphism, hyperchromatic nuclei, and tumor giant cells). Note thpleomorphis nuclei, and tumor giant cells.
  25. 25. FIGURE : Anaplastic tumor showing cellular and nuclear variation in size and shape. The prominent cell in the center field has an abnormal tripolar spindle.
  26. 26. Comparisons between Benign and Malignant Tumors • Local invasion • Metastasis Differentiation / anaplasia Rate of growth
  27. 27. • METASTASIS - Metastases are tumor implants discontinuous with the primary tumor.
  28. 28.  Pathways of Spread Dissemination of cancers may occur through one of three pathways: (1) direct seeding of body cavities or surfaces, Sometimes mucus-secreting appendiceal carcinomas fill the peritoneal cavity with a gelatinous neoplastic mass referred to as pseudomyxoma peritonei. (2) lymphatic spread,- most common pathway for the initial dissemination of carcinomas. (3) hematogenous spread - Typical of sarcomas but is also seen with carcinomas. liver and lungs are most frequently involved in such hematogenous dissemination.
  29. 29. Skip metastasis : Local lymph nodes, however, may be bypassed because of venous- lymphatic anastomoses or because inflammation or radiation has obliterated lymphatic channels. Sentinel lymph node : The first node in a regional lymphatic basin that receives lymph flow from the primary tumor.
  30. 30. • Oncogenes: Genes that promote autonomous cell growth in cancer cells. • Proto-oncogenes: Unmutated cellular counterparts
  31. 31. Carcinogenic Agents & Their Cellular Interactions • Major Chemical Carcinogens • DIRECT-ACTING CARCINOGENS • Alkylating Agents • β-Propiolactone • Dimethyl sulfate • Diepoxybutane • Anticancer drugs (cyclophosphamide, chlorambucil, nitrosoureas, and others • Acylating Agents • 1-Acetyl-imidazole • Dimethylcarbamyl chloride
  32. 32. • Polycyclic and Heterocyclic Aromatic Hydrocarbons • Benz[a]anthracene • Benzo[a]pyrene • Dibenz[a,h]anthracene • 3-Methylcholanthrene • 7,12-Dimethylbenz[a]anthracene • Aromatic Amines, Amides, Azo Dyes • 2-Naphthylamine (β-naphthylamine) • Benzidine • 2-Acetylaminofluorene • Dimethylaminoazobenzene (butter yellow)
  33. 33. • RADIATION CARCINOGENESIS
  34. 34. MICROBIAL CARCINOGENESIS Oncogenic RNA Viruses Human T-Cell Leukemia Virus Type 1 HTLV-1 causes a form of T-cell leukemia/lymphoma Oncogenic DNA Viruses Human Papilloma virus Epstein-Barr Virus Hepatitis B and C Viruses Helicobacter pylori
  35. 35. Precancerous Conditions • Certain non-neoplastic disorders have a well- defined association with cancer that they have been termed precancerous conditions. chronic atrophic gastritis of pernicious anemia, solar keratosis of the skin, chronic ulcerative colitis, and leukoplakia of the oral cavity, vulva, and penis
  36. 36. Clinical Aspects of Neoplasia • Local and Hormonal Effects • Cancer Cachexia • Paraneoplastic Syndromes
  37. 37. Paraneoplastic Syndromes • Paraneoplastic syndromes: Symptom complexes in cancer-bearing individuals that cannot readily be explained, either by the local or distant spread of the tumor or by the elaboration of hormones indigenous to the tissue from which the tumor arose.
  38. 38. • Important to recognize, for several reasons: • They may represent the earliest manifestation of an occult neoplasm. • In affected patients they may represent significant clinical problems and may even be lethal. • They may mimic metastatic disease and therefore confound treatment.
  39. 39. Cushing syndrome Small-cell carcinoma of lung Pancreatic carcinoma Neural tumors ACTH or ACTH-like substance Syndrome of inappropriate antidiuretic hormone secretion Small-cell carcinoma of lung; intracranial neoplasms Antidiuretic hormone or atrial natriuretic hormones Hypercalcemia Squamous cell carcinoma of lung Breast carcinoma Renal carcinoma Parathyroid hormone related protein (PTHRP), TGF-α, TNF, IL-1
  40. 40. • The major staging system currently in use is the American Joint Committee on Cancer Staging. This system uses a classification called the TNM system. T for primary tumor, N for regional lymph node involvement, and M for metastases.
  41. 41. LABORATORY DIAGNOSIS OF CANCER 1) Histological examination: Biopsy: A mass or piece of tissue is removed from the diseased organ for histopathological examination. Biopsy are several types- Excisional biopsy, Incisional Biopsy, Punch Biopsy, core needle biopsy, Wedge biopsy, Ultrasound/ CT guided Biopsy
  42. 42. 2) Cytological examination: FNAC(Fine needle aspiration cytology), Exfoliative cytology, Abrasion cytology. 3) New techniques: a) Tumor markers, Immunocytochemistry, Molecular diagnosis- Southern blot- to detect DNA, Northern blot-to detect RNA, Polymerase chain reaction, FISH, Flow cytometry
  43. 43. Tumor Markers Tumor markers are biochemical indicators of the presence of a tumor. The include cell- surface antigens, cytoplasmic proteins, enzymes and hormones.
  44. 44. Importance/ utility of tumor marker 1) As a laboratory test to support the diagnosis. 2) In determining the response to therapy. 3) In indicating relapse during the follow up period.
  45. 45. Selected Tumor Markers Human chorionic gonadotropin Trophoblastic tumors, nonseminomatous testicular tumors Calcitonin Medullary carcinoma of thyroid Catecholamine and metabolites Pheochromocytoma and related tumors ONCOFETAL ANTIGENS α-Fetoprotein Liver cell cancer, nonseminomatous germ
  46. 46. ISOENZYMES Prostatic acid phosphatase Prostate cancer Neuron-specific enolase Small-cell cancer of lung, neuroblastoma SPECIFIC PROTEINS Immunoglobulins Multiple myeloma and other gammopathies Prostate-specific antigen and prostate-specific membrane antigen Prostate cancer
  47. 47. MUCINS AND OTHER GLYCOPROTEINS CA-125 Ovarian cancer CA-19-9 Colon cancer, pancreatic cancer CA-15-3 Breast cancer NEW MOLECULAR MARKERS p53, APC, RAS mutants in stool and serum Colon cancer p53 and RAS mutants in stool and serum Pancreatic cancer p53 and RAS mutants in sputum and serum Lung cancer

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