Chapter 7 (Neoplasia) from Robbins and Cotran Pathologic Basis of Disease (9th Edition) for MBBS 2nd Year. After going through this presentation, it will be easy to understand Neoplasia from Robbins.

1. NEOPLASIA -
INTRODUCTION
Nida Us Sahr
MBBS 2nd Year
Chhattisgarh Institute of Medical
Sciences (CIMS), Bilaspur

2. INTRODUCTION
• In the United States, MCC of death – CVS Diseases.
• 2nd MCC of death – Cancer
• The mortality rate of cancer is painful to know, but
along with that it brings physical, mental and
emotional suffering too.
• There is no particular “single cure” for cancer
because:-
Each case has a wide variety of histories
Every case responds to different treatment modalities.
It is a multifactorial disease

3. • Different cancers have different curability, for e.g.,
Hodgkin’s Lymphomas are almost always curable,
whereas pancreatic adenocarcinomas are fatal most of
the time.
• Learning about the causes, molecular basis and
pathogenesis has helped humankind in making great
strides towards the treatment of cancer.
• Number of cancer cases in the United States has
markedly reduced in the 20th and 21st Centuries.

4. NOMENCLATURE
• Tumour – A cardinal sign of inflammation OR the
swelling caused by inflammation.
Earlier, the word ‘Tumour’ was used in relation to
inflammation, but this usage has become obsolete
nowadays.
But now it is used synonymously with neoplasm.
• Neoplasia – Literally means “new growth” {neo
= new; plasia = growth}. It is the phenomenon of
uncontrolled and abnormal growth of cells or
tissues of the body.

5. • Neoplasm – The abnormal (uncontrolled, irreversible,
monoclonal ) growth as a result of neoplasia is called a
neoplasm.
The eminent British oncologist, Dr. Willis, gave a close-to-
accurate definition of a neoplasm. According to him, a
neoplasm :-
 Is an abnormal mass of tissue.
Its growth exceeds that of the normal tissue.
Its growth is not in coordination with the normal tissue.
Its growth persists even after the cessation (stoppage) of
the stimuli that evoked the change (i.e. the abnormal
growth).

6. In the modern era, a neoplasm can be defined as :-
A disorder of cell growth
Triggered by a series of acquired mutations
Affecting a single cell and its clonal progeny.
These mutations give the neoplastic cells an added
advantage for growth and survival.
Which results in excessive autonomous proliferation, i.e.
independent of physiologic growth signals.
• Oncology (Greek “oncos” = tumour; “logos” = study) : It
is the study of tumours/neoplasms.

7. STRUCTURE OF A TUMOUR/NEOPLASM

9. PARENCHYMA
• Consists of the neoplastic
cells.
• Classification of tumours
and their biologic behaviour
is based on parenchyma.
• The neoplasm with more
parenchyma and scant
connective tissue is soft and
fleshy.
REACTIVE STROMA
• Consists of connective tissue,
blood vessels and variable
number of cells of the
adaptive and innate immune
system.
• Growth and spread of a
tumour largely depends on its
stroma.
• There are some tumours
where parenchyma stimulates
the formation of abundant
collagenous stroma. This is
called desmoplasia.
Desmoplastic tumours are
stony hard.

10. CLINICAL HISTORY
A 48 year old woman
presented with a painless
lump in the breast. Radical
mastectomy was performed
PATHOLOGY
Slice through a female breast
showing a large, rounded,
poorly demarcated yellowish
lesion of approximately 5*7
cm and engaging in the
nipple which is retracted.
Scirrhous Carcinoma of the
Breast (example of desmoplasia)
Source : Monash University; Museum of Pathology

12. NOMENCLATURE OF BENIGN
TUMOURS
• Definition – A tumour is said to be benign when
Its gross and microscopic appearances are more
or less similar to the original ones,
It does not show propensity of spreading to other
sites (remains local),
It can be removed by local surgery without
hassles.
• Chances of survival of patient are bright.
• Benign tumours can cause significant morbidity
and can sometimes be fatal too.

13. • Suffix –oma is used along with the name of
cell type from which the tumour has
originated, for the nomenclature of benign
mesenchymal tumours. For e.g., chondroma
(benign cartilagenous tumour).
• For benign epithelial tumours, suffix –oma is
used, but the choice of root word depends on
cell of origin or microscopic pattern or
macroscopic appearance.

14. • Adenoma
Benign epithelial neoplasms
Have glandular origin or glandular characteristics
or both.
May or may not form glandular structures
E.g., renal tubular adenoma – arises from epithelial
cells of renal tubules, arranged in the form of a
gland
Adrenal adenoma – heterogeneous mass of adrenal
cortical cells growing as a solid sheet

15. This image shows a solid,
homogeneous, yellow-orange
adenoma of the adrenal cortex in
a 25-year-old female with Cushing
syndrome. Note the rim of
uninvolved cortex to the right and
left of the tumour mass.
Adenomas are usually small,
solitary and encapsulated
tumours. They rarely exceed 5 cm
in size or 50 g in weight.
Adrenal cortical adenomas may be
discovered
 Incidentally during autopsy
 During imaging studies
performed for other reasons
 In case of hormonal
dysfunction
Image copyright : pathorama.ch

16. • Papilloma
Benign epithelial neoplasm
Has finger-like projections either in
microscopic structure or macroscopic
appearance
ORAL SQUAMOUS
PAPILLOMA
The image shows a few
papillary projections
lined by keratinizing
stratified squamous
epithelium around
fibrovascular cores.

17. • Cystadenomas
Large cystic masses, benign epithelial tumours.
Picture shows mucinous cystadenoma of the ovary. A
large multiloculated cystic tumour with smooth inner
walls that are coated with viscous mucoid material.
Image courtesy:
Dr.Jean-Christophe
Fournet, Paris, France
humpath.com

18. • Papillary cystadenomas
When a tumour protrudes into cystic spaces by
producing papillary patterns.
For e.g.,papillary cystadenoma of epididymis.
It accounts for 35% of all primary epididymal neoplasms.
About 40% are bilateral and these cases are usually seen
in the setting of von Hippel-Lindau syndrome. Molecular
studies have shown allelic deletion of VHL gene in
papillary cystadenoma of epididymis and related lesions.
The tumour consists of dilated ducts containing papillary
structures lined by cuboidal or columnar epithelium. The
cells have clear to lightly eosinophilic cytoplasm.
Shen T, et al. Int J Surg Pathol 2000 Jul;8(3):207-212
Image copyright : pathorama.ch

20. • Polyp – When a neoplasm, benign or
malignant, produces a macroscopically visible
projection above a mucosal surface and
projects into a lumen, like the gastric or
colonic lumen, it is called a polyp. If it has
glandular tissue, it is called ADENOMATOUS
POLYP.

21. Colonic polyp. A, An aedonmatous (glandular) polyp is projecting into the colonic lumen
and is attached to the mucosa by a distinct stalk. B, Gross
appearance of several colonic polyps.

22. NOMENCLATURE OF MALIGNANT TUMOURS
• Called cancers (Latin = crab) because they
adhere to any part they can seize on, in an
obstinate manner.
• Definition – These are the tumours that can
invade and destroy adjacent structures and
spread to distant sites (metastasize) to cause
death.
• Malignant tumours do not always cause
death, if discovered and treated on time.

23. SARCOMA
• Arise in solid mesenchymal
tumours.
CARCINOMA
• Arise from epithelial cells,
any three of the germ layers
LYMPHOMA/LEUKAEMIA
Arise from blood
forming cells

25. NOMENCLATURE OF MIXED TUMOURS
• Definition – A mixed tumour is one where
Cells of parenchyma do not resemble each other
closely,
There occurs divergent differentiation of a single
neoplastic clone
The cells arise from a
single germ layer (in fact,
majority of neoplasms
arise from a single germ
layer).

26. • Pleomorphic adenoma – It is the mixed tumour of
salivary gland, benign in nature. The elements of
this arise from a single clone capable of producing
both epithelial and myoepithelial cells.
• Teratoma – A mixed tumour, where recognizable
mature and/or immature cells or tissues
belonging to different germ layers are present. It
originates from the totipotent germ cells normally
present in the testis or ovary or in abnormal
midline embryonic rests. E.g., ovarian cystic
teratoma (dermoid cyst).

28. • Hamartoma – Disorganized, benign masses
composed of cells indigenous to the original site,
i.e. abnormal mass in normal location.
According to recent developments, somatic
mutations cause clonal chromosomal aberrations
and because of this, hamartoma is considered a
neoplasm.
• Choriostoma – Heterotopic rest of cells, i.e.
normal tissue in abnormal location.
This is not a true neoplasm.

29. MALIGNANCIES WITH SUFFIX -OMA
• These neoplasms sound benign by their name,
but they are malignant.
• They are :-
Lymphoma
Melanoma
Mesothelioma
Seminoma
Meningioma is a benign tumour, whereas
INVASIVE MENINGIOMA is a MALIGNANT tumour.
Mature teratoma is benign, while IMMATURE
TERATOMA is MALIGNANT.