This document discusses the characteristics of benign and malignant neoplasms. It describes how malignant tumors are less differentiated, grow faster, are more locally invasive, and can metastasize to other parts of the body compared to benign tumors. The document also discusses epidemiological factors that affect cancer incidence such as geographic location, age, heredity, and preexisting conditions. Common cancer types and causes of cancer death worldwide are also presented.

1. Neoplasia 2Neoplasia 2
By Suraj DharaBy Suraj Dhara
(MMCH)(MMCH)
CHARACTERISTICS OF BENIGN AND MALIGNANT NEOPLASMS
EPIDEMIOLOGY
CHARACTERISTICS OF BENIGN AND MALIGNANT NEOPLASMS
EPIDEMIOLOGY

2. ObjectivesObjectives
 Compare and contrast benign and malignant tumors with respect to:
 demarcation from surrounding tissue (capsule, local invasiveness.
 rate of growth
 degree of differentiation (Explain the meaning of differentiation).
 distant spread (metastases).
 Describe the morphologic changes associated with poorly differentiated
tumors; define and understand the usage of the terms anaplasia,
pleomorphism, nuclear atypia, abnormal mitoses and tumor giant cells.
 Understand the clinical significance of invasiveness and metastasis.
 Describe the anatomic pathways utilized by tumors in metastatic
spread. Know which pathways are commonly used by carcinomas
versus sarcomas.
 List some common sites of distant metastases.
 Recognize the epidemiologic data of cancer distribution in regard to
age, race, geographic factors, and genetic backgrounds.
 List some inherited syndromes with a genetic predisposition to cancer.

3. NeoplasiaNeoplasia
Characteristics of benign and malignant
neoplasms
 Differentiation and anaplasia
 Rate of growth
 Local invasion
 Metastasis

4. NeoplasiaNeoplasia
1.1. Differentiation and anaplasia:Differentiation and anaplasia:
 Differentiation means : the extent to which
the parenchymal cells of the tumor
resemble their normal counterparts
morphologically and functionally

5. NeoplasiaNeoplasia
 well differentiated = closely resemble their
normal counterparts
 Moderately differentiated
 Poorly differentiated
 Undifferentiated ( Anaplasia )

6. NeoplasiaNeoplasia
 Benign tumors = well differentiated
 Malignant tumors =
well differentiated -----> anaplastic

7. Well differentiated squamous cell CA of skin. The tumor cells are strikingly similar to normal
squamous epithelial cells, with intercellular bridges & nests of keratin pearls (arrow)

8. Pleomorphic tumor of the skeletal muscle (rhabdomyosarcoma). Note the marked cellular & nuclear
pleomorphism, hyperchromatic nuclei & tumor giant cells.

9. Anaplastic tumor showing cellular and nuclear variation in size & shape. The prominent cell showing
atypical mitotic figure (arrow).

10. NeoplasiaNeoplasia
 In the histological examination of a tumor
you should look for :
 Pleomorphism : variation in size
 High nuclear/ cytoplasm ratio ( N/C ratio)
 Hyperchromasia ( dark cell )
 Mitosis ….(abnormal one)

11. NeoplasiaNeoplasia
Characteristics of benign and malignant neoplasmsCharacteristics of benign and malignant neoplasms
 Differentiation and anaplasiaDifferentiation and anaplasia
 Rate of growthRate of growth
 Local invasionLocal invasion
 MetastasisMetastasis

12. NeoplasiaNeoplasia
 Rate of growth:Rate of growth:
 Benign tumors:
 grows slowly
 are affected by blood supply, hormonal effects , location
 Malignant tumors :
 grows faster
 Correlate with the level of differentiation

13. NeoplasiaNeoplasia
Characteristics of benign and malignant neoplasmsCharacteristics of benign and malignant neoplasms
 Differentiation and anaplasiaDifferentiation and anaplasia
 Rate of growthRate of growth
 Local invasionLocal invasion
 MetastasisMetastasis

14. NeoplasiaNeoplasia
 Local invasion :Local invasion :
 Benign tumors :
 Remain localized
 Cannot invade
 Usually capsulated
 Malignant tumors :
 Progressive invasion
 Destruction
 Usually not capsulated

15. Fibroadenoma of the breast. The tan coloured encapsulated small tumor is sharply demarcated from
the whitish breast tissue.

16. Microscopic view of fibroadenoma of the breast.

17. Cut section of an invasive ductal CA of breast. The lesion is restricted, infiltrating the surrounding
breast substance, and would be stony hard on palpation.

18. NeoplasiaNeoplasia
Characteristics of benign and malignant neoplasmsCharacteristics of benign and malignant neoplasms
 Differentiation and anaplasiaDifferentiation and anaplasia
 Rate of growthRate of growth
 Local invasionLocal invasion
 MetastasisMetastasis

19. NeoplasiaNeoplasia
 Metastasis :Metastasis :
 Definition : the development of secondary
implants discontinuous with the primary tumor,
possibly in remote tissues

20. A liver studded with metastatic growth.

21. NeoplasiaNeoplasia
 Metastasis :Metastasis :
 Cancers have different ability to metastasize
 Approximately 30% patients present with
clinically evident metastases.
 Generally, the more anaplastic and the larger the
primary tumor, the more likely is metastasis

22. NeoplasiaNeoplasia
 Metastasis : three pathwaysMetastasis : three pathways
 Lymphatic spread :
 Hematogenous spread :
 Seeding of the body cavities: pleural, peritoneal
cavities and cerebral ventricles

23. NeoplasiaNeoplasia
 LymphaticLymphatic spread :spread :
 Favored by carcinomas
 Breast carcinoma  axillary lymph nodes
 Lung carcinomas  bronchial lymph nodes

24. NeoplasiaNeoplasia
 HematogenousHematogenous spread :spread :
 Favored by sarcomas
 Also used by carcinomas
 Veins are more commonly invaded
 The liver and lungs are the most frequently
involved secondary sites

25. Comparison between a benign tumor (leiomyoma) and a malignant tumor (leiomyosarcoma) of the
same origin.

26. NeoplasiaNeoplasia
 In the histological examination of a tumor youIn the histological examination of a tumor you
should look for :should look for :
 Pleomorphism : variation in size
 High nuclear/ cytoplasm ratio ( N/C ratio)
 Hyperchromasia ( dark cell )
 Mitosis ….abnormal one

27. NeoplasiaNeoplasia
 Dysplasia :Dysplasia :
 Definition: a loss in the uniformity of the individual
cells and a loss in their architectural orientation.
 Non-neoplastic
 Occurs mainly in the epithelium
 Dysplastic cells shows a degree of : pleomorphism,
hyperchromasia, increased mitosis and loss of
polarity.

28. NeoplasiaNeoplasia
 Dysplasia does not mean cancer
 Dyplasia does not necessarily progress to
cancer
 Dysplasia may be reversible
 If dysplastic changes involve the entire
thickness of the epithelium it is called :
CARCINOMA IN-SITU

29. What’s that ??

30. NeoplasiaNeoplasia
 Carcinoma in-situCarcinoma in-situ
 Definition: an intraepithelial malignancy in
which malignant cells involve the entire
thickness of the epithelium without penetration
of the basement membrane.
 Applicable only to epithelial neoplasms.

31. Carcinoma in situ
Low power view shows that epithelium is
entirely replaced by atypical cells. There is no
orderly differentiation of squamous cells. The
basement membrane is intact, & no tumor in
the sub-epithelial stroma.
Carcinoma in situ
High power view of another region shows
failure of normal differentiation, marked nuclear
& cellular pleomorphism, and numerous mitotic
figures extending toward surface.

33. Dysplasia Features:Dysplasia Features:
 Increased rate of
multiplication.
 Disordered
maturation.
• Nuclear abnormality
– Increased N/C ratio
– Irregular nuclear membrane
– Increased chromatin content
• Cytoplasmic abnormalities due
to failure of normal maturation

34. DysplasiaDysplasia
Uterine cervixUterine cervix
Mild Dysplasia
Sever Dysplasia

35. Dysplasia (cervical pap smear)Dysplasia (cervical pap smear)

36. DysplasiaDysplasia
 Clinical significance:Clinical significance:
 It is a premalignant condition.
 The risk of invasive cancer varies with:
 grade of dysplasia (mild, moderate, sever)
 duration of dysplasia
 site of dysplasia

37. DysplasiaDysplasia
 Differences between dysplasia and cancer.Differences between dysplasia and cancer.
∗∗lack of invasiveness.lack of invasiveness.
∗∗ReversibilityReversibility

38. Carcinoma in situCarcinoma in situ
 A true neoplasm with all of the features of
malignant neoplasm except invasiveness
 Displays the cytological features of
malignancy without invasion of the
basement membrane.

39. Squamous cell CarcinomaSquamous cell Carcinoma
Uterine CervixUterine Cervix
Dysplasia

40. NeoplasiaNeoplasia
 EpidemiologyEpidemiology
 Will help to discover aetiology
 Planning of preventive measures
 To know what is common and what is rare.
 Development of screening methods for early
diagnosis

43. Cancer is a leading cause of death worldwide, accounting for an
estimated 9.6 million deaths in 2018.
The most common cancers are:
Lung (2.09 million cases)
Breast (2.09 million cases)
Colorectal (1.80 million cases)
Prostate (1.28 million cases)
Skin cancer (non-melanoma) (1.04 million cases)
Stomach (1.03 million cases)
The most common causes of cancer death are cancers of:
Lung (1.76 million deaths)
Colorectal (862 000 deaths)
Stomach (783 000 deaths)
Liver (782 000 deaths)
Breast (627 000 deaths)
Always check the updates …
https://www.who.int/news-room/fact-sheets/detail/cancer

44. NeoplasiaNeoplasia
 Factors affecting incidence of cancerFactors affecting incidence of cancer
 Geographic and Environmental
 Age
 Heredity
 Aquired preneoplastic disorders

45. NeoplasiaNeoplasia
 Factors affecting incidence of cancerFactors affecting incidence of cancer
 Geographic and EnvironmentalGeographic and Environmental
 AgeAge
 HeredityHeredity
 Aquired preneoplastic disordersAquired preneoplastic disorders

46. NeoplasiaNeoplasia
 Geographic and Environmental factors:Geographic and Environmental factors:
 Rate of stomach carcinoma in Japan is seven
times the rate in North America and Europe.
 Breast carcinoma is five times higher in North
America comparing to Japan
 Liver cell carcinoma is more common in African
populations

48. NeoplasiaNeoplasia
 Geographic andGeographic and EnvironmentalEnvironmental factors:factors:
 Asbestos : mesothelioma
 Smoking : lung cancer
 Multiple sexual partners: cervical cancer
 Fatty diets : colonic cancer
Please see table for occupational cancers (Robbins)Please see table for occupational cancers (Robbins)
Table No. is not given as the edition of book will keepTable No. is not given as the edition of book will keep
on changing.on changing.

49. NeoplasiaNeoplasia
 Factors affecting incidence of cancerFactors affecting incidence of cancer
 Geographic and Environmental
 Age
 Heredity
 Aquired preneoplastic disorders

50. NeoplasiaNeoplasia
 Age:Age:
 Generally, the frequency of cancer increases with
age.
 Most cancer mortality occurs between 55 and 75.
 Cancer mortality is also increased during
childhood
 Most common tumors of children: Leukemia,
tumors of CNS, Lymphomas, soft tissue and bone
sarcomas.

51. NeoplasiaNeoplasia
 Factors affecting incidence of cancerFactors affecting incidence of cancer
 Geographic and Environmental
 Age
 Heredity
 Aquired preneoplastic disorders

52. NeoplasiaNeoplasia
 HeredityHeredity
 Autosomal dominant cancer syndromes
 Autosomal Recessive Syndromes of Defective
DNA Repair
 Familial Cancers of Uncertain Inheritance

53. HeredityHeredity
 Autosomal dominant cancer syndromesAutosomal dominant cancer syndromes
 Inheritance of a single mutant gene greatly
increases the risk of developing neoplasm
 E.g. Retinoblastoma in children :
 40% of Retinoblastomas are familial
 carriers of the gene have 10000 fold increase in the
risk of developing Retinoblastoma
 E.g. multiple endocrine neoplasia
 See table for more example (Robbins)

54. HeredityHeredity
 Autosomal Recessive Syndromes of DefectiveAutosomal Recessive Syndromes of Defective
DNA RepairDNA Repair ::
 Small group of autosomal recessive disorders
 Characterized by DNA instability
 E.g. xeroderma pigmentosum

55. HeredityHeredity
 Familial Cancers of Uncertain InheritanceFamilial Cancers of Uncertain Inheritance
 All common types of cancers occur in familial
form
 E.g. breast, colon, ovary, brain
 Familial cancers usually have unique features:
 Start at early age
 Multiple or bilateral
 Two or more relatives

56. NeoplasiaNeoplasia
 Factors affecting incidence of cancerFactors affecting incidence of cancer
 Geographic and Environmental
 Age
 Heredity
 Aquired preneoplastic disorders

57. NeoplasiaNeoplasia
 Aquired preneoplastic disorders:Aquired preneoplastic disorders: SomeSome
Clinical conditions that predispose to cancerClinical conditions that predispose to cancer
 Dysplastic bronchial mucosa in smokers lung
carcinoma
 Liver cirrhosis  liver cell carcinoma
 Margins of chronic skin fistula  squamous cell
carcinoma

58. THANK YOUTHANK YOU