neoplasia...robbins & cotran pathologic basis of disease- th9 edition images- above mentioned...
TRANSCRIPT
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4/6/2020 Tamanna Choudhury 1
Professor Tamanna Choudhury
HOD, Pathology
MCWH
NEOPLASIA
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Tamanna Choudhury
2
References:
Robbins & Cotran Pathologic Basis
of Disease- 9th edition
IMAGES- Above mentioned book &
internet
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Nomenclature
NEOPLASIA
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Nomenclature means choosing of names for
things, especially in science or other discipline
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NEOPLASIA
• Neoplasia literally means “new growth”
• A new growth is called a neoplasm
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Nomenclature
TUMOUR = NEOPLASM
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ONCOLOGY (Greek oncos = tumor)
is the study of tumors or neoplasms
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Definition
The eminent British oncologist Sir Rupert Willis
defined neoplasm as
"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."
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Nomenclature
Basic Components All tumors, benign and malignant
2 basic components
(1) Parenchyma proliferating neoplastic cells
(2) Stroma made up of connective tissue and
blood vessels
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Nomenclature
Basic Components 4/6/2020 Tamanna Choudhury 8
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Nomenclature
Basic Components
Soft and fleshy when supporting connective
tissue is scant
Desmoplasia the parenchymal cells stimulate
the formation of an abundant collagenous
stroma
Scirrhous some desmoplastic tumors—are
stony hard or (for example, some cancers of
the female breast)
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Desmoplasia
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Nomenclature
Neoplasm
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Benign Malignant
Carcinoma Sarcoma
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BENIGN TUMOURS
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Benign tumour
Innocent (gross µscopic)
Localized
Amenable (responsive) to local surgical resection
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Patient usually survives
May cause significant morbidity (a
diseased state or symptom)
Rarely fatal
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Nomenclature-Benign
tumours
• Benign tumors are designated by the suffix -oma to the cell of origin
• Tumors of mesenchymal cells generally follow this rule
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Mesenchyme - connective and skeletal tissues,
including blood and lymph (fibroblasts, myoblasts,
endothelium, mesothelium, osteoblasts,
chondroblasts, adipocytes)
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Nomenclature-Benign
tumours
For example,
a benign tumour of smooth muscle is called a leiomyoma
a benign tumor arising from fibroblastic cells is called a fibroma,
a benign cartilaginous tumor is a chondroma
a benign tumor of osteoblasts is an osteoma
a benign tumour of mature fat cells is a lipoma
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Leiomyoma of uterus
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Nomenclature-Benign tumours
Leiomyoma -gross Leiomyoma - microscopic
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Nomenclature
Some exceptions are
Oma but NOT BENIGN
Lymphoma
Seminoma
Dysgerminoma
Mesothelioma
Melanoma
All blastomas
(hepatoblastoma,neuroblastoma,nephroblastoma)
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Nomenclature-Benign
tumours
• In contrast, nomenclature of benign epithelial tumors is more complex
• They are variously classified
cells of origin,
microscopic architecture, and
macroscopic patterns.
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Nomenclature-Benign
epithelial tumours
Adenoma- thyroid, parathyroid, pituitary,
liver
Cystadenoma- ovary
Papilloma- skin, larynx, breast, eyelid,
colon
Polyp- colon, cervix, larynx
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Nomenclature- Adenoma
Adenoma is the term applied to
• a benign epithelial neoplasm that forms glandular
patterns as well as
• to tumors derived from glands but not
necessarily reproducing glandular patterns
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Thyroid- Follicular Adenoma
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Follicular Adenoma- thyroid
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Parathyroid adenoma
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Pituitary adenoma
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Hepatic Adenoma
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Normal
Adenoma
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Nomenclature-cystadenoma
Cystadenomas- those
that form large cystic
masses, as in the
ovary
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Nomenclature- papillary
cystadenoma
Papillary cystadenomas –
those tumors that produce
papillary patterns and
protrude into cystic spaces
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Papilloma
Papilloma- eyelid
Papilloma of the colon with finger-like projections into the lumen
Benign epithelial
neoplasms producing
microscopically or
macroscopically visible
finger-like or warty
projections from epithelial
surfaces
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Papilloma
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Nomenclature-POLYP
When a neoplasm, benign or malignant, produces a macroscopically visible
projection above a mucosal surface and projects ( gastric or colon lumen)
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Nomenclature-POLYP
Colonic polyp Cervical polyp
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Colonic Polyp
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Nomenclature
ADENOMATOUS POLYP
An adenomatous (glandular) polyp is
projecting into the colonic lumen and is
attached to the mucosa by a distinct
stalk
If the polyp has
glandular tissue it is
called an
adenomatous polyp
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MALIGNANT TUMOURS
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Nomenclature- Malignant
tumour
• Cancer is the common term for all malignant tumors.
• Probably derived from the Latin for crab
• ―Adheres to any part that it seizes upon in an obstinate manner like the crab."
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Nomenclature- Malignant tumour
Can invade & destroy adjacent structures
Spread to distant sites (metastasize) to cause death
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Comparisons between benign and malignant tumours
Characteristics Benign Malignant
Differentiation/
anaplasia
Well differentiated;
structures sometimes typical
tissue of origin
Some lack of
differentiation
(anaplasia);
structures often atypical
Rate of growth Slow growing Erratic, may be slow or
rapid;
Usually faster growth
Local invasion No local invasion; well
circumscribed and have a
capsule
Locally invasive
Infiltrate to surrounding
tissues; poorly
circumscribed
Metastasis Absent Frequent
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Nomenclature- Malignant tumour
CARCINOMA
Malignant neoplasm of epithelial cell origin (derived
from any of the three germ layers) is called
CARCINOMA
Examples include:
◦ Squamous cell carcinoma of cervix
◦ Adenocarcinoma of stomach
◦ Hepatocellular carcinoma
◦ Renal cell carcinoma
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Nomenclature-Malignant tumour
SARCOMA
Malignant tumors arising in mesenchymal tissues is
called SARCOMA
Examples include:
◦ Leiomyosarcoma
◦ Chondrosarcoma
◦ Osteosarcoma
◦ Liposarcoma
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Nomenclature- Sarcoma
(Greek sar = fleshy) because they have little
connective tissue stroma)
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Carcinoma
When neoplastic epithelial cells
grow in a glandular pattern
microscopically it is termed an
Adenocarcinoma
A cancer in which the tumour
cells resemble stratified
squamous epithelium is termed a
Squamous cell carcinoma
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Adenocarcinoma Squamous cell
carcinoma
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Differences between Carcinoma and Sarcoma
Trait Carcinoma Sarcoma
Age incidence Middle age All age including early age
Structure
Cells are usually arranged in
groups or columns; well formed
stroma; less haemorrhage and
necrosis
Cells are diffusely arranged
in sheets; poor stroma ;
haemorrhage and necrosis
Growth
Somehow slow growing Usually rapid
Metastasis
Early lymphatic; later
bloodborne
Usually blood borne
metastases; lymphatic
spread uncommon
Radiosensitivity
Highly sensitive More resistant
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Nomenclature
Leukaemia (arising from white blood cells)
Lymphomas ( tumours of lymphocytes and
their precursors)
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Nomenclature-
Undifferentiated Malignant tumour
a cancer composed of unknown tissue origin
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Nomenclature- Mixed tumour
Neoplasms with more than one cell type but
arising from only one germ layer are called
"mixed tumors".
Divergent differentiation of a single neoplastic
clone creates a mixed tumour
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Germ layers
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Nomenclature- Mixed tumour
The best example is the benign mixed tumor
(also called pleomorphic adenoma) of
salivary gland
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Pleomorphic adenoma- Mixed tumour
Epithelial component Epithelial component and cartilaginous area
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Pleomorphic adenoma
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Gross appearance of pleomorphic
adenoma
Microscopic appearance of
Pleomorphic adenoma
FNAC of Pleomorphic
adenoma
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Teratoma
Originates from totipotential germ cells
Contains both mature & immature cells or
tissues belonging to more than one germ
layer (sometimes all three)
May give rise to neoplasm that contain bone,
epithelium, muscles, fat, nerve and other
tissues
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Totipotential germ cells
An embryonic cell that is capable of developing
into any variety of body cells
Such as - bone, epithelium, muscle, fat,
nerve, and other tissues
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Totipotential germ cells
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Teratoma- Common sites
Ovary Testis Abnormal midline embryonic rests Head neck Mediastinum Sacrococcygeal region Retroperitoneum
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Teratoma
A particularly common pattern is ovarian
cystic teratoma (dermoid cyst)
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Ovarian Cystic Teratoma- gross
Dermoid cyst
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Teratoma- microscopic
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Teratoma- microscopic
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Tumour like conditions
Hamartomas
Choriostoma
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Hamartoma
A disorganized but benign masses composed
of cells indigenous to the involved site
Once thought – developmental malformation
Many have clonal chromosomal abberations
for somatic mutation- now considered as
neoplasms
Example: pulmonary hamartoma
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INDIGENOUS: originating or occurring naturally in a particular
place; native
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Choriostoma
Heterotopic rest of cells
Examples:
A small nodule of well developed & normally
organized pancreatic tissue in submucosa of
the stomach, duodenum, or small intestine
Actual significance not known
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CHORIOSTOMA- ectopic pancreatic tissue in the
stomach
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Nomenclature of Tumours
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Tissue of origin Benign Malignant
COMPOSED OF ONE PARENCHYMAL CELL TYPE
Tumours of Mesenchymal origin
Connective tissue and derivatives Fibroma Fibrosarcoma
Lipoma Liposarcoma
Chondroma Chondrosarcoma
Osteoma Osteogenic
sarcoma
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Nomenclature of Tumours
Tissue of origin
Benign
Malignant
COMPOSED OF ONE PARENCHYMAL CELL
TYPE
Vessels and surface coverings
Blood vessels Haemangioma
Angiosarcoma
Lymph vessels Lymphangioma Lymphangiosarcoma
Mesothelium Benign fibrous
tumor
Mesothelioma
Brain coverings Meningioma Invasive meningioma
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Nomenclature of Tumours
Tissue of origin
Benign Malignant
COMPOSED OF ONE PARENCHYMAL CELL TYPE
Blood cells and related cells
Haematopoetic cells Leukaemia
Lymphoid cells Lymphoma
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Nomenclature of Tumours
Tissue of origin Benign Malignant
COMPOSED OF ONE PARENCHYMAL CELL TYPE
Muscle
Smooth Leiomyoma Leiomyosarcoma
Striated Rhabdomyoma Rhabdomyosarcoma
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Nomenclature of Tumours Tissue of origin Benign Malignant
COMPOSED OF ONE PARENCHYMAL CELL
TYPE
Tumors of Epithelial origin
Stratified squamous Squamous cell papilloma Squamous cell carcinoma
Basal cell of skin & adnexa Basal cell carcinoma
Epithelial linings of glands or
ducts
Adenoma, Papilloma,
Cystadenoma
Adenocarcinoma, Papillary
carcinoma
Cystadenocarcinoma
Respiratory passages Bronchial adenoma Bronchogenic carcinoma
Renal epithelium Renal tubular adenoma Renal cell carcinoma
Liver cells Hepatic adenoma Hepatocellular carcinoma
Urinary tract epithelium Transitional cell papilloma Transitional cell carcinoma
Placental epithelium Hydatidiform mole Choriocarcinoma
Testicular epithelium Seminoma, Embryonal
carcinoma
Tumours of melanocytes Nevus Malignant melanoma
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Nomenclature of Tumours
Tissue of origin Benign Malignant
More than one neoplastic
cell type- mixed tumors,
usually derived from one
germ layer
Salivary gland Pleomorphic
adenoma (mixed
tumor of salivary
gland)
Malignant mixed tumor
of salivary gland origin
Renal anlage Wilms tumor
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Anlage: Rudimentary basis of a particular organ or other part especially
in a embryo
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Nomenclature of Tumours
Tissue of origin Benign Malignant
More than one neoplastic cell
type derived from more than
one germ layer- teratogenous
Totipotential cells in gonads
or in embryonic tissues
Mature teratoma,
dermoid cysts
Immature teratoma,
teratocarcinoma
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What we have learnt from this
lecture?
Neoplasm
Definition
Components
Parenchyma
Stroma
Benign tumour
Adenoma
Papilloma
Cystadenoma
Polyp
Malignant tumour
Carcinoma
Sarcoma
Leukaemia
Lymphoma
Undifferentiated
Mixed tumour
Teratoma
Hamartoma
Choriostoma
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What we have learnt from this lecture?
Differences between benign and malignant tumours
Differences between carcinoma and sarcoma
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