benign and malignant epithelial tumors - … ·  · 2016-10-12benign and malignant epithelial...

BENIGN AND MALIGNANT EPITHELIAL

TUMORS

(Squamous cell carcinoma, Basal cell carcinoma, Adenocarcinoma, Medular type

of adenocarcinoma,Scirrhotic type of adenocarcinoma, Ductal mammary

carcinoma, Lobular mammary carcinoma, Papiloma, Adenomaous polyp)

General medicine

MUDr. Michal Palkovič

MUDr. Svetoslav Štvrtina

Department of pathology, Comenius University

Sasinkova 4, Bratislava

Prof. MUDr. Ľudovít Danihel, CSc.

Benign and malignant epithelial tumors

Tumor (neoplasma)

• Extensive and excessive growth

– proliferation of the cells – changes in the regulation

• Uncoordinated growth

– without any regulation of the organism

• Independent growth

– autonomous growth

Benign and malignant epithelial tumors

Tumor

By the biological behaviour:

• benign

• malignant

Benign vs malignant tumor

Benign tumor

• slow growing

• capsulated

• non-invasive

• do not metastasize

• suffix –oma

Malignant tumor

• fast growing

• non capsulated

• Invasive / infiltrate

• metastasize

• suffix – carcinoma /

sarcoma

Benign and malignant epithelial tumors

Pseudotumors

• Inflammatory tumor

• Hyperplasia

• Cysts

Congenital cysts

Acquired cysts

Implant cysts

Parasitic cysts

• Pathologic material deposition

Benign and malignant epithelial tumors

Malignant tumor

• Grading – histological differentiation of

tumor

• Staging – the extent of spread of tumor

TNM classification

Benign and malignant epithelial tumors

Spreading

• lympfatic (carcinomas)

• hematogenous (sarcomas)

• transcoelomic

• implantation

• Physical

• Chemical

• Biological

Benign and malignant epithelial tumors

Reasons of the tumor development

• Physical – Ultraviolet radiation (UV)

• Mostly UVB 280 – 320 nm

– Infrared

– Ionizing radiation • Rtg, α, β, γ radiation

– diagnostical methods, radon, industry

• Chemical – cancerogenic substances (mutagens)

– procancerogenic substances – need of metabolic activation

Benign and malignant epithelial tumors

Reasons of the tumor development

Benign and malignant epithelial tumors

Reasons of the tumor development

• Biological – Viral cancerogenesis

• Retrovirus HTLV-I(T-cell leukaemia/lymphoma)

• Human DNA papillomavirus (epidermoid carcinoma)

• DNA virus hepatitis B (hepatocellular carcinoma)

• RNA virus hepatitis C (hepatocellular carcinoma)

• EBV (Epstein-Barr virus) (Burkitt´s lymphoma)

• HHV-8 (Kaposi´s sarcoma)

– Oncogenes – part of the DNA responsible for the tissue growth - without the regulations

– Metaplasia – change of one type of differentiated tissue to the other type

Tumor classification

1. Tumors from one type of cells

epithelial

squamous epithelium

glandular epithelium

transitional epithelium

mesenchymal (non-epithelial, „soft tissue“)

neuroectodermal

placental (trofoblast)

Tumor classification

mesenchymal (non-epithelial, „soft tissue“)

adipose tissue

fibrous tissue (adult, embryonic), cartilage, bone

synovium

smooth and skeletal muscle

mesothelium

blood and lymph vessels

glomus

meninges, nerve sheath, nerve cells

haematopoietic cells

lymphoid tissue

Tumor classification

2. Special categories of tumors:

mixed tumors – two types of tumors in the same tumor

adenosquamous carcinoma, adenoacanthoma,

carcinosarcoma

Tumors derived from the three germ cell layers – ectoderm, mesoderm,

endoderm – mature, immature teratoma

Blastomas – from embryonal or partially differentiated cells

Hamartoma – from mature but disorganised cells of tissues indigenous to

the particular organ

Choristoma – not a true tumor, ectopic islands of normal tissue

Benign and malignant epithelial tumors

• From squamous epithelium

- benign: papiloma

- malignant: carcinoma

• From glandular epithelium

- benign: adenoma

- malignant: adenocarcinoma

Benign and malignant epithelial tumors

Tumors from the squamous epithelium

Papiloma (43)

• benign tumor of the skin or mucosa with the squamous epithelium, or of the tissues with transitional epithelium

• exophytic or inverted; isolated or multiple

• during the development the infection by HPV – Human Papiloma Virus can play an important role

Benign and malignant epithelial tumors

Tumors from the squamous epithelium

Squamous cell carcinoma (45) (Spinocellular carcinoma, epidermoid carcinoma)

• malignant transformation and proliferation of the stratum spinosum

• solid isles and stripes growing deeply into the tissue, penetrating the lymphatic and vascular vessels

• loss of the stratification, differentiation to the stratum granulosum, keratinization - the depositions of keratin in the cells

• keratinization depends on the differentiation level

• tissues with the primary keratinizating epithelium or the metaplastic epithelium (e. g. in esophagus)

– screening: cervical carcinoma, bronchogenic carcinoma

Benign and malignant epithelial tumors

Tumors from the squamous epithelium

Basal cell carcinoma (46) (Basalioma)

• skin tumor (predominantly on the face) – proliferation of the cells similar to the immature cells of the basal layer of the epidermis (but arises from hair follicule)

• variable histological features

• grows predominantly endophytic, with the dermis infiltration, and surface exulceration (ulcus rodens)

• without metastasis (semimalignant), locally destructive, with relapses – the adequate surgical extirpation with the histopathological examination of the borders is necessary

Benign and malignant epithelial tumors

Tumors from the glandular epithelium

Adenomatous polyp (44)

• benign, exophytic growth, polypous (adenoma polyposum)

Benign and malignant epithelial tumors

Tumors from the glandular epithelium

Adenocarcinoma (Carcinoma adenomatosum)

• the most frequent malignant tumor

• transformation and proliferation of the exocrine and endocrine

glands epithelium or cylindric epithelium of mucous membranes,

„de novo“ or secondary (malignant transformation of adenoma,

abnormal or dysplastic epithelial proliferation)

Benign and malignant epithelial tumors

Tumors from the glandular epithelium

Adenocarcinoma (Carcinoma adenomatosum)

• classification: in parenchymatous organ

» irregular nodular structure, often without the capsule

» trabecular – equal proportion of stroma and

parenchyma

» scirrhotic – stroma predominance

» medullary – parenchyma predominance

» gelatinous – mucus

» cystic – cystic cavities

Benign and malignant epithelial tumors

Tumors from the glandular epithelium

Adenocarcinoma (Carcinoma adenomatosum)

• classification: on the surface of organ with lumen

» Exophytic or endophytic growth

» Endophytic has forms as described before

» Exophytic can be according to the apperance:

papilar, polypous, villous, disciform (central

necrosis)

Benign and malignant epithelial tumors

Tumors from the glandular epithelium

Adenocarcinoma (Carcinoma adenomatosum)

• classification: according to the source:

– Adenocarcinoma of trabecular glands (liver, cortex of adrenal gland,

hypophysis) are solid with trabecular form

– Adenocarcinoma of tubular, acinar and alveolar glands and of cylindric

epithelium

– Both types resemble original tissue according to the differentiaton

• classification: according to mucus production:

– Carcinomas of signet-ring cells – mucus in cytoplasm

– Mucinous carcinomas – mucus in stroma

Medullary type of adenocarcinoma (49)

Scirrhotic type of adenocarcinoma (50)

Benign and malignant epithelial tumors

Tumors from the glandular epithelium

Ductal mammary carcinoma (304)

• malignant proliferation of the ducts (the terminal ducts

predominantly)

• scirrhotic carcinoma, solid or tubular growth

Benign and malignant epithelial tumors

Tumors from the glandular epithelium

Lobular mammary carcinoma (294)

• the cells form structures – strands („Indian filing“) or target-like

structures around the small preserved ducts

• stroma rich tumor