neoplasia abdulmalik alsheikh, md, frcpc. neoplasia definitions definitions classification...
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NeoplasiaNeoplasia
Abdulmalik Alsheikh, MD, Abdulmalik Alsheikh, MD, FRCPCFRCPC
NeoplasiaNeoplasia DefinitionsDefinitions ClassificationClassification NomenclatureNomenclature Characteristics of benign and Characteristics of benign and
malignant neoplasmsmalignant neoplasms
NeoplasiaNeoplasia
Cancer is one of the leading causes Cancer is one of the leading causes of death worldwide.of death worldwide.
Emotional and physical suffering by Emotional and physical suffering by the patient.the patient.
Different mortality rate …..Different mortality rate ….. Some are curable Some are curable Others are fatalOthers are fatal
NeoplasiaNeoplasia
Neoplasia = new growthNeoplasia = new growth Neoplasm = tumorNeoplasm = tumor Tumor = swellingTumor = swelling The study of tumors = OncologyThe study of tumors = Oncology
Oncos = tumor + ology = study of Oncos = tumor + ology = study of
NeoplasiaNeoplasia
Definition:Definition: is an abnormal mass of tissue, is an abnormal mass of tissue, the growth of which is uncoordinated with the growth of which is uncoordinated with
that of normal tissues, that of normal tissues, and that persists in the same excessive and that persists in the same excessive
manner after the cessation of the manner after the cessation of the stimulus which evoked the changestimulus which evoked the change
With the loss of responsiveness to normal With the loss of responsiveness to normal growth controlsgrowth controls
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Classification Classification
Benign Benign malignantmalignant
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Benign tumors :Benign tumors : Will remain localizedWill remain localized Cannot spread to distant sitesCannot spread to distant sites Generally can be locally excisedGenerally can be locally excised Patient generally survives Patient generally survives
NeoplasiaNeoplasia
Malignant neoplasms:Malignant neoplasms: Can invade and destroy adjacent Can invade and destroy adjacent
structurestructure Can spread to distant sitesCan spread to distant sites Cause death (if not treated )Cause death (if not treated )
NeoplasiaNeoplasia
All tumors have two basic All tumors have two basic components:components: Parechyma: Parechyma: made up of made up of
neoplastic cellsneoplastic cells Stroma: Stroma: made up of non-made up of non-
neoplastic, host-derived neoplastic, host-derived connective tissue and blood connective tissue and blood vesselsvessels
NeoplasiaNeoplasia
The parenchyma:The parenchyma: Determines the biological behavior of Determines the biological behavior of
the tumorthe tumor From which the tumor derives its name From which the tumor derives its name
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The stroma:The stroma: Carries the blood supplyCarries the blood supply Provides support for the growth of the Provides support for the growth of the
parenchymaparenchyma
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NomenclatureNomenclature Benign tumors: Benign tumors:
prefix + suffixprefix + suffix Type of cell + (-oma)Type of cell + (-oma)
NeoplasiaNeoplasia
Examples:Examples: Benign tumor arising in fibrous tissue:Benign tumor arising in fibrous tissue:
Fibro + oma = FibromaFibro + oma = Fibroma
Benign tumor arising in fatty tissue:Benign tumor arising in fatty tissue:
Lipo + oma = lipomaLipo + oma = lipoma
NeoplasiaNeoplasia
Benign tumor arising in cartilageBenign tumor arising in cartilage
chondro + oma = chondromachondro + oma = chondroma Benign tumor arising in smooth Benign tumor arising in smooth
musclemuscle
Leiomyo + oma = leiomyomaLeiomyo + oma = leiomyoma Benign tumor arising in skeletal Benign tumor arising in skeletal
musclemuscle
Rhabdomyo + oma = rhabdomyomaRhabdomyo + oma = rhabdomyoma
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epithelial benign tumors are epithelial benign tumors are classified on the basis of :classified on the basis of : The cell of origin The cell of origin Microscopic patternMicroscopic pattern Macroscopic patternMacroscopic pattern
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Adenoma Adenoma : benign epithelial neoplasms : benign epithelial neoplasms producing gland pattern….OR … producing gland pattern….OR … derived from glands but not necessarily derived from glands but not necessarily exhibiting gland pattern exhibiting gland pattern
Papilloma Papilloma : benign epithelial : benign epithelial neoplasms growing on any surface that neoplasms growing on any surface that produce microscopic or macroscopic produce microscopic or macroscopic finger-like patternfinger-like pattern
NeoplasiaNeoplasia
PolypPolyp : a mass that projects above a : a mass that projects above a mucosal surface to form a mucosal surface to form a macroscopically visible structure. macroscopically visible structure.
e.g. - colonic polype.g. - colonic polyp
- nasal polyp - nasal polyp
NeoplasiaNeoplasia
Examples : Examples : Respiratory airways: Bronchial Respiratory airways: Bronchial
adenomaadenoma Renal epithelium: Renal tubular Renal epithelium: Renal tubular
adenomaadenoma Liver cell : Liver cell adenomaLiver cell : Liver cell adenoma Squamous epithelium: squamous Squamous epithelium: squamous
papilloma papilloma
NeoplasiaNeoplasia
Malignant tumors:Malignant tumors: Malignant tumor arising in Malignant tumor arising in
mesenchymal tissue : SARCOMAmesenchymal tissue : SARCOMA From fibrous tissue: FibrosarcomaFrom fibrous tissue: Fibrosarcoma From bone : OsteosarcomaFrom bone : Osteosarcoma From cartilage : chondrosarcomaFrom cartilage : chondrosarcoma
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Malignant tumors arising from Malignant tumors arising from epithelial origin : CARCINOMAepithelial origin : CARCINOMA Squamous cell carcinomaSquamous cell carcinoma Renal cell adenocarcinomaRenal cell adenocarcinoma cholangiocarcinomacholangiocarcinoma
NeoplasiaNeoplasia
Melanoma ( skin )Melanoma ( skin ) Mesothelioma (mesothelium )Mesothelioma (mesothelium ) Seminoma ( testis )Seminoma ( testis ) Lymphoma ( lymphoid tissue ) Lymphoma ( lymphoid tissue )
See table 6 – 1 page 176 ( Robbins )See table 6 – 1 page 176 ( Robbins )
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Eponymically named tumorsEponymically named tumors Hodgkin’s LymphomaHodgkin’s Lymphoma Wilm’s Tumor ( nephroblastoma )Wilm’s Tumor ( nephroblastoma ) Burkitt’s LymphomaBurkitt’s Lymphoma
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Characteristics of benign and Characteristics of benign and malignant neoplasmsmalignant neoplasms
Differentiation and anaplasiaDifferentiation and anaplasia Rate of growthRate of growth Local invasionLocal invasion metastasis metastasis
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1.1. Differentiation and anaplasia: Differentiation and anaplasia:
Differentiation means : the extent Differentiation means : the extent to which the parenchymal cells of to which the parenchymal cells of the tumor resemble their normal the tumor resemble their normal counterparts morphologically and counterparts morphologically and functionallyfunctionally
NeoplasiaNeoplasia
well differentiated = closely well differentiated = closely resemble their normal counterpartsresemble their normal counterparts
Moderately differentiatedModerately differentiated Poorly differentiatedPoorly differentiated Undifferentiated ( Anaplasia ) Undifferentiated ( Anaplasia )
NeoplasiaNeoplasia
Benign tumors = well differentiatedBenign tumors = well differentiated Malignant tumors = Malignant tumors =
well differentiated -----> anaplasticwell differentiated -----> anaplastic
NeoplasiaNeoplasia
In the histological examination of a In the histological examination of a tumor you should look for :tumor you should look for : Pleomorphism : variation in sizePleomorphism : variation in size High nuclear/ cytoplasm ratio ( N/C High nuclear/ cytoplasm ratio ( N/C
ratio)ratio) Hyperchrmasia ( dark cell )Hyperchrmasia ( dark cell ) Mitosis ….?abnormal one Mitosis ….?abnormal one
NeoplasiaNeoplasia
Characteristics of benign and Characteristics of benign and malignant neoplasmsmalignant neoplasms
Differentiation and anaplasiaDifferentiation and anaplasia Rate of growthRate of growth Local invasionLocal invasion metastasis metastasis
NeoplasiaNeoplasia
Rate of growth: Rate of growth: Benign tumors: Benign tumors:
grows slowly grows slowly are affected by blood supply, hormonal are affected by blood supply, hormonal
effects , locationeffects , location Malignant tumors : Malignant tumors :
grows faster grows faster Correlate with the level of differentiationCorrelate with the level of differentiation
NeoplasiaNeoplasia
Characteristics of benign and Characteristics of benign and malignant neoplasmsmalignant neoplasms
Differentiation and anaplasiaDifferentiation and anaplasia Rate of growthRate of growth Local invasionLocal invasion metastasis metastasis
NeoplasiaNeoplasia
Local invasion :Local invasion : Benign tumors : Benign tumors :
Remain localizedRemain localized Cannot invadeCannot invade Usually capsulatedUsually capsulated
Malignant tumors : Malignant tumors : Progressive invasionProgressive invasion DestructionDestruction Usually not capsulatedUsually not capsulated
NeoplasiaNeoplasia
Characteristics of benign and Characteristics of benign and malignant neoplasmsmalignant neoplasms
Differentiation and anaplasiaDifferentiation and anaplasia Rate of growthRate of growth Local invasionLocal invasion metastasis metastasis
NeoplasiaNeoplasia
Metastasis : Metastasis : Definition : the development of Definition : the development of
secondary implants discontinuous with secondary implants discontinuous with the primary tumor, possibly in remote the primary tumor, possibly in remote tissuestissues
NeoplasiaNeoplasia
Metastasis : Metastasis : Cancers have different ability to Cancers have different ability to
metastasizemetastasize Approximately 30% patients present Approximately 30% patients present
with clinically evident metastases.with clinically evident metastases. Generally, the more anaplastic and the Generally, the more anaplastic and the
larger the primary tumor, the more larger the primary tumor, the more likely is metastasislikely is metastasis
NeoplasiaNeoplasia
Metastasis : three pathways Metastasis : three pathways Lymphatic Lymphatic spread :spread : Hematogenous Hematogenous spread : spread : Seeding of the Seeding of the body cavitiesbody cavities: pleural, : pleural,
peritoneal cavities and cerebral peritoneal cavities and cerebral ventriclesventricles
NeoplasiaNeoplasia
Lymphatic Lymphatic spread :spread : favored by carcinomasfavored by carcinomas Breasr carcinoma Breasr carcinoma axillary lymph axillary lymph
nodesnodes Lung carcinomas Lung carcinomas bronchial lymph bronchial lymph
nodes nodes
NeoplasiaNeoplasia
Hematogenous Hematogenous spread : spread : favored by sarcomasfavored by sarcomas Also used by carcinomasAlso used by carcinomas Veins are more commonly invadedVeins are more commonly invaded The liver and lungs are the most The liver and lungs are the most
frequently involved secondary sites frequently involved secondary sites
NeoplasiaNeoplasia
In the histological examination of a In the histological examination of a tumor you should look for :tumor you should look for : Pleomorphism : variation in sizePleomorphism : variation in size High nuclear/ cytoplasm ratio ( N/C High nuclear/ cytoplasm ratio ( N/C
ratio)ratio) Hyperchrmasia ( dark cell )Hyperchrmasia ( dark cell ) Mitosis ….?abnormal one Mitosis ….?abnormal one
NeoplasiaNeoplasia
Dysplasia : Dysplasia : Definiton: a loss in the uniformity of the Definiton: a loss in the uniformity of the
individual cells and a loss in their individual cells and a loss in their architectural orientation.architectural orientation.
Non-neoplasticNon-neoplastic Occurs mainly in the epitheliaOccurs mainly in the epithelia Dysplastic cells shows a degree of : Dysplastic cells shows a degree of :
pleomorphism, hyperchrmasia,increased pleomorphism, hyperchrmasia,increased mitosis and loss of polarity.mitosis and loss of polarity.
NeoplasiaNeoplasia
Dysplasia does not mean cancerDysplasia does not mean cancer Dyplasia does not necessarily Dyplasia does not necessarily
progress to cancerprogress to cancer Dysplasia may be reversibleDysplasia may be reversible If dysplastic changes involve the If dysplastic changes involve the
entire thickness of the epithelium it entire thickness of the epithelium it is called : is called :
CARCINOMA IN-SITUCARCINOMA IN-SITU
NeoplasiaNeoplasia
Carcinoma in-situCarcinoma in-situ Definition: an intraepithelial malignancy Definition: an intraepithelial malignancy
in which malignant cells involve the in which malignant cells involve the entire thickness of the epithelium entire thickness of the epithelium without penetration of the basement without penetration of the basement membrane.membrane.
Applicable only to epithelial neoplasms. Applicable only to epithelial neoplasms.
NeoplasiaNeoplasia
Based on the biological behavior : Based on the biological behavior : Benign and malignantBenign and malignant
Based on the cell of origin : Based on the cell of origin : One neoplastic cell type : lipoma, One neoplastic cell type : lipoma,
adenocarcinomaadenocarcinoma More than one neoplastic cell type : More than one neoplastic cell type :
fibroadenomafibroadenoma More than one neoplastic cell type derived More than one neoplastic cell type derived
from more than one germ-cell layer: teratomafrom more than one germ-cell layer: teratoma
NeoplasiaNeoplasia
Teratoma:Teratoma: Teratoma contains recognizable Teratoma contains recognizable
mature or immature cells or tissues mature or immature cells or tissues representative of more than one germ-representative of more than one germ-cell layer and some times all three.cell layer and some times all three.
Teratomas originate from totipotential Teratomas originate from totipotential cells such as those normally present in cells such as those normally present in the ovary and testis.the ovary and testis.
NeoplasiaNeoplasia
Such cells have the capacity to Such cells have the capacity to differentiate into any of the cell types differentiate into any of the cell types found in the adult body. So they may found in the adult body. So they may give rise to neoplasms that mimic give rise to neoplasms that mimic bone, epithelium, muscle, fat, nerve bone, epithelium, muscle, fat, nerve and other tissues.and other tissues.
Most common sites are: ovary, testisMost common sites are: ovary, testis
NeoplasiaNeoplasia
If all the components parts are well If all the components parts are well differentiated, it is a benign (mature) differentiated, it is a benign (mature) teratoma.teratoma.
If less well differentiated, it is an If less well differentiated, it is an immature (malignant) teratoma. immature (malignant) teratoma.
NeplasiaNeplasia Hamartoma is apparently developmental Hamartoma is apparently developmental
malformation that presents as a mass of malformation that presents as a mass of disorganized tissue indigenous to disorganized tissue indigenous to particular site. particular site. They are distinguished from neoplasms by the They are distinguished from neoplasms by the
fact that they do not exhibit continued growth. fact that they do not exhibit continued growth. they are group of tumor-like tissue masses they are group of tumor-like tissue masses which may be confused with neoplasmswhich may be confused with neoplasms
ChoristomaChoristoma Congenital anomalyCongenital anomaly Heterotopic rest of cellsHeterotopic rest of cells
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EpidemiologyEpidemiology Will help to discover aetiologyWill help to discover aetiology Planning of preventive measuresPlanning of preventive measures To know what is common and what To know what is common and what
is rare.is rare. Development of screening methods Development of screening methods
for early diagnosisfor early diagnosis
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Factors affecting incidence of Factors affecting incidence of cancercancer
Geographic and EnvironmentalGeographic and Environmental AgeAge HeredityHeredity Aquired preneoplastic disordersAquired preneoplastic disorders
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Geographic and Environmental Geographic and Environmental factors:factors: Rate of stomach carcinoma in Japan is Rate of stomach carcinoma in Japan is
seven times the rate in North America seven times the rate in North America and Europe.and Europe.
Breast carcinoma is five times higher in Breast carcinoma is five times higher in North America comparing to JapanNorth America comparing to Japan
Liver cell carcinoma is more common in Liver cell carcinoma is more common in African populations African populations
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Geographic and Geographic and EnvironmentalEnvironmental factors:factors: Asbestos : mesotheliomaAsbestos : mesothelioma Smoking : lung cancerSmoking : lung cancer Multiple sexual partners: cervical cancerMultiple sexual partners: cervical cancer Fatty diets : colonic cancerFatty diets : colonic cancer
Please see table 6-2 for occupational Please see table 6-2 for occupational cancerscancers
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Factors affecting incidence of cancerFactors affecting incidence of cancer Geographic and EnvironmentalGeographic and Environmental AgeAge HeredityHeredity Aquired preneoplastic disordersAquired preneoplastic disorders
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Age:Age: Generally, the frequency of cancer Generally, the frequency of cancer
increases with age.increases with age. Most cancer mortality occurs between 55 Most cancer mortality occurs between 55
and 75. and 75. Cancer mortality is also increased during Cancer mortality is also increased during
childhoodchildhood Most common tumors of children: Most common tumors of children:
Leukemia, tumors of CNS, Lymphomas, Leukemia, tumors of CNS, Lymphomas, soft tissue and bone sarcomas. soft tissue and bone sarcomas.
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Factors affecting incidence of cancerFactors affecting incidence of cancer Geographic and EnvironmentalGeographic and Environmental AgeAge HeredityHeredity Aquired preneoplastic disordersAquired preneoplastic disorders
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HeredityHeredity Inherited Cancer SyndromesInherited Cancer Syndromes Familial CancersFamilial Cancers Autosomal Recessive Syndromes of Autosomal Recessive Syndromes of
Defective DNA repair Defective DNA repair
HeredityHeredity
Inherited Cancer Syndromes:Inherited Cancer Syndromes: Inheritance of a single mutant gene Inheritance of a single mutant gene
greatly increases the risk of developing greatly increases the risk of developing neoplasmneoplasm
E.g. Retinoblastoma in children : E.g. Retinoblastoma in children : 40% of Retinoblastomas are familial40% of Retinoblastomas are familial carriers of the gene have 10000 fold carriers of the gene have 10000 fold
increase in the risk of developing increase in the risk of developing RetinoblastomaRetinoblastoma
E.g. multiple endocrine neoplasiaE.g. multiple endocrine neoplasia
HeredityHeredity
Familial Cancers:Familial Cancers: All common types of cancers occur in All common types of cancers occur in
familial formfamilial form E.g. breast, colon, ovary,brainE.g. breast, colon, ovary,brain Familial cancers usually have unique Familial cancers usually have unique
features:features: Start at early ageStart at early age Multiple or bilateralMultiple or bilateral Two or more relatives Two or more relatives
HeredityHeredity
Autosomal Recessive Syndromes of Autosomal Recessive Syndromes of Defective DNA repair :Defective DNA repair : Small group of autosomal recessive Small group of autosomal recessive
disordersdisorders Characterized by DNA instabilityCharacterized by DNA instability
Please see table 6-3 for more Please see table 6-3 for more examplesexamples
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Factors affecting incidence of cancerFactors affecting incidence of cancer Geographic and EnvironmentalGeographic and Environmental AgeAge HeredityHeredity Aquired preneoplastic disordersAquired preneoplastic disorders
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Aquired preneoplastic Aquired preneoplastic disorders: disorders: Some Clinical Some Clinical conditions that predispose to cancerconditions that predispose to cancer Dysplastic bronchial mucosa in Dysplastic bronchial mucosa in
smokerssmokers lung carcinoma lung carcinoma Atypical endometrial hypeplasia Atypical endometrial hypeplasia
endometrial carcinomaendometrial carcinoma Liver cirrhosis Liver cirrhosis liver cell carcinoma liver cell carcinoma Margins of chronic skin fistula Margins of chronic skin fistula
squamous cell carcinomasquamous cell carcinoma