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Pathology of Neoplasia

Pathology of Neoplasia. Tumor – tissue mass Neoplasm – “ new growth ” , clonal expansion of cells with somatic mutations and variable autologous growth regulation Cancer – neoplasm with invasive or metastatic properties.

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Pathology of Neoplasia

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  1. Pathology of Neoplasia

  2. Tumor – tissue mass Neoplasm – “new growth”, clonal expansion of cells with somatic mutations and variable autologous growth regulation Cancer – neoplasm with invasive or metastatic properties

  3. Morphology of Neoplasia

  4. Malignant neoplasms invade normal tissues and cause mechanical disruption of normal function mesothelioma gastric cancer

  5. Superior vena cava syndrome

  6. Invasion and metastasis of colon cancer primary invasive colon cancer colon cancer metastases to liver

  7. tubular adenoma with in situ and early invasive cancer

  8. tubular adenoma with in situ and early invasive cancer

  9. “Benign tumors” are not invasive (leiomyoma of uterus)

  10. Lymph node metastasis

  11. Determinants of Cancer Metastatic Growth Sites Colorectal Cancer Breast Cancer • Pathways of lymphatic and • vascular drainage • 2. Molecular determinants • for cell survival and growth

  12. Summary: Growth of Metastatic Cancer • Spread of cancer cells to distant sites generally follows pathways of lymphatic and vascular drainage. • Growth of cancer cells in metastatic site depends on ability of neoplastic cells to accommodate to new tissue (e.g., altered molecular composition of cell surface).

  13. Well circumscribed, sometimes encapsulated Non-invasive No associated metastases Organized tissue structures Poorly circumscribed Penetrates capsule if present Invasive into adjacent tissues, lymphatics and vasculature Metastases Poorly organized aggregates of cells Features of Benign and Malignant Tumors Benign Malignant

  14. Low N/C ratio Round nucleus, even distribution of chromatin Maintenance of differentiation Uncommon mitoses High N/C ratio Irregular nuclear shape Clumped chromatin Prominent nucleoli Loss of differentiation Common mitoses, often atypical Features of Benign and Malignant Cells Benign Malignant

  15. Cellular Features of Benign and Malignant Cells Benign Malignant

  16. Leiomyoma of Uterus

  17. Leiomyosarcoma of Uterus

  18. Follicular adenoma (left) with intact capsule Follicular carcinoma (right) invading through capsule

  19. Nomenclature of tumors Pathological features of benign and malignant tumors Grading and staging cancer Ancillary techniques to diagnose and classify neoplasms

  20. Nomenclature of Tumors bile duct adenoma tissue/ organ of origin

  21. Nomenclature of Tumors bile duct adenoma pattern of differentiation

  22. Nomenclature of Tumors bile duct adenoma benign

  23. Nomenclature of Tumors adenocarcinoma malignant, epithelial

  24. Nomenclature of Tumors squamous cell carcinoma malignant, epithelial

  25. Nomenclature of Tumors leiomyosarcoma malignant, mesenchymal

  26. -oma as a suffix for malignant tumors • Lymphoma • Melanoma • Hepatoma (hepatocellular carcinoma) • Astrocytoma

  27. Common terms for epithelial tumors • Epidermoid – a synonym for squamous cell • Adeno – glandular or ductal • Transitional cell – urothelial cells lining bladder, renal pelvis, ureters

  28. Common terms for mesenchymal tumors • Leiomyo – smooth muscle • Rhabdomyo – skeletal muscle • Chondro – cartilage • Osteo – bone (osteoid) • Fibro - fibrous

  29. Features of Benign and Malignant Tumors • Well circumscribed, sometimes encapsulated • Non-invasive • No associated metastases • Organized tissue structures • Poorly circumscribed • Penetrates capsule if present • Invasive into adjacent tissues, lymphatics and vasculature • Metastases • Poorly organized aggregates of cells Benign Malignant

  30. Features of Benign and Malignant Cells • Low N/C ratio • Round nucleus, even distribution of chromatin • Maintenance of differentiation • Uncommon mitoses • High N/C ratio • Irregular nuclear shape • Clumped chromatin • Prominent nucleoli • Loss of differentiation • Common mitoses, often atypical Benign Malignant

  31. Cellular Features of Benign and Malignant Cells Benign Malignant

  32. Leiomyoma of Uterus

  33. Leiomyosarcoma of Uterus

  34. Follicular adenoma (left) with intact capsule Follicular carcinoma (right) invading through capsule

  35. Tubular Adenoma of Colon

  36. Invasive Colon Cancer

  37. Descriptive terms used in cancer nomenclature • Cystic • Papillary • Polypoid • Mucinous • Scirrhous • Annular

  38. Neoplasms with intermediate levels of malignancy • Borderline / Low malignant potential tumors (e.g., ovary) • Carcinoid tumors (e.g., lung and gastrointestinal system)

  39. Pulmonary Carcinoid

  40. Pulmonary Carcinoid

  41. Clinical situation as a determinant of cancer diagnosis • Site – smooth muscle tumor in uterus or in retroperitoneum/ mesentery. • Gender – teratoma in woman (ovary) or in man (testis). • Age – teratoma in testis of child or in testis of adult man

  42. Preinvasive neoplasia defies traditional definitions of benign and malignant tumors Carcinoma in situ (or severe dysplasia) of squamous mucosa Tubular adenoma of colon

  43. In situ neoplasia • Atypical cells • Loss of maturation • Mitotic activity

  44. Examples of early (pre-invasive) neoplasia risk for malignancy neoplasm “tumor” adenoma of colon yes variable dysplasia of cervix no variable dysplasia of bronchial epithelium no unknown atypical junctional nevus yes moderate

  45. Examples of “benign tumors” risk for malignancy neoplasm “tumor” leiomyoma yes minimal lipoma yes minimal fibroadenoma of breast yes minimal intradermal nevus of skin yes minimal variable yes adenoma of colon

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