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Neoplasia

Neoplasia. Dr. Gehan Mohamed. Learning objectives. Understand the definition of neoplasia . List the Classification of neoplasia . Describe the General characters of benign tumors. Understand the Nomenclature of benign tumors. Nomenclature of Malignant tumors.

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Neoplasia

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  1. Neoplasia Dr. Gehan Mohamed

  2. Learning objectives Understand the definition of neoplasia. List the Classification of neoplasia. Describe the General characters of benign tumors. Understand the Nomenclature of benign tumors. Nomenclature of Malignant tumors. Nomenclature of some Malignant tumors with Exceptions. Describe etiology of malignant tumors

  3. Learning objectives definition,Microscopic changes and types of dysplasia. Describe Pathogenesis of tumor formation. Describe General characters of malignant tumors. Understand method of gading and stagging of Malignant Neoplasms. Understand definition of Carcinoma in-situ Describe methods of Spread of malignant tumors. Describe laboratory diagnosis of malignant tumors. Identify the causes of death in malignant tumors. Describe the paraneoplastic syndrome.

  4. Neoplasia • Neoplasia = new growth • Neoplasm = onco • tumor = swelling • The study of neoplasms = Oncology • Onco = tumor + ology=study

  5. Neoplasia • Definition: It is a self controlling growth formed by unlimited multiplication of abnormal cells

  6. Neoplasia • Classification • Benign • Epithelial • Mesenchymal • Malignant • Primary • Epithelial (carcinoma) • Mesenchymal (sarcoma) • Secondary (metastatic) • Locally malignant tumors

  7. General characters of benign tumors • Pathology • Gross pathology • Size: Usually small in size • Shape: usually ovoid or rounded in shape • Capsule: usually capsulated • Cut section solid or cystic • Hemorrhage and necrosis: usually absent • Microscopic pathology • Differentiation: The cells are well differentiated i.e tumor cells closely similar to the tissue of origin. • Nucleocytoplasmic ratio (N/C) ratio: small or normal • Stroma: is usually well formed with few blood vessels

  8. Behavior of benign tumors • Rate of growth: usually slow • Mode of growth: by expansion • Localization: usually localized • Effects on the host: usually do not destroy the surrounding structures and do not kill the patient (except in certain sites as in brain) • Recurrence: usually not recurrent • Metastasis: Do not metastatise • Malignant change: may occur

  9. Benign tumors • Nomenclature • Benign tumors: • prefix + suffix • Type of cell + (-oma)

  10. Neoplasia • Examples: • Benign tumor arising in fibrous tissue: Fibro + oma = Fibroma Benign tumor arising in fatty tissue: Lipo + oma = lipoma

  11. Benign epithelial tumors • Papilloma • Adenoma • Benign mesenchymal tumors • CT tumors • Fibroma • Lipoma • Chondroma • Osteoma • Benign tumors of muscles • Leiomyoma • Rhabdomyoma • Benign tumors of vessels • Haemangioma • lymphangioma

  12. Lipoma

  13. Chondroma

  14. Adenoma : benign epithelial neoplasms producing gland pattern….OR … derived from glands but not necessarily exhibiting gland pattern Examples : • Respiratory airways: Bronchial adenoma • Renal epithelium: Renal tubular adenoma • Liver cell : Liver cell adenoma • Papilloma : benign epithelial neoplasms growing on any surface that produce microscopic or macroscopic finger-like pattern Squamous epithelium: squamous papilloma

  15. Adenoma

  16. Fibroadenoma

  17. Papilloma

  18. Malignant tumors • have two basic components: • Parenchyma: made up of neoplastic cells • Stroma: made up of non-neoplastic, host-derived connective tissue and blood vessels. • The parenchyma: • Determines the biological behavior of the tumor • From which the tumor derives its name • The stroma: • Carries the blood supply • Provides support for the growth of the parenchyma

  19. Adenocarcinoma formed of malignant glands and stroma

  20. Malignant tumors: • Malignant tumor arising in mesenchymal tissue : SARCOMA • From fibrous tissue: Fibrosarcoma • From bone : Osteosarcoma • From cartilage : chondrosarcoma

  21. Osteosarcoma

  22. Malignant tumors arising from epithelial origin : CARCINOMA • Squamous cell carcinoma • Renal cell adenocarcinoma • cholangiocarcinoma

  23. Carcinomas arising from any epithelium of the body that exhibit squamous differentiation are termed squamous cell carcinoma.

  24. Nomenclature other descriptive terms may be added such as: PapillaryCystadenocarcinomaof the Ovary

  25. Nomenclature of some Malignant tumors with Exceptions • Melanoma ( skin ) • Mesothelioma (mesothelium ) • Seminoma ( testis ) • Lymphoma ( lymphoid tissue )

  26. Neoplasm (Tumors) Etiology of malignant tumors A- Precancerous lesions Examples of some lensions that exhibit a tendency to undergo malignant transformation 1- Endometrial hyperplasia endometrial carcinoma. 2- Fibrocystic disease of the breast cancer breast 3- Liver cirrhosis hepatocellular carcinoma

  27. Dysplasia • Definition:Abnormal development or growth of cells (i.e maturation abnormality). • Commonest sites : • Cervix(cervical intraepithelial neoplasia) (CIN) • Vagina(vaginal intraepithelial neoplasia) ( VIN). • bronchi(bronchial intraepithelial neoplasia BIN)

  28. Microscopic changes of dysplasia Dysplasia is characterized by : -Anisocytosis(cells of unequal size) -Poikilocytosis (cells of variable shape) -Hyperchromatism -Presence of mitotic figures (an unusual number of cells which are currently dividing).

  29. Types of dysplasia 1- low grade dysplasia: -not affect the whole thickness of epithelium. -it is reversible if the irritant is removed. High grade dysplasia: - it is precancerous (not reversible) -affect the whole thickness of epithelium. -it is also called carcinoma in situ as the basement membrane not invaded by the abnormal cells

  30. Here, there is normal cervical squamous epithelium at the left, but dysplastic squamous epithelium at the right. The dysplastic epithelial cells are darker, smaller, and more crowded,. Dysplasia is still confined to the epithelium. Dysplasia is still reversible.

  31. At high magnification, the normal cervical squamous epithelium at the left merges into the dysplastic squamous epithelium at the right in which the cells are more disorderly and have darker nuclei with more irregular outlines.

  32. This is "carcinoma in situ" because the carcinoma is still confined to the epithelium, as the entire portion of epithelium is composed of abnormal cells and the basement membrane is still intact.

  33. This is invasive squamous cell carcinoma.the squamous epithelial cells in these large nests with pink keratin in the centers.

  34. Neoplasm (Tumors) Etiology of tumors A- Precancerous lesions 4- Squamous metaplasia lead to squamous cell carcinoma as in : a- Urinarry bladder in bilharziasis b- Bronchial mucosa with chronic bronchitis and smoking 5- Benign tumors a- Papilloma of urinary bladder b- Adenoma of thyroid or colon

  35. Neoplasm (Tumors) Etiology of tumors B- Helping factors (Cocarcinogens) 1- Age With aging there is a more chance of exposure to the carcinogen 2- Sex Most of tumors are common in male

  36. Neoplasm (Tumors) Etiology of tumors B- Helping factors (Cocarcinogens) 3- Diet Fat may be related to colonic cancer. Smoked fish is related to gastric carcinoma. Excess alcohol is related to liver cancer. 4- Smoking May lead to lung cancer 5- Heredity Some tumors are inherited i.e. retinoblastoma and colonic cancer

  37. Neoplasm (Tumors) Etiology of tumors C- Carcinogens Types of carcinogens 1- Chemical carcinogens Methylated hydrocarbons-A 20 dyes bladder cancer Aflatoxins produced from Aspergillus fungus liver cancer 2- Viruses Hepatitis B virus liver cancer Human papilloma virus cancer cervix

  38. Neoplasm (Tumors) Etiology of malignant tumors C- Carcinogens 3- Radiations Ionizing radiation, ultraviolet or prolonged exposure to sunlight Cancer of the skin Leukemia

  39. Neoplasm (Tumors) Etiology of malignant tumors C-mechanism of action of Carcinogens Chemical carcinogens, viruses and radiation result in DNA damage and initiation of cancer by : 1- Activation of oncogenes e.g myc gene,K-ras (genes responsible for abnormal growth and proliferation of cell). 2- Inactivation of cancer suppressor genes e.g RB ,P53 genes.

  40. Neoplasm (Tumors) Etiology of tumors C-mechanism of action of Carcinogens Hormones act as promoters i.e. they stimulate the proliferation of the already transformed cells e.g. Estrogen cancer breast and endometrial cancer Androgen prostatic cancer

  41. Pathogenesis of tumor formation

  42. General characters of malignant tumors • Pathology • Gross pathology • Size: Usually reach large size • Shape • Polypoid or fungating mass in tumors of solid organs • Malignant ulcer in tumors of surface epithelium • Infiltrating annular mass in tumors of hollow organs • Capsule: non-capsulated • Cut section sold or cystic • Hemorrhage and necrosis: common • Microscopic pathology • Differentiation: The cells show loss of differentiation • The cells show some or all features of malignancy as loss of polarity of the cells ,hyperchromaticneuclei, increase N/C ratio,abnorml mitosis and prominent neucleolus. • Stroma: is usually desmoplastic with rich vascularity

  43. Behavior of malignant tumors • Rate of growth: usually rapid • Mode of growth: by infiltration • Localization: usually not localized • Effects on the host: can kill the patient wherever present • Recurrence: may recur • Metastasis: may occur • Precancerous lesions • Chronic inflammatory lesions • Hyperplastic lesions • Some benign tumors • Other lesions as peptic ulcer and un-descended testis

  44. Grading of Malignant Neoplasms Grade Definition I Well differentiated II Moderately differentiated III Poorly differentiated IV Nearly anaplastic

  45. Oat cell carcinima of the lung Undifferenciated carcinoma Grade IV Poorly differentiated neoplasms have cells that are difficult to recognize as to their cell of origin. Higher grade means: a lesser degree of differentiation and the worse the biologic behavior Adenocarcinoma of the colon Well differenciated carcinoma A welldifferentiated neoplasm is composed of cells that closely resemble the cell of origin.

  46. Clinical Staging T (primary tumor): T1, T2, T3, T4 N (regional lymph nodes): N0, N1, N2, N3 M (metastasis): M0, M1

  47. TNM staging system in cancer

  48. Staging of Malignant Neoplasms Stage Definition Tis In situ, non-invasive (confined to epithelium) T1 Small, minimally invasive within primary organ site T2 Larger, more invasive within the primary organ site T3 Larger and/or invasive beyond margins of primary organ site T4 Very large and/or very invasive, spread to adjacent organs N0 No lymph node involvement N1 Regional lymph node involvement N2 Extensive regional lymph node involvement N3 More distant lymph node involvement M0 No distant metastases M1 Distant metastases present

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