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Pathology of Neoplasia

Pathology of Neoplasia. Introduction:. Inflammatory, Degenerative & Neoplastic Growth – Increase in size due to synthesis of tissue components. Proliferatation- Cell division. Differentiation: functional and structural maturity of cells. Tumor – Swelling / new growth / mass.

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Pathology of Neoplasia

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  1. Pathology of Neoplasia

  2. Introduction: • Inflammatory, Degenerative & Neoplastic • Growth – Increase in size due to synthesis of tissue components. • Proliferatation- Cell division. • Differentiation: functional and structural maturity of cells. • Tumor – Swelling / new growth / mass

  3. Controls of Growth: • Cytokines: Cyclins, Cyclin dependent kinases (CDK). • Growth factors – PDGF, FGF • Growth Inhibitors. • Cancer suppressor genes – p53 • Oncogenes – c-onc, p-onc, v-onc etc.

  4. Non-Neoplastic Proliferation: *Controlled & Reversible • Hypertrophy – Size • Hyperplasia – Number • Metaplasia – Change • Dysplasia – Disordered

  5. Neoplastic Proliferation: Uncontrolled & Irreversible* • Benign • Localized, non-invasive. • Malignant (Cancer) • Spreading, Invasive.

  6. Neoplasia: • Progressive, Purposeless, Pathologic, Proliferation of cells characterized by loss of control over cell division. • DNA damage at growth control genes is central to development of neoplasm. • Carcinogens – Chemical, physical & genetic  DNA damage  Neoplasm.

  7. Willis Definition: • Neoplasm is an abnormal mass of tissue the growth of which exceeds and is uncoordinated with that of normal tissue and persists in the same excessive manner after cessation of the stimuli which evoked the change

  8. Pathogenesis of Neoplasia: • Normal  Hyperplasia  Metaplasia (DNA damage)  Dysplasia  (DNA damage)  (DNA damage) Anaplasia (DNA damage) Infiltration  (DNA damage)  Metastasis…. • Progressive DNA Damage – features of neoplasia.

  9. Pathogenesis of Neoplasia: • Non lethal DNA Damage leading to uncontrolled cell division.

  10. Normal Adaptation Benign Malignant Mechanism of Neoplams Non-Neoplastic Neoplastic (Polyclonal) (Monoclonal)

  11. Structure of Neoplasm: • Neoplastic cells parenchyma. • Non-neoplastic - stroma (Connective tissue & BV) • Fast growth  less stroma • Less stroma  more necrosis,

  12. Cell of origin Rate of growth Differentiation Local Invasion Metastasis Lung cancer Grade - low, high Well, Mod, P, Un. Staging Staging Biology of Neoplasm: Lung cancer: Squamus cell carcinoma. Poorly differentiated, high grade, stage 4, Liver+

  13. Slow growing, capsulated, Non-invasive do not metastasize, well differentiated, suffix “oma” eg. Fibroma. Fast growing, non capsulated, Invasive & Infiltrate Metastasize. poorly differentiated, Suffix “Carcinoma” or “Sarcoma” Benign Malignant:

  14. Suffix - oma Fibroma Osteoma Adenoma Papilloma Chondroma Carcinoma / Sarcoma Fibrosarcoma Osteosarcoma Adencarcinoma Squamous cell carcinoma Chondrosarcoma Nomenclature: Cell of origin + Suffix Exceptions: Leukemia, Lymphoma, Glioma,

  15. Grading & Staging of Tumor • Grading – Cellular Differentiation (Microscopic) • Staging – Progression or Spread (clinical)

  16. TNM: Staging of tumor:

  17. Pathways of Spread: • Direct Spread • Body cavities • Blood vessels • Lymphaticvessels • Lungs – Systemic Venous blood • Liver – GIT venous return, nutrition. • Brain – End arteries.

  18. Tumor Diagnosis: • Historyand Clinical examination • Imaging - X-Ray, US, CT, MRI • Tumor markers Laboratory analysis • Cytology –Papsmear, FNAB • Biopsy - Histopathology, markers. • MolecularTech – Gene detection.

  19. Clinical Features. • Tumor Impingement on nearby structures • Pancreatic ca on bile duct  Obst. Jaund. • Ulceration/bleeding • Colon, Gastric, and Renal cell carcinomas • Infection (often due to obstruction) • Pneumonia, Urinary inf. • Rupture or Infarction • Ovarian, Bladder, colon,

  20. Cancer Cachexia • Progressive weakness, loss of appetite, anemia and profound weight loss (>20%) • Often correlates with tumor mass & spread • Etiology includes a generalized increase in metabolism and central effects of tumor on hypothalamus • Probably related to macrophage production of TNF-a

  21. Paraneoplastic Syndromes • Due to Products released by tumor • Cushing’s Syndrome • Adrenal, Lung Ca – ACTH • Inappropriate ADH syndrome (Hyponatremia) – lung ca • Hypothalamic tumors (vasopressin) • Hypercalcemia – Ca is the common cause. – lung. • Hypoglycemia - insulin or insulin like activities Fibrosarcoma, Cerebellar hemangioma.

  22. summary • neoplasia- uncontrolled cell division non responsive to growth controls. • Benign and Malignant • Naming – Cell of origin + Suffix • Oma, Carcinoma, Sarcoma • benign  slow-growing, well-differentiated, localized, do not metastasize, amenable to surgery.

  23. summary • malignant neoplasms tend to be fast-growing lesions which invade normal structures • malignant neoplasms vary in the degree of differentiation and some show anaplasia. • malignant neoplasms are capable of infiltration, invasion & metastasis.

  24. summary • The prognosis of a patient with any type of neoplasm depends on a number of factors including: the rate of growth of the tumor, the size of the tumor, the tumor site, the cell type and degree of differentiation, the presence of metastasis, responsiveness to therapy, and the general health of the patient.

  25. NEOPLASM Uncontrolled cell Division(DNA abnormality)

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