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NEOPLASM-3

NEOPLASM-3. Zhu keqing 竺可青 Pathology Department Zhejiang University School of Medicine 2014-5-27. 5. 良性肿瘤和恶性肿瘤的区别. 组织分化程度，异型性 核分裂像 生长速度 生长方式 继发改变 转移 复发 对机体影响. Comparisons Between Benign and Malignant Tumors. Differentiation/anaplasia

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NEOPLASM-3

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  1. NEOPLASM-3 Zhu keqing 竺可青 Pathology Department Zhejiang University School of Medicine 2014-5-27

  2. 5. 良性肿瘤和恶性肿瘤的区别 • 组织分化程度，异型性 • 核分裂像 • 生长速度 • 生长方式 • 继发改变 • 转移 • 复发 • 对机体影响

  3. Comparisons Between Benign and Malignant Tumors • Differentiation/anaplasia • B:Well differentiated; structure may be typical of tissue of origin • M:Some lack of differentiation with anaplasia; structure is often atypical • Rate of growth • B:Usually progressive and slow; may come to a standstill or regress; mitotic figures are rare and normal • M:Erratic and may be slow to rapid; mitotic figures may be numerous and abnormal • Local invasion • B:Usually cohesive and expansile well-demarcated masses that do not invade or infiltrate surrounding normal tissues • M:Locally invasive, infiltrating the surrounding normal tissues; sometimes may be seemingly cohesive and expansile • Metastasis • B:Absent • M:Frequently present; the larger and more undifferentiated the primary, the more likely are metastases

  4. Borderline tumor 交界性肿瘤 • 组织形态介于良恶性肿瘤之间的肿瘤 • 有恶变倾向Malignant potential、Malignant change • 良恶性并非一成不变。 • 如卵巢交界性浆液性乳头状囊腺瘤。

  5. Comparison between a benign tumor of the myometrium (leiomyoma) and a malignant tumor of similar origin (leiomyosarcoma).

  6. 6 肿瘤的命名和分类 命名原则 • 根据其组织来源和生物学行为命名 • 良性肿瘤—组织来源+瘤 • 恶性肿瘤---组织来源+癌（上皮来源） • 组织来源+肉瘤（间叶来源） • 结合形态特点命名 • 少数肿瘤的命名 肿瘤分类原则 • 以组织发生为依据 • 根据分化成熟程度 • 对机体影响

  7. Nomenclature & Classification • In general, benign tumors are designated by attaching the suffix -oma to the cell of origin. Tumors of mesenchymal cells generally follow this rule • Malignant tumors arising in mesenchymal tissue are usually called sarcomas (Greek sar = fleshy) • Malignant neoplasms of epithelial cell origin, derived from any of the three germ layers, are called carcinomas

  8. benign tumors -oma fibroma lipoma adenoma squamous cell papilloma papillary cystadenoma

  9. malignant tumors (cancers) epithelial： carcinoma squamous cell carcinoma adenocarcinoma papillary cystadenocarcinoma mesenchymal： sarcoma fibrosarcoma liposarcoma

  10. Exceptions: -blastoma Neuro-blastoma Medullo-blastoma Nephro-blastoma Osteo-blastoma Chondro-blastoma Lipo-blastoma

  11. Schwannoma Ewing’s sarcoma Hodgkin’s lymphoma Wilms’ tumor

  12. malignant melanoma malignant schwannoma malignant meningioma malignant lymphoma oat cell carcinoma clear cell sarcoma seminoma leukemia

  13. The WHO Classification of Tumors

  14. Precancerous Conditions • Certain non-neoplastic disorders mostly related with chronic inflammatory states, have a well-defined association with cancer that they have been termed precancerous conditions • Certain forms of benign neoplasia also constitute precancerous conditions

  15. Nomenclature and classification • -oma:adenoma,leiomyoma • Carcinoma 癌:squamous cell carcinoma, adenocarcinoma, Sarcoma 肉瘤: undifferentiated sarcoma • Carcinosarcoma 癌肉瘤 • -blastoma:osteoblastoma, neuroblastoma, medulloblastoma • Seminoma, leukemia • Ewing’s sarcoma, Hodgkin lymphoma • Neurofibromatosis • Teratoma

  16. 肿瘤分类 • 上皮组织来源的肿瘤 • 间叶组织来源的肿瘤 • 淋巴造血组织来源的肿瘤 • 神经组织来源的肿瘤 • 其他肿瘤

  17. Nomenclature of Tumors • Tissue of Origin Benign Malignant • Tumors of epithelial origin 上皮来源 • Stratified squamous Squamous cell papilloma Squamous cell carcinoma • Basal cells of skin or adnexa Basal cell carcinoma • Epithelial lining of glands or ducts Adenoma Adenocarcinoma • Papilloma Papillary carcinomas •   Cystadenoma Cystadenocarcinoma • Respiratory passages Bronchial adenoma Bronchogenic carcinoma • Renal epithelium Renal tubular adenoma Renal cell carcinoma • Liver cells Liver cell adenoma Hepatocellular carcinoma • Urinary tract epithelium (transitional) Transitional cell papilloma Transitional cell carcinoma • Placental epithelium Hydatidiform mole Choriocarcinoma • Testicular epithelium (germ cells) Seminoma， Embryonal carcinoma • Tumors of melanocytes Nevus Malignant melanoma

  18. Nomenclature of Tumors • Tissue of Origin Benign Malignant • Tumors of mesenchymal origin 间叶组织来源 • Connective tissue and derivatives Fibroma Fibrosarcoma • Lipoma Liposarcoma • Chondroma Chondrosarcoma • Osteoma Osteogenic sarcoma • Endothelial and related tissues • Blood vessels Hemangioma Angiosarcoma • Lymph vessels Lymphangioma Lymphangiosarcoma • Synovium Synovial sarcoma • Mesothelium Mesothelioma • Brain coverings Meningioma Invasive meningioma • Blood cells and related cells • Hematopoietic cells Leukemias • Lymphoid tissue Lymphomas • Muscle • Smooth Leiomyoma Leiomyosarcoma • Striated Rhabdomyoma Rhabdomyosarcoma

  19. Tissue of Origin Benign Malignant • More Than One Neoplastic Cell Type-Mixed Tumors, Usually Derived from One Germ Cell Layer • Salivary glands Pleomorphic adenoma (mixed tumor of salivary origin) Malignant mixed tumor of salivary gland Renal anlage 肾胚基 Wilms tumor • More Than One Neoplastic Cell Type Derived from More Than One Germ Cell Layer-Teratogenous • Totipotential cells in gonads or in embryonic rests Mature teratoma Immature teratoma, teratocarcinoma

  20. 7. 常见肿瘤举例 上皮性肿瘤 良性上皮性肿瘤 • 乳头状瘤 papilloma • 腺瘤 adenoma • 囊腺瘤 cystadenoma • 纤维腺瘤 fibroadenoma • 多形性腺瘤 pleomorphic adenoma • 息肉状腺瘤 polypous adenoma

  21. 乳头状瘤 papilloma • 好发部位：皮肤、胃肠道、泌尿道 • 眼观：向表面呈外生性生长，乳头状或指状突起，并可呈菜花状或绒毛状 • 镜下：每一乳头由具有血管的分支状结缔组织间质构成轴心（中心索），表面覆盖上皮可为鳞状上皮、柱状上皮、移行上皮 • 外耳道、阴茎、膀胱、结肠的乳头状瘤易恶变为乳头状癌

  22. Papilloma of the colon with finger-like projections into the lumen

  23. Colonic polyp

  24. 腺瘤 adenoma • 多见于甲状腺、卵巢、乳腺、唾液腺、肠道 • 眼观：位于粘膜面多呈息肉状或绒毛状；腺器官内多呈结节状，且有包膜、边界清。常有分泌功能。 • 镜下：腺上皮伴不同程度的异型性，腺体大小形状不规则，排列较密集。 • 类型： • 囊腺瘤 • 纤维腺瘤 • 多形性腺瘤 • 息肉状腺瘤

  25. 囊腺瘤 cystadenoma • 多见于卵巢、偶见甲状腺及胰腺。 • 肉眼：腺体分泌物淤积，腺腔扩大融合呈囊状，可见大小不等的囊腔。 • 镜下： • 浆液性乳头状囊腺瘤 serous papillary cystadenoma • 粘液性囊腺瘤 mucinous cystadenoma • 浆液性乳头状囊腺瘤易恶变

  26. 纤维腺瘤 fibroadenoma • 女性乳腺 • 镜下：除腺上皮细胞增生形成腺体外，同时伴大量纤维结缔组织增生，共同构成实质

  27. Fibroadenoma

  28. 多形性腺瘤 pleomorphic adenoma • 由腺组织、粘液样及软骨样组织等多种成分混合组成 • 常发生于唾液腺（腮腺），又称混合瘤 • 生长缓慢，但易侵犯包膜，切除后易复发

  29. This mixed tumor of the parotid gland contains epithelial cells forming ducts and myxoid stroma that resembles cartilage

  30. 息肉状腺瘤 polypous adenoma • 又称腺瘤性息肉 • 多见直肠，也见于结肠、胃 • 表面乳头状恶变率高 • 结肠多发性腺瘤性息肉病有家族遗传性，癌变率高，易早期癌变。

  31. Hyperplastic polyp

  32. Familial adenomatous polyposis in an 18-year-old woman

  33. Here is a small hepatic adenoma, an uncommon benign neoplasm, but one that shows how well-demarcated an benign neoplasm is.

  34. 恶性上皮组织肿瘤 • 人类最常见恶性肿瘤，统称为癌 • 浸润性生长 • 质地硬，切面灰白色，干燥 • 形成癌巢，早期淋巴道转移 • 常见类型 • Squamous cell carcinoma • Basal cell carcinoma • Transitional cell carcinoma • Adenocarcinoma • Undifferentiated carcinoma

  35. Squamous cell carcinoma • 披覆鳞状上皮如皮肤、口腔、唇、子宫颈、阴道、食管、喉、阴茎 • 通过鳞化：支气管、胆囊、肾盂 • 眼观：菜花状或结节状，中央可坏死脱落形成溃疡。切面向深处浸润性生长。 • 镜检：细胞间桥和角化珠 keratin pearl,低分化者无

  36. Well-differentiated squamous cell carcinoma of the skin.

  37. 鳞状细胞癌Ⅰ级 大部分棘细胞呈分化现象，有明显的细胞间桥和角化珠形成，间变的棘细胞较少。

  38. Basal cell carcinoma • 好发于老年人面部如眼睑、脸颊、鼻翼 • 起源于表皮原始上皮或基底细胞层 • 眼观：扁平斑块 中央坏死形成溃疡 • 癌巢由浓染的基底细胞样癌细胞构成 • 生长缓慢，很少转移 • 对放疗敏感，低度恶性

  39. Basal cell carcinoma of the vulva

  40. Transitional cell carcinoma • 好发部位：膀胱、肾盂 • 乳头状，多发性 • 似移行上皮，多层排列，异型性明显 • 易复发

  41. The urothelial carcinoma does resemble urothelium, but the thickness is much greater than normal and the cells show more pleomorphism.

  42. Adenocarcinoma • 胃肠、甲状腺、胆囊、乳腺 • 腺上皮发生 • 类型 • 腺癌 adenocarcinoma：乳头状腺癌、囊腺癌、乳头状囊腺癌 • 粘液癌 mucoid carcinoma（胶样癌colloid carcinoma）：印戒细胞癌 signet ring cell carcinoma、粘液腺癌 mucinous adenocarcinoma • 实体癌solid carcinoma（单纯癌 carcinoma simplex）：低分化腺癌硬癌 scirrhous carcinoma、髓样癌 medullary carcinoma

  43. Malignant tumor (adenocarcinoma) of the colon

  44. Benign tumor (adenoma) of the thyroid. Note the normal-looking (well-differentiated), colloid-filled thyroid follicles

  45. Invasive ductal carcinoma

  46. A, Well-differentiated invasive carcinoma of no special type. Well-formed tubules and nests of cells with small monomorphic nuclei invade into the stroma with a surrounding desmoplastic response. B, Poorly differentiated invasive carcinoma of no special type. Ragged sheets of pleomorphic cells without tubule formation infiltrate into the adjacent stroma.

  47. Invasive lobular carcinoma. Parallel arrays of small, regular cells with scant cytoplasm infiltrate singly in linear arrays or as small clusters of cells.

  48. Medullary carcinoma 髓样癌The cells are highly pleomorphic with frequent mitoses and grow as sheets of cohesive cells.

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