Pre-Lab Lecture Dr.

Renan Neoplasia / New Growth Abnormal mass of tissue, the growth of which exceeds and is uncoordinated with that of the normal tissues and persist in the same excessive manner after the cessation of stimuli, which evoked the change. Fundamental to the origin of all neoplasms are heritable or genetic changes that allow excessive and unregulated proliferation that is independent of physiologic growth regulatory stimuli.

Provides support for the growth of parenchymal cells, carries blood supply.

Nomenclature Benign Tumors Designated by attaching the suffix: OMA to the cell type which the tumor attaches. Ex: Fibroma benign tumor arising from fibrous tissue. Chondroma benign cartilaginous tumor Adenoma applied to benign epethial tumors producing gland patterns and neoplasm derived from glands. Papilloma composed of papillary structures. Exceptions: o o o o o o Sarcoma Lymphoma Mesothelioma Melanoma Seminoma Hepatoma Dysgerminoma Malignant neoplasm arising from mesenchymal tissues or its derivatives Fibrosarcoma malignant tumor fibrous tissue origin. Chondrosaroma neoplasm composed malignant chrondocytes. of a of

Oncology The study of tumors

Benign Tumors Gross and microscopic features are relatively innocent Remain localized Cannot spread to other sites Amenable to local surgical removal Patient generally survives Malignant Tumors Referred to as cancers Can invade tissues Can destroy adjacent structures Spread to distant sites: Metastasize to cause death. Basic Tumor Components Parenchyma Made up of transformed neoplastic cells Largely determines the tumors biological behavior Stroma The supporting, host derived, non-neoplastic portion of the tumor. Made up of connective tissue, blood vessels, hostderived inflammatory cells.

Ex:

Carcinoma

 Ex:

Malignant neoplasm of epithelial cell origin. Adenocarcinoma carcinomas that grow in a glandular pattern, Squamous Cell Carcinoma produces squamous cells.

Designated based on organ or tissue of origin. o Renal Cell Carcinoma kidneys o Cholangiocarcinoma bile ducts. Mixed Tumors Pleomorphic Adenomas (Salivary Gland) / Benign Mixed Tumor Epithelial elements on a fibromyxoid stroma Mesenchymal elements: islands of cartilage or bone. Fibroadenoma (Breast) Proliferation of ductal epithelial elements (adenoma_ Loose fibrous stroma (Fibroma)

Choristoma A congenital anomaly composed of heterotropic rest of cells, presenting as mass or nodule. (normal tissue in abnormal locations/site) Ex: A small nodule of well developed and normally organized pancreatic tissue may be found in the submocusa of the stomach or duodenum. Characteristics of Malignant Tumors Benign and

Differentiation Refers to the extent to which the parenchymal cells resemble their normal forebears morphologically and functionally. Desmoplasia Stromal reaction induced by the tumor, producing a dense, abundant fibrous stroma. Tumor Differentiation Well Differentiated Closely resemble normal counterparts. Retains the functional capabilities found in normal counterparts. Moderately Differentiated Some of the above criteria are retained and can also be like normally resembling the normal counterparts. Poorly Differentiated Do not resemble normal counterparts. Looks primitive, disorganized and immature.

Teratoma Tumors containing mature of immature cells representative of more than one, sometimes all three germ layers Normally present in ovary or testis, sometimes in sequestered midline embryonic rest. Should not be confused with mixed tumors. Harmatoma A malformation that presents as a mass of disorganized tissue indigenous to a particular site.

(Squamous cell carcinoma)

Keratin pearl automatically categorizes a tumor as well differentiated type. Anaplasia To form backward. Dedifferentiation or loss of the structural and functional differentiation of cells. Hallmark for malignancy. Pleomorphism Marked variation in size and shape Hyperchromasia Large, darkly staining nuclei (increase in DNA) Increased Nuclear to Cytoplasmic Ratio Normal NC ration 1:4 to 1:6 Tumor Giant Cells One enormous nucleus or several nuclei. Large/Prominent Nucleoli. Coarse and Clumped Chromatin. Presence of Abnormal Mitosis Dysplasia

Failure to develop recognizable patters of orientation to one another. are only

Polarized nucleoli oriented to one direction.

o Loss in the uniformity of individual cells and their architectural orientation in the epithelium. o Disorderly but not neoplastic proliferation of cells. o Exhibit pleomorphism, possess large, hyperchromatic nuclei. o More abundant mitotic figures than usual, appearing in abnormal locations within the epithelium All anaplastic cells are dysplastic but no all dysplastic cells are anaplastic

Tumor Giant Cells characteristic of metastatic neoplasm

Atypical Mitosis (Tripolar form) Loss of Polarity

Carcinoma in Situ o Dysplastic changes are marked o Involvement of the entire thickness of the epithelium o Pre- invasive cancer

Invasion Benign Tumors o Well-circumscribed and remain localized at their site of origin. o Does not have the capacity to infiltrate. invade of metastasize o May be encapsulated or unencapsulated. Malignant Tumors o Poorly circumscribed o Grow by progressive infiltration o Invade, destroy and penetrate the surrounding Metastasis Identifies a neoplasm as malignant The most reliable feature that distinguishes malignant from benign tumor. The more anaplastic and larger the primary neoplasm, the more like is the metastatic spread. Pathways Seeding within the body cavities Typical of ovarian cancers / most common in the peritoneal cavity Lymphatic spread Typical of carcinomas Hematogenous spread Typical of sarcomas

Tumors of mesenchymal origin o Connective tissues and derivatives Fibrous tissues Fibrous and Histolytic Fatty tissue Bone o Endothelial and related tissues o Blood cells and related cells o Muscle

Tumors of Epithelial Origin

Spindle in shape with blond nuclei benign

Simple Tumors

Nuclei are confined the periphery rendering the appearance of singlet ring.

Interlacing fascicles of fibrous tissues, no hemorrhage, necrosis and mitotic figures. Histogenetic origin Mesenchyme Cell Origin adipocytes

Cells (nuclei) are pleomorphic, hyperchromatic and coarse pattern of chromatic, prominent nuclei, increased NC ratio.

Benign Tumor of the bone

Adipose tissue, prominent in the back and extremities.

Benign osteocytes forming bone

rimming

the

Presence of bone erosion, tumor invaded the bone and bone marrow. Presence of hemorrhage.

Tumor giant cells with multiple nuclei Endothelial & Related Tissue Blood Vessels Lymph Vessels

2 Types of Hemangioma Capillary Hemangioma Small slit like capillaries Cavernous Hemangioma Bigger and more dilated capillaries

Note: Dilated Lymph vessels and absence of RBCs

Lymphadenopathies common on the cervical area, cannot diagnose without Reed sternberg cells. (binucleated, prominent macro nucleoli and shares common cytoplasm (acidophilic and eosinophilic) RS cell is malignant.

Tumors of Epithelial Origin Stratified Squamous Epithelium Basal cells of the skin Glandular Ductal Epithelial lining Respiratory Epithelium Neuroectoderm Renal Epithelium Liver cell Urinary tract epithelium Placental Epithelium Testicular Epithelium

Fingerlike projection of the squamous epithelium

Malignant cells are the lymphocytes.

Ulcerated/Necrotic/Hemorrhagic

+ keratin pearls.

Nuclei are polarized and located basally/ no invasion/ necrosis / hemorrhage

AKA: Rodents Ulcer Only difference is the presence of mucinous material in the cytoplasm

Basaloid Cells / Peripheral Palicading??? / Retraction artifact Route of metastasis: Lymphatic

Route of metastasis: lymphatic Histogenic Origin: Epithelial

Glandular proliferation / Presence of inflammatory cell infiltrates.

+ Psammoma bodies Well differentiated almost 100% glandular pattern.

Hemorrhage/ necoris/ distribution of papliations.

irregular

Their should be fibrovascular core for diagnostic of papillary type of cancinoma.

+papillations.

Cannot commit whether epithelial or mesenchymal - very prominent nucleoli and macro nucleoli / no particular pattern whether glandular, squamous or sarcomatous . + Orphan Ani Nuclei.

Several layers of proliferating malignant transitional cells.

Presence of trophoblastic (syncytiotrophoblast cytotrophoblast)

proliferation cells and

Extensive areas of hemorrhage Should not have the presence of villi

Trabecular thickened composed of several layers of malignant hepatocytes.

Germ Cell Tumor / Neoplasm of the testis.

Malignant

Malignant immature

Mixed tumor. Epithelial Components (duct architecture) and Mesenchymal Derivative (either cartilaginous of bony)

Presence of neuroectoderm signifies immaturity of the tumor Histologic and Cytologic Features of Tumors Benign Neoplasm Encapsulation Differentiation

Triphasic tumor 3 different cell types proliferation. 1. Stroma 2. Ductal Epithelial Cell 3. Blastema. Teratogenous Tumor. Benign mature teratoma. Ex. Ovary Complete encapsulation incomplete capsulation might be follicular carcinoma

Presence of capsule and proliferation of follicles, some does not contain colloid material. Malignant Neoplasm Differentiation Features of Anaplasia Mitosis Tumor Giant Cells Tumor Necrosis Stromal Invasion Desmoplasia Metastasis

and Features of Anaplasia Pleomorphism Hyperchromasia Increased N:C ratio Prominence of Nucleoli

Keratin Pearl Dyskeratotic Cells / Individual keratinization Intracellular Bridges tight junction connecting each keratonic cell

Invasion at LOWER LEFT side Presence of desmoplasia

Presence of malignant ductal cells in cords and tubular structures accompanied by a desmoplastic stroma.

Right side remnants of normal lymph nodes, Left - metastatic cells. Pre-invasive Lesions Ex: Dysplasia Intact Basement Membrane Cervical intraepithelial neoplasia (CIN III), Cervix. Intraductal CarcinomaIn-Situ, Breast

Urinary Bladder Transitional cells Malignant

Left side desplastic Right normal Lymph node

Full thickness dysplasia Metastasis

Malignant Intact Basement Membrane/Polarized Nuclei Serous Adenoma

Lymphoid Tissue Metastasis Adenocarcinoma

Lipoma Adipocytes Histogenetic mesenchymal

origin

Malignant Hyperchomicity/Increased ratio/Mitotic figures NC

Lipoma Adipocyes Mesenchymal Hematogenous

Liver Malignant

Benign Pleomorphic Adenoma (mixed type)

Thyroid Papillary Carcinoma of the Thyroid Lyphatic Route

Teratoma 3 germ cell layers Metastatic Adeno Carcinoma

Desmoplasia Cannon balling - classic sign, as a general rule metastasis are usually multiple against benign which is solitary

Renal Cell Carcinoma

Metastatic Adenocarcinoma

Benign Follicular Adenoma of the Thyroid