Carcinomas

Carina Dudas (Petricau) and Maria

Anastasapolu

Definition
A carcinoma is a malignant growth that

arises from the _____________.

Two general classes:
Epithelial Membranes covering/lining of

organs
________________

Glandular Epithelium - epithelial cells grow

down into the connective tissue and form

glands
________________

Classified by epithelium type

Columnar/ Cuboidal epithelium

GI tract (ex: Colorectal carcinoma)

Thyroid (ex: thyroid carcinoma)
Trachea (ex: Adenoid cystic carcinoma )
Kidney (ex: Renal cell carcinoma, urothelial carcinoma of
renal pelvis)

Squamous epithelium
Skin (ex: Basal cell carcinoma)
Vagina/ outer cervix (ex: adenosquamous carcinoma of

cervix)
Distal urethra (ex: squamous cell carcinoma of distal urethra)
Esophagus (ex: squamous cell carcinoma of the esophagus)
Larynx (ex: laryngeal carcinoma)
Glandular epithelium
Breast, cervix, fallopian tubes, ovaries, prostate, pancreas

Figure 1

Urothelial (transitional cell)

tumors

Represent about 90% of all bladder tumors

May appear anywhere between the renal

pelvis to the distal urethra

Urothelial tumors vary by form (papillary,
nodular, flat) and by depth (noninvasive,
invasive)

Morphology of urothelial
tumors

Histological criteria:
Transitional cell carcinoma
Hyperplasia (increased number) of epithelial cell

layers
Increased papillary folding of urothelium
Abnormalities of nuclear morphology
Hyperchromatic nuclei

Loss of cellular polarity

Abnormalities of the normal cellular maturation

from basal to superficial layers

Presence of giant cells
Increased nuclear to cytoplasm ratio
Frequent mitotic figures
Loss of cellular cohesiveness
Widened intracellular spaces

Papillary urothelial
carcinomas

Low-grade papillary urothelial

carcinoma with an overall
orderly appearance, a thicker
lining than in papilloma, and
scattered hyperchromatic nuclei
and mitotic figures.

High-grade papillary
urothelial carcinoma with
marked dyscohesive cells, large
hyperechromatic nuclei, frequent
mitotic figures

Carcinoma in situ ( flat)

Normal urothelium with uniform

nuclei and well-developed umbrella
cell layer

Flat carcinoma in situ with

numerous cells having enlarged
and pleomorphic nuclei, loss of
cellular cohesiveness, hyperplasia
of urothelium

Invasive urothelial cancer

Urothelial carcinoma which

invades the lamina propria or

deeper
Associated with either highgrade papillary urothelial cancer
or with carcinoma in situ

Figure 2

Colorectal Cancer

98% of colorectal cancers are adenocarcinomas

Colorectal cancer
Distribution of the colorectal cancers:

22%: cecum/ascending colon

11%: transverse colon
6%: descending colon
55%: rectosigmoid colon
6%: other sites

All colorectal carcinomas begin as in situ lesions, but

evolve into different morphologic patterns (gross

pathology):

Right-sided colonic adenocarcinomas- extend along one

wall of the cecum and/or ascending colon; usually no

obstruction is present
Left-sided colonic adenocarcinomas- annular, encircling
lesions that produce constrictions of the bowel (lumen is
narrowed and proximal bowel distended)

Gross Pathology

Carcinoma of the cecum

Carcinoma of the descending colon

Subtypes of colorectal cancer

Mucinous carcinoma
Signet ring carcinoma
Basaloid carcinoma
Anaplastic carcinoma
Endocrine differentiation
Scattered endocrine cells
Small cell carcinoma

Histopathology of colorectal
cancer

Well-to-moderately differentiated adenocarcinoma secreting

variable amounts of mucin

Tumor cells are a combination of

Columnar cells and goblet cells; occasional endocrine cells

Consistent inflammatory and desmoplastic reaction:

prominent at edges
Presence of inflammatory cells:
most T lymphocytes
May also find:
B lymphocytes
plasma cells
Histocytes
occasionally numerous eosinophils

Edge of tumor:

may show foci of residual polyp

hyperplastic change in glands:
taller
more tortuous
more goblet cells
alterations in mucin secretion

Pathologic staging of colorectal

cancer

Figure 3

Skin Cancer
Most common types:
Basal cell carcinoma
Squamous cell carcinoma
Melanoma

Basal cell carcinoma

Figure 4
Common, slow-growing tumor, not painful and does not itch; rarely

metastasizes but destroys adjacent tissue by extending downward into

the dermis
Clinically: pearly papules often containing telangiectasias (nodular
subtype)
Open sore- rodent ulceration

Morphological changes of
BCC
Tumor cells resemble the normal basal cells of
epidermis, but tumor cells have larger nucleus :
cytoplasm ratio and hyperchromic nuclei
Two major patterns are seen:
Multifocal growths- originating from epidermis and
extending over skin surface
Nodular lesions- growing downward, deep into dermis
as cords and islands
The cells forming the periphery of the tumor cell islands
have a palisading arrangement but the central cell are
irregular or spindle shaped with intracellular bridges
Basal cell nests or islands are separated from
surrounding stroma by clefts
Mitotic figures are very rarely observed

Basal Cell Carcinoma

Squamous cell carcinoma

Common, derived from keratinocytes of the

epidermis, invades the dermis

Clinically: raised, firm, pink-to-fleshcolored
keratotic papule, often ulcerated

Morphological changes in
SCC
Tumor cells are large and have

hyperchromatic, pleomorphic nuclei

Dysplasia of cell in the full depth of epithelium
When these cells break through basement

membrane= invade dermis

Most cells are well differentiated and produce
large amounts of keratin
keratin pearls (onion like swirls) in the dermis
Intracellular bridges (space)- loss of
homotypic cell adhesion

Squamous Cell Carcinoma

References
http://www.ilpi.com/msds/ref/carcinoma.html
Kumar et al., Pathologic Basis of Diseases 7 th edition, Robbins and Cotran.

2005.
Figure 1: Dangle et al. World Journal of Surgical Oncology 2008 6:103

Davison et al., Oxford textbook of cinical nephrology, Volume 1. 2005.

Figure 2:

http://www.microscopyu.com/staticgallery/pathology/adenocarcinomaofcolon20x
02.html
http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-

8675%2806%2970060-2
http://www.mayoclinic.com/health/skin-cancer/DS00190
Figure 3: http://skincancer-fact.com/skin-cancer-type-basal-cell-carcinoma-bcc/
http://emedicine.medscape.com/article/1101535-overview
Figure 4: http://dermnetnz.org/lesions/img/bcc-face/source/1.html