TUMOR SISTEM

ALIMENTARI
 Reparative lesion:
EPULIS

Excessive reparative process

-Granulomatous epulis
-Fibromatous epulis
-Giant cell epulis
-Haemangioform epulis
-Pregnancy epulis
LEUKOPLAKIA
- white patches of keratosis
- premalignant lesion
- hyperkeratosis, hyperplasia of the squamous epithelium
- dysplastic changes

SQUAMOUS CELL CARCINOMA

Pleomorphic adenoma (parotid)
Pleomorphic adenoma (parotid)
Pleomorphic adenoma (gross)
Pleomorphic adenoma
Pleomorphic adenoma
 Warthin tumor

Benign tumor mostly occur in parotid gland

 Warthin tumor

Cystic spaces lined by double-layered eosinophilic epithelium,

and all embedded in lymphoid stroma
 Oncocytoma

Mostly in parotid gland

 Oncocytoma

Large granular appearing, eosinophilic-staining epithelial cells

Adenoid cystic carcinoma

Minor salivary gland

Adenoid cystic carcinoma
 Adenoid cystic carcinoma

Most characteristic appearance consists of cribriform pattern

with masses of small, dark-staining cells arrayed arround
cystic spaces
Adenoid cystic carcinoma
Mucoepidermoid tumor
(Palatal gland)

Mostly in parotid gland

 Mucoepidermoid tumor
(Low grade)

Comprised of mucus-producing and epidermoid omponents

and cells intermediate between the two
Mucoepidermoid tumor
(moderate grade)
Mucoepidermoid tumor
(High grade)
Perforation of the cheek:
cancer of the tongue
 III. Diseases of the Esophagus
F.2. BARRET’S ESOPHAGUS

Columnar metaplasia (often of intestinal type with prominent goblet cells) of

esophageal squamous epithelium.
Complication of long-standing gastroesophageal reflux, to be a well-known
precursor of esophageal adenocarcinoma
 III. Diseases of the Esophagus
G.1. Squamous Cell Carcinoma

Arises most frequently in the upper and middle thirds

of the esophagus
 III. Diseases of the Esophagus
G2. Adenocarcinoma

Arises most frequently in the lower third, and mostly from

aberrant gastric mucosa or Barret’s esophagus
STOMACH
ATROPHIC
GASTRITIS
H.pylori
Helicobacter pylori (gastric mucosa)
(silver stain) x 300
H. PYLORY AND CHRONIC GASTRITIS
Intestinal metaplasia: stomach
(alkaline phosphatase) x 50
 OTHER GASTRITIS

 Eosinophyillic gastritis: food allergy ?

 Granulomatus gastritis: tuberculosis,
syphilis, sarcoidosis, fungi, Crohn
disease
 Reflux gastritis: duodenal and bile
reflux
 Menetrier disease (giant hypertrophic
gastritis)
Menetrier disease (HYPERTROPHIC GASTROPATHY)
 Severe hyperplasia of mucosal layer
cells + glandular atrophy  extreme
enlargement of gastric rugae
 Hypertrophic gastropathy + hyper-
secretion: mucosal cells, parietal and
chief cells hyperplasia.
 Gastrinoma  excessive gastrin
excretion  gastric glandular
hyperplasia (Zollinger-Ellison
syndrome)
 Sometimes with severe loss of plasma
proteins from the altered mucosa
 Risk of peptic ulcer
TRIGER FACTORS OF PEPTIC ULCER
 Cylindric epithelia

Necrotic debris

Granulation tissue with lymphocytic infiltration

Glands hyperplasia

Edema

PEPTIC ULCER
 I. Diseases of the stomach
D. Tumors of the stomach (benign)
POLYP
- Polypoid mass
– >90% non neoplasm (inflammatory/
hyperplasia)
– Sessile / pedunculated
– 20-25% multiple
– Mostly occur in chronic gastritis
– No malignant potential
ADENOMA
– neoplasm  5-10% of gastric polyp
– Sessile / pedunculated
– distal – antrum predominant
– Six decade, Male: female = 2:1
– Some cases origin from chronic gastritis with
intestinal metaplasia
 I. Diseases of the stomach

D. Tumors of the stomach (malignant)

 90-95% of gastric malignancy
 High incidence: japan, Chili, Costa Rica, China
 Location: - 40-50% pylorus/anthrum; 25% cardia
- 40% minor curvature; 12% c. major
- Etiology:
- Diet
- Chronic atrophic gastritis
- H. pylori infection
- partial gastrectomy
- Gastric Adenoma
- Genetic : A blood group, family factor
 GASTRIC CANCER
– Invasion
 Early ( mucosa and sub- mucosa)

 Advanced (invade the sub- mucosa)

– Macroscopic growth
 Exophytic

 flat/ depressed

 Excavation

Linitis plastica – tumor cells diffusely infiltrate

gastric wall  leather bottle appearance
– Histology
 intestinal gland type

 Diffuse: signet-ring cell

 The differences between a
benign and a malignant ulcer
Benign or malignant?
 Answer :
 Benign.
 Clear, sharp, punched out borders.
No neoplastic mass present. Benign
peptic ulcer.
Benign or malignant?
 Answer :

Malignant.
 Large ulcer. The margins are
irregular and you can see the mass
under the ulcer.
The Growth of Gastric Cancer
 Sessile adenoma

Dysplasia: characterized by a flat lesion

 Other gastric tumors
 MALIGNANT LYMPHOMA
– 40% malignant lymphoma of GIT
– 5% of gastric malignancy
– B cell type predominant, MALT origin
 CARCINOID TUMOR  Carcinoid syndrome
– Low grade malignancy
– Metastasis to the liver
– Multiple lesions
 LEIOMYOMA
 SECONDARY TUMORS (METASTASIS)
– rare
– Mostly from leukemia or general
lymphoma
– From breast / lung cancer  diffuse 
linitis plastica
Early Gastric Carcinoma
Early Gastric Carcinoma

Scanning power view of histologic section

Early Gastric Carcinoma

Scanning power view of histologic section

 Gastric
Carcinoma
 Gastric
Carcinoma
 Gastric
Carcinoma
 Gastric
Carcinoma
 Gastric
Carcinoma

Signet ring cells

Signet ring cells (PAS +)

Gastric Carcinoid Tumor
Gastric Carcinoid Tumor
Gastric Carcinoid Tumor
Gastric Carcinoid Tumor
Gastric Carcinoid Tumor
Gastric Carcinoid Tumor
Gastro-Duodenal junction

Stomach: Glandular
arrangement

Pyloric sphincter

Duodenum: villous
arrangement

Brunner’s gland

Circular muscle

Longitudinal muscle
 Duodenum
Villi

Mucosa

Submucosa
Muscularis
mucosae

Circular layer

Longitudinal layer Brunner’s gland

Duodenum

Villi

Crypt of Lieberkuhn

Lamina propria

Muscularis mucosa

Submucous

Glands
 Duodenum
(PAS staining)

Goblet cells

Brunner’s gland
Duodenum
Small Intestine

Mucosa

Villi

Peyer’s patches

Plicae circulares

Vascular submucosa

Muscularis mucosae

Circular muscle layer

Longitudinal muscle

Serosa
Small Intestine
Villi

Lamina propria

Crypt of Lieberkuhn

Muscularis mucosae
 Ileocecal Junction

Lymphoid tissue

Small intestine Muscularis propria Large intestine

II. Diseases of the Small Intestine

A. Peptic Ulcer
B. Crohn Disease
C. Meckel Diverticulum
D. Malabsorption syndrome
E. Tumors of the Small Intestine
 Colon

Lymphoid
aggregates

Circular layer

Longitudinal
layer
Colon
Colon
Colon
Recto-anal Junction

The junction

Squamous epithelia

Rectal mucosa
Adenomatous polyp
Colon adenoma
What kind of polyp is this?
 The answer :
tubulovillous adenoma
 What kind of polyp is this?
 This is a gross morphologic term and does
not describe the histopathologic features of
the lesion.
 It could be adenomatous or a simple type of
polyp.
 A correct diagnosis of a polyp can only be
given after a histologic examination.
Ulcerative Colitis
Familial Adenomatous Polyposis
Polyposis of the colon
ULCUS CARCINOMATOSA
Ulcerating carcinoma of the colon
Adenocarcinoma of the colon
Colon Carcinoma
Adenocarcinoma of the colon
(PAS) x 100
Mucinous carcinoma of the colon
Signet-ring cell carcinoma of the colon
(HE) x 100
Adenocarcinoma, NOS
CEA: carcinoma of the colon
(IH) x 50
 Peritoneal carcinosis:
metastatic rectal carcinoma
Dukes’ Stage
 ASTLER - COLLER
Five-year survival rate
A – tumor terbatas di mukosa  100%
B1 – sampai dengan muskularis propria,
belum sampai ke limfonodi 67%
B2 – menembus muskularis propria,
belum sampai ke limfonodi  54%
C1 – sampai dengan muskularis propria,
sudah sampai limfonodi  43%
C2 – menembus muskularis propria,
sudah sampai limfonodi  22%
D – metastasis jauh  sangat rendah
SINDROM CARCINOID
DIARRHOEA
FLUSHING --------- > CYANOSIS
HYPOTENSION
DYSPNEU
EDEMA / ASCITES
STENOSIS OF TRICUSPID OF PULMONARY VALVES
Carcinoid of the appendix
(HE) x 75

(IH; chromogranin) x 75
 Practical Work:

Hepatobiliary & Pancreas

Normal liver
Normal hepatic lobe (EvG)

Normal hepatocytes
Diagram of the
liver lobule

(Vena centralis)
Simple hepatic
acinus
 Acinar
agglomerate
 Hepatic Lobule

Central vein Portal tract

Collagenous tissue
 Hepatic Lobule

Portal tract Central vein

Hepatic Lobule

Central vein

Portal tract

Collagenous tissue
Portal Tract
Hepatic artery

Lymphatics

Hepatocytes (anatomosing
plates)

Hepatic portal vein

Bile ductules

Hepatic sinusoid
 Liver parenchyme

Binucleate cells Glycogen granules

Sinusoid lining cells
Sinusoid lining cells

Kupffer cells

Endothelial cells
Bile canaliculi

Canals of Hering
 Bile
canaliculi

Binucleate cells

Walls of the canaliculi

 Fetal Liver

Erythroid

Megakaryocytes Myeloid precursors

 Chronic Hepatitis

Piecemeal necrosis, irregular interface between

parenchyma and connective tissue
 Chronic Hepatitis

The outlines of the enlarged and inflamed portal tract are

blurred by iecemeal necrosis
 Chronic Hepatitis

Spikes of inflammation extent from portal connective tissue

into the parenchyma
 Chronic Hepatitis

Reticulin staining: fibrosis is more clearly seen

Chronic Hepatitis

Bridging necrosis
Chronic Hepatitis (C)

Lymphoid tissue with germinal center

Cirrhosis Hepatis
Cirrhosis Hepatis
 liver cirrhosis

Micronodular Macronodular
Cirrhosis Hepatis
Cirrhosis Hepatis

Hepatocellular regenration
Cirrhosis Hepatis

Recently formed bridging necrosis

Cirrhosis Hepatis

Micronodular pattern
 Liver cirrhosis

active septum passive septum

Cirrhosis Hepatis
Steatosis
Microcystic Steatosis
Periportal Steatosis
Hepatocellular Carcinoma
Hepatocellular Carcinoma
Hepatocellular Carcinoma
Hepatocellular Carcinoma
Hepatocellular carcinoma
 Hepatocellular Carcinoma

Bile production
Left: moderately diff. (abundant); right: poorly diff.(hardto find)
Hepatocellular Carcinoma
Hepatocellular Carcinoma
 Cholangiocarcinoma

The large tumor has an irregular, infiltrative margin. The central

white area is calcified. No cirrhosis in non-neoplastic liver.
Intrahepatic Cholangiocarcinoma

The yellow foci of necrosis in the large mass

Intrahepatic Cholangiocarcinoma

Moderately diff. glandular lumina are present (left), but not

well-formed; on the right there are glandular lumna as well
as solid areas.
 Intrahepatic Cholangiocarcinoma

Vascular spread is shown in sinusoid (left), and in portal vein

branches (right)
 Intrahepatic Cholangiocarcinoma

Hepatocyte antigen positive in Cytokeratin 7, cytoplasmic staining

normal liver cell (left), while the
tumor on the right is negative
 Gall Bladder

Muscular layer

Collagenous adventitial coat (serosa)

Submucosa
 Gall Bladder

Spiral valve of Heister: the wall of cystic duct which is

formed into a twisted mucosa-covered fold.
 Pancreas
Intralobular duct Septa

Fat cells Islet of Langerhans

 Pancreas

Glandular acini

Supporting tissue
Pancreas

Intercalated ducts

Centroacinar cells

Interlobular ducts
Pancreas Ectopic