NEOPLASIA 1

Berti Nelwan
NEOPLASMA I

 DEFINISI & NOMENKLATUR

 KARAKTERISTIK NEOPLASMA JINAK
& GANAS
• Diferensiasi & Anaplasia
• Kecepatan Pertumbuhan
• Invasi Lokal
• Metastasis
Neoplasia

• Process of “new growth”

• State of poorly regulated cell

growth in which the neoplastic
cells are said to be transformed
Neoplasm

• Abnormal mass or tissue  neoplastic

mass of cells called tumor
 Composed of cells that grow in a
poorly regulated manner
 Cellular proliferation and growth occur
in the absence of any continuing
external stimulus
 Each neoplastic cell has an alteration in its
genome, responsible for abnormal growth
DEFINISI NEOPLASMA
Pertumbuhan baru dimana
terdapat diferensiasi sel,
maturasi dan kontrol
pertumbuhan yang
abnormal
Ruppert Willis, Oncologist, 1954:
Suatu massa jaringan abnormal yang tumbuh
berlebihan dan tidak teratur di sekitar jaringan
normal yang akan berlangsung terus walaupun
rangsangan penyebab sudah hilang dan
mengakibatkan timbulnya perubahan.
 Insiden

• Why we have to learn about cancer/ tumor?

• Cancer is the second leading cause of death
• In the year 2000,
–10 million new cases of cancer
–6 million cancer deaths worldwide.
• In the United States 2003,
–Cancer caused 556,000 death/year
–1500 cancer deaths per day.
Neoplasm
 Neoplasm
Heritable genetic alterations

Passed down from

progeny of tumor
cells Excessive and unregulated
proliferation

Becomes independent of
physiologic growth stimuli
(autonomous growth)

PERSISTENCE OF TUMOR
Characteristics of Neoplasia

Uncontrolled growth of Abnormal cells

1. Benign
2. Malignant
3. Borderline
Oncology defined

• Branch of
medicine that
deals with the
study,
detection,
treatment and
management
of cancer and
neoplasia
 Language of Oncology
• Neoplasm: (meaning new growth that is
“autonomous”); scientific term for a tumor.
• May be “malignant or benign”
• Other “plasias”:
– Hyperplasia: an increase in cell number
– Hypertrophy: an increase in cell size but not
number
– Metaplasia: a reversible process where one cell
type changes into another cell type
 Non-Neoplastic Proliferation:
Controlled & Reversible
• Hypertrophy – Size
• Hyperplasia – Number
• Metaplasia – Change
• Dysplasia – Disordered
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.

• Normal  Hyperplasia  Metaplasia (DNA damage) 

Dysplasia  (DNA damage)  (DNA damage) Anaplasia (DNA damage)
Infiltration  (DNA damage)  Metastasis….
• Progressive DNA Damage – features of neoplasia.
 KARSINOGEN (PENYEBAB KANKER)

• Bahan kimia
• Nitrosamin kanker usus
• Virus
• HPV kanker serviks
• HCV, HBV kanker hati
• Epstein Barr kanker nasofaring
• Radiasi
• bom hiroshima kanker paru,
• Chernobil kanker tiroid
• Hormon
• Estrogen kanker payudara dan
endometrium
• Dll
 Pathogenesis of Neoplasia:
• Non lethal DNA Damage leading to uncontrolled
cell division.
Klasifikasi & Tata Nama
Structure of Neoplasm:
• Parenchyma:
–sel tumor yang proliferatif, yang
menunjukkan sifat pertumbuhan dan
fungsi bervariasi menyerupai sel
asalnya (produksi kolagen, musin,
keratin).
• Stroma
–Pendukung parenkim tumor: jaringan
ikat dan pembuluh darah
 NOMENKLATUR

Tumor ada 2 komponen dasar:

1. Parenkhim
2. Stroma penunjang

parenchyma

supporting stroma
 BENIGN TUMORS
Suffix- “OMA” is used
• Adipose tissue: LipOMA
• Bone : osteOMA
• Muscle : myOMA
• Blood vessels : angiOMA
• Fibrous tissue : fibrOMA
Tumor Ganas

Mesenkhim Sarkoma
Neoplasma ganas asal
Epitelial Karsinoma

LIPOSARKOMA
FIBROSARKOMA
OSTEOSARKOMA
ADENOKARSINOMA
KARSINOMA SEL SKUAMOUS
Nomenclature: Cell of origin + Suffix
Suffix - oma Carcinoma / Sarcoma
• Fibroma • Fibrosarcoma
• Osteoma • Osteosarcoma
• Adenoma • Adenocarcinoma
• Papilloma • Squamous cell carcinoma
• Chondroma • Chondrosarcoma
 KLASIFIKASI

1. SIFAT BIOLOGIK TUMOR

2. ASAL JARINGAN (HISTOGENESIS)

 1.SIFAT BIOLOGIK TUMOR
Benign Malignant
• Slow growing, • Fast growing,
• capsulated, • non capsulated,
• Non-invasive • Invasive & Infiltrate
• do not metastasize, • Metastasize.
• well differentiated, • poorly differentiated,
• suffix “oma” eg. • Suffix “Carcinoma” or
Fibroma. “Sarcoma”
 Characteristics of Neoplasia

BENIGN
• Well-differentiated
• Slow growth
• Encapsulated
• Non-invasive
• Does NOT metastasize
 Characteristics of Neoplasia
MALIGNANT
• Undifferentiated
• Erratic and Uncontrolled
Growth
• Expansive and Invasive
• Secretes abnormal proteins
• METASTASIZES
 Intermediate Tumor
Diantara tumor jinak dan
ganas yang mempunyai sifat
invasif lokal tetapi
kemampuan metastasis
kecil.

Contoh: Karsinoma Sel

Basal kulit
2. ASAL JARINGAN (HISTOGENESIS)

Tumor 1. Sel totipoten

diklasifikasikan 2. Sel embrional
dan diberi nama pluripoten
atas dasar asal 3. Sel
sel tumor berdiferensiasi
 1. Sel totipoten
Sel yang • Tumor sel germinal
– Seminoma /
berdiferensiasi ke disgerminoma
dalam setiap jenis – Karsinoma embrional
– Choriocarcinoma, yolk
sel tubuh. sac carcinoma
• Diferensiasi somatik:
teratoma (ektoderm,
mesoderm, endoderm)
– Kistik, padat
– Matur, immatur
 2. Sel embrional pluripoten
• Berdiferensiasi ke dalam • Nefroblastoma,
berbagai jenis sel dan berdiferensiasi ke:
sebagai tumor – Tubulus ginjal
membentuk berbagai – Jaringan otot
jenis struktur alat tubuh – Tulang rawan
• Disebut embrioma /
blastoma:
– Retinoblastoma
– Hepatoblastoma
– Embryonal
rhabdomyosarcoma
 3. Sel berdiferensiasi
• Jenis sel dewasa yang • Tumor Epitel
berdiferensiasi • Tumor jaringan
• Bentuk sel pada mesenkim
kehidupan postnatal
• Umumnya tumor jenis • Tumor Campur (Mixed
ini Tumor)
• Hamartoma dan
Koristoma
• Kista
 Mixed Tumor/ Tumor Kelenjar Liur

This mixed tumor of the parotid gland contains epithelial cells

forming ducts and myxoid stroma that resembles cartilage
Nomenclature of Neoplasia
Tumor is named according to:
1. Parenchyma, Organ or Cell
• Hepatoma- liver
• Osteoma- bone
• Myoma- muscle
 Nomenclature of Neoplasia

2. Pattern and Structure, either

GROSS or MICROSCOPIC
• Fluid-filled CYST
• Glandular ADENO
• Finger-like PAPILLO
• Stalk POLYP
 PAPILLOMA
Papilloma is benign epithelial neoplasm

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

 Benign tumor:Adenomatous polyp of the colon,

A, Gross appearance of several colonic polyps B, This benign

glandular tumor (adenoma) is projecting into the colonic lumen and is
attached to the mucosa by a distinct stalk
 Nomenclature of Neoplasia
3. Embryonic origin
• Ectoderm ( usually gives rise to
epithelium)
• Endoderm (usually gives rise to
glands)
• Mesoderm (usually gives rise
to Connective tissues)
 Teratoma

Gross appearance of an opened cystic teratoma of the ovary. Note the

presence of hair, sebaceous material, and tooth
 MALIGNANT TUMOR
• Named according to embryonic cell origin
1. Ectodermal, Endodermal, Glandular,
Epithelial
• Use the suffix- “CARCINOMA”
– Pancreatic AdenoCarcinoma
– Squamos cell Carcinoma
 MALIGNANT TUMOR
2. Mesodermal, connective tissue
origin
• Use the suffix “SARCOMA
– FibroSarcoma
– Myosarcoma
– AngioSarcoma
 EXCEPTS
1. “OMA” but Malignant
– HepatOMA, lymphOMA, gliOMA, melanOMA
2. THREE germ layers
– “TERATOMA”
3. Non-neoplastic but “OMA”
– Choristoma
– Hamatoma
 Pengecualian
• Kedengaran jinak tapi ganas
– Limfoma, plasmasitoma, glioma, astrositoma, melanoma

• Kedengaran ganas tapi jinak

– Osteoblastoma, kondroblastoma

• Lekemia
– Tumor alat pembentuk darah

• Tumor yang asal selnya tidak diketahui

– Nama orang dipakai sebagai pertama yang menggambarkan
tumor itu
• Ewing’s sarcoma, Hodgkin’s lymphoma, Brenner’s tumor, Wilm’s
tumor (nefroblastoma), Burkitt’s lymphoma (B-cell lymphoma),
Grawitz’s tumor (adenokarsinoma ginjal)
 WHAT IS CANCER
A large group of diseases characterized by:
– Uncontrolled growth and spread of abnormal
cells
– Proliferation (rapid reproduction by cell
division)
– Metastasis (spread or transfer of cancer cells
from one organ or part to another not directly
connected)
 FAKTOR PREDISPOSISI
• Geografik/ Suku/ras
– Jepang banyak kanker lambung
– Negro jarang kanker kulit
• Usia
– >55 th
• Jenis kelamin
– Man : paru, kolon dan prostat
– Woman: paru, payudara dan kolon
• Hereditas
– Kanker Payudara dan ovarium
• Kelainan neoplastik didapat
– Hepatitis HCC (Hepatocellular carcinoma)
 Grading & Staging of Tumor
• Grading – Cellular Differentiation
(Microscopic)
• Staging – Progression or Spread (clinical)
TNM: Staging of tumor:
 Tumor Diagnosis:

• History and Clinical examination

• Imaging - X-Ray, US, CT, MRI
• Tumor markers Laboratory analysis
• Cytology –Pap smear, FNAB
• Biopsy - Histopathology, markers.
• Molecular Tech – Gene detection.
KARATERISTIK TUMOR JINAK & GANAS

Kriteria membedakan Tumor jinak

dan ganas

1. Diferensiasi & Anaplasi

2. Kecepatan Pertumbuhan
3. Invasi Lokal
4. Metastase
  Benign and Malignant Tumor

Characteristic Benign Malignant

Differentiation Well differentiation, structure Lack of differentiation/

may be typical of tissue origin anaplasia
Structure is often
atypical
Rate of growth Usually progressive and slow Erratic, may be slow to
growth, rapid,
Mitotic figures are rare and Abnormal and
normal Numerous mitotic figure
Local invasion Usually well demarcated and Locally invasive,
no infiltration to the infiltration to the
surrounding tissue surrounding tissue
Metastasis Absent Frequently present
Diferensiasi & Anaplasi

Diferensiasi menunjukkan seberapa banyak

kemiripan sel parenkhim dibanding dengan
sel normal (morfologi/ fungsional)
Baik Mirip sel matur normal asal
jaringan neoplasma
Sedang
Jelek/ tidak berdif.
Sel primitif/ sel tidak spesifik
T. Jinak umumnya berdiferensiasi baik
T. Ganas berdiferensiasi jelek
 Leiomyoma uteri, benign smooth muscle tumor

Leiomyoma of the uterus. This benign, well-differentiated

tumor contains interlacing bundles of neoplastic smooth
muscle cells that are virtually identical in appearance to
normal smooth muscle cells in the myometrium
 Benign tumor of thyroid gland

Normal thyroid

Benign tumor (adenoma) of the thyroid. Note the normal-

looking (well-differentiated), colloid-filled thyroid follicles.
 KARATERISTIK TUMOR JINAK & GANAS
Anaplasi : Neoplasma ganas yang tidak berdiferensiasi
Karakteristik :
● Sel dan inti pleomorfik,
● Inti hiperkromatik,
● tumor sel raksasa
● Gambaran mitosis, T. ganas atipik dan aneh
● Sel bentuk spindel dengan tripolar, kwadripolar/ multipolar

Displasia : Proliferasi yang tidak beraturan, tetapi bukan

neoplasma (pleomorfik, hiperkromatik, mitosis)
Ringan
Sedang
Berat = Ca. in situ/ Ka. Primitif
Anaplastic tumor of the skeletal muscle (rhabdomyosarcoma).

Note the marked cellular and nuclear pleomorphism,

hyperchromatic nuclei, and tumor giant cells.
Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 11 November 2005 02:05 PM)
© 2005 Elsevier
Anaplastic tumor showing cellular and nuclear variation in size
and shape. The prominent cell in the center field has an
abnormal mitotic tripolar spindle (arrow).
 Gambaran skematik lesi prakanker/displasia
dan karsinoma in situ pada serviks uteri.

I. Displasia Derajat 1 Derajat 2 Derajat 3

Sangat
Ringan Normal I II III IV V
II. Displasia
Ringan

III. Displasia
Sedang

IV. Displasia
Berat
Membrana basalis
V. Karsinoma
In Situ
Karsinoma mikroinvasif
 Carcinoma In situ
• A preinvasive stage of cancer referred to as carcinoma in situ.
• Occurs in tumors of the skin, breast, uterine cervix
• In situ epithelial cancers display the cytologic features of malignancy
(marked nuclear and cellular pleomorphism, and numerous mitotic
figures extending toward the surface) without invasion of the
basement membrane.
KARATERISTIK TUMOR JINAK & GANAS
Kecepatan Pertumbuhan
T. Jinak tumbuh lambat, gambaran mitotik : jarang dan normal
T. Ganas tumbuh lebih cepat, mitotik: banyak dan abnormal
Invasi Lokal
T. Jinak :
● biasanya kohesif & ekspansif,
● massa berbatas tegas karena tidak ada invasi
dan infiltrasi ke jaringan normal sekitarnya.

T. Ganas :
● invasi lokal dan infiltrasi ke jaringan normal
sekitarnya,
● kadang-kadang kohesif & ekspansif dan
mendesak kedalam struktur sekitarnya yang
normal.
FIBROUS CAPSULE in BENIGN TUMOR
A. Fibroadenoma of
the breast. The tan-
colored, encapsulated
small tumor is sharply
demarcated from the
whiter breast tissue.

B. Microscopic view
of fibroadenoma of
the breast. The
fibrous capsule (right)
delimits the tumor
from the surrounding
tissue.
LOCAL INVASION
A. Cut section of an invasive
ductal carcinoma of the
breast. The lesion is
retracted, infiltrating the
surrounding breast
substance, and would be
stony hard on palpation.

B. The microscopic view of the

breast carcinoma seen in A
illustrates the invasion of
breast stroma and fat by
nests and cords of tumor
cells. Note the absence of
a well-defined capsule.
 KARATERISTIK TUMOR JINAK & GANAS
Metastasis
Metastasis adalah suatu perpindahan tumor yang terpisah
dengan tumor primernya T. ganas.

P. Darah
Kanker invasif penetrasi P. Limfe menyebar
ke Organ tubuh
Cara Metastasis
Penyebaran kanker terjadi melalui
1. Langsung rongga tubuh dan permukaan
2. P. Limfe
3. Hematogen
 KARATERISTIK TUMOR JINAK & GANAS

Melalui Rongga Tubuh dan Permukaan

Terjadi pada neoplasma ganas yang menembus ke dalam
tempat yang terbuka / rongga kavum peritonium, pleura,
perikardial, subarachnoid dan rongga sendi
Contoh: Ka. Ovarium pseudomiksoma peritonei
Melalui Pembuluh Limfe
Transportasi melalui limfatik cara utama penyebaran
karsinoma.
Contoh: Ka. Mammae
Penyebaran Hematogen
Cara ini spesifik untuk sarkoma.
Arteri dengan dinding lebih tebal kurang cepat penetrasi dari
pada vena
 Pathways of Spread:
1. Direct Spread
2. Body cavities
3. Blood vessels
4. Lymphatic vessels

• Lungs – Systemic Venous blood

• Liver – GIT venous return, nutrition.
• Brain – End arteries.
Metastasis

Liver metastatic cancer from pancreatic adenocarcinoma

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