SITUATIONAL ANALYSIS

CELL REACTIONS TO INJURY

NEOPLASIA

Prepared by
EMMANUEL R. de la FUENTE, M.D.
 Objectives
2. To recognize the essential morphologic
features of benign and malignant
neoplasms
3. To correlate the molecular biology of
benign and malignant neoplasms with
their morphology
4. To correlate the situational events with
the tumor morphology
 SITUATION NO. 1

A 34 year-old man had a warty growth on

his neck. The physician advised excision
to determine the nature of the lesion.
Describe the gross and microscopic features. Does
the lesion appear benign or malignant? Give your
basis.
Which of the two picture is consistent with the gross
lesion? Identify the lesion and describe.
1. Give the proper nomenclature of this lesion

3. Briefly discuss the possible pathogenesis of

this lesion, including the role of viruses in
the evolution of neoplasm
 SITUATION NO. 2
A 28 year old woman consulted a physician
because of a left thyroid mass. A lobectomy
was performed.
The pictures illustrate the gross and microscopic
features. Identify, describe, and classify the lesion as
to whether it is malignant or benign. Give your basis..
If these are the gross and microscopic features,
identify, describe, and classify the lesion as to
whether it is malignant or benign. Give your basis.
1. Discuss briefly the gross and
microscopic features of benign and
malignant lesions
2. Discuss briefly the etiopathogenesis
of neoplasms
 SITUATION NO. 3
A 62 year-old woman had a routine paps
smear. The smear was interpreted by the
pathologist as squamous cell carcinoma.
3 paps smears are shown. Which of the 3 reflects the
interpretation of the pathologist? Explain why and
describe. (All smears are of the same magnifications.)
Discuss briefly the biomolecular basis for
the cellular features of your choice in the
previous slide.
 SITUATION NO. 4
This is the cervical biopsy of a 42 year old woman with
post-coital bleeding. Identify, describe, and classify the
lesion. Discuss the possible etiopathogenesis.
 SITUATION NO. 5

Hysterectomy specimen with a cervical lesion. Identify,

describe, and classify the lesion. Give your basis.
Two microscopic lesions of the cervix (A & B). C is a high
power view of B. Which of the two is more consistent with
the gross lesion? Explain why.
1.Give the proper nomenclature of these
lesions
2 Briefly discuss the pathogenesis of each
lesion, including the biomolecular aspects
3.Is there a relationship between the two
lesions?
 SITUATION NO. 6

A 36 year-old woman had experienced prolonged

menstrual bleeding accompanied by vague
abdominal pain. An ultrasound of the uterus
disclosed well-circumscribed masses in the
myometrium measuring from 1 x 1 cm to 2 x 2 cm.
She was loss to follow-up. Four years later, with
persistence of the same sign and symptom, she
again had another ultrasound. The same masses
were larger, the largest measuring 3 x 2.5 cm. A
hysterectomy was done.
The hysterectomy specimen. Do the lesions appear
malignant or benign? Explain why and describe.
Two microscopic sections of uterine lesions. Describe
each lesion. Which of the 2 is more consistent with the
gross and history of the patient? Explain why.
1. Give the proper nomenclature for each
lesion
2. Briefly discuss the pathogenesis of each
lesion, including the biomolecular aspects
3. Is there a relationship between these two
lesions?
 SITUATION NO. 7

A 63 year-old woman had a right breast mass

measuring 4 x 3 cm. The mass was described as
hard and fix with poorly defined margins. The right
axillary lymph nodes were enlarged. A right modified
radical mastectomy was done. The pathology of the
mass was described as follows:
Sections of the tumor disclose a malignant neoplasm
composed of invasive nests and sheets of polygonal to
oval-shaped cells in areas forming tubules. The cells are
large with increased nucleo-cytoplasmic ratio. The
cytoplasm is scanty. The nuclei are enlarged and
pleomorphic with increased chromatin, most showing
prominent nucleoli. Increased mitotic activity is noted. In
areas, dilated ducts are filled with large round cells with
similar nuclear characteristics as described earlier but
confined within the basement membrane. The stroma is
fibrous in areas showing moderate amount of lymphocytic
infiltrates. Occasional blood vessels are filled with tumor
cells.

Diagnosis: Invasive Duct Carcinoma with Extensive Ductal

Carcinoma in Situ
Mastectomy specimen. Indicate the lesion and
describe the features that favor malignancy.
In the following microscopic sections from the different
areas of the tumor identify the following:
2. Invasive sheets and cords of malignant cells in
areas forming acini
3. Increased nucleo-cytoplasmic ratio
4. Enlarged and pleomorphic nuclei with increased
chromatin
5. Increased mitotic activity
6. Moderate stromal lymphocytic infiltrates
7. Dilated ducts filled with tumor cells confined to the
basement membrane
8. Blood vessels partially filled with tumor cells
Discuss briefly the pathogenesis of
each lesion, including the
biomolecular aspects.
NEOPLASIA IS A DECLARATION
OF INDEPENDENCE BY A GROUP
OF DISORDERED CELLS.