Morpho Table Tumors

7/28/2019 Morpho Table Tumors

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MorphopathologyMadnessTable:onlytumorsandcancersclassifica8onreviewforthe2semesterexamAlessandroMo6a,UVVG,3rdyear

Chapter Name MorphologicalAspects Extras

Cardiac Mixoma

Moreoenlocalizedinthetheleatrium.Thetumorappearsasapedunculatedpolypoidmass,

gela8nous,withadiameterofabout5cm.Some8mesitcanfilltheen8reatrialcavity,blockingthe

atrioventricularorifice.Microscopicallythetumoriscomposedofstellatecellsembeddedinamyxoid

matrix

Cardiac Rabdomioma

isintheformofmul8plenodularmasses,dispersedmorefrequentlyintheventricularmyocardium.Canprotrudesintocardiaccavi8eswithblockingvalveopenings.Histologicallytheyarecomposedof

smallcellswithcentrallylocatednucleus,clearcytoplasminwhichfibersradiatestothecell

membrane(spideraspect)

Noseand

paranasal

sinus

tumors

Epidermoid

carcinoma

themostcommontumorin

thisloca8on

Adenocarcino

ma

withstar8ngpointin

mucinousglands;

Plasmacytoma

Laryngeal

Tumors

SingerNodulesmallbenignpolyp,generallyoccurredasaresultofexcessiveuseofvoiceandsmoking.Islocalized

usuallyonvocalcords

Laryngeal

papilloma

benigntumorusuallylocalizedonthevocalcords.Inadultsappearsasasolitaryforma8onwhich

frequentlybecomemalignant.Inchildrenmanifestsasmul8plelaryngealforma8onscausedbyHPV

infec8on

Epidermoid

carcinomacommoninmenover40,especiallythosethatassociatesmokingwithalcoholism

Glo?ccarcinoma localizedonthevocalcords,hasagoodprognosis,unlikeover-orsubgloRsloca8ons

Benign

Bronco-

Pulmonary

Papilloma

developsinlargebronchi,asapolypoidforma8on,oenseveral.Microscopically,thetumorconsists

ofthinconjunc8ve-vascularaxis,coveredwithcylindricalorsquamousmetaplasiaepithelium.

Frequentlycanbecomemalignant

Adenomaformedinlargebronchi,,whereappearsasapedunculatedorsessileendobronchialforma8on.May

causebronchialobstruc8onandmaybecomemalignant

Malignant

Bronco-Pulmonary

Bronchogeniccarcinoma

mostcommonprimi8vepulmonarycancer,themaincauseofdeathfrommalignancyofmen.Amongtheriskfactorsforthiscondi8oncouldbeconsidered:smoking,airpollu8on,asbestosisetc

Intermsoflocaliza8oncan

bedescribedtwotypesof

broncho-pulmonary

cancers:centraland

peripheral.

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pleural

tumors

Benign

Mesothelioma

mesotheliomaiscomposedofre8culinandcollagenfibersbetweenwhicharefibroblast-likecells

(pleural"fibroma)

Malign

Mesothelioma

mesotheliomaisoenassociatedwithasbestosis.Tumorappearsasagraymassthatproduces

oblitera8onofpleuralcavityandpulmonarycompression;cancontaincys8ccavi8esfilledwith

mucoidmaterial.Microscopicstructureismixedwithamesenchymalcomponent(suchas

fibrosarcoma),andanepithelialcomponent(differenttypesofadenocarcinoma)

Benign

Gastric

Tumors

Adenomatouspolyps

arefoundmostlyinthepyloricantrum,whereappearassolitary,sessileforma8ons.Microscopically

arecomposedofglandularstructures,villous,tubularortubulo-villous,coveredbyanintes8nalor

gastricepitheliumtype.Malignisa8oniscommon,theriskincreasespropor8onallywithpolypsize.

Gastric

leiomyomamaybesingleormul8ple,mayulcerate,producingsymptomssimilartopep8culcer

Gastric

Cancer

95%Adenocarcino

mas

earlygastriccancerisdefinedasatumorlimitedtothemucosaandsubmucosaofthe

stomach.Macroscopicallycanpresentinthreeforms:

TypeI,representedbypolipidcancer,developedintogastriccavity; TypeII,representedbysuperficialcancer.Canbedescribedherethreevariants:

superficialelevated,superficialflat,superficialdepressed;

TypeIII,representedbyex-ulceratedformofcancer.advancedgastriccancerisdefinedasatumorwhichatthe8meofini8aldiagnosishas

penetratedbeyondthesubmucosa.Ithasthreemacroscopicforms:polypoid,ulceratedand

infiltra8vediffuse.Fordiffuseinvolvementoftheen8restomachisusedthetermlini8s

plas8ca.

Gastriccancer

disseminates,givingriseto

metastases:lymphpath,in

loco-regionallymphnodes.

Notably,lesupraclavicular

lymphnodeinvolvementat

distance(Virchowsign)

hematogenouspath,in

liver,lung,etc.Peritoneal

serouspath,withbilateral

ovarianinvolvement

(Krukenbergtumor).

Small

Intes8ne

Adenomaoccurmorefrequentlyintheileum,asapolypforma8on,pedicledorsessile,villous

structure,tubularortubulo-villous.Maligniza8onisrare,exceptvillousone

Adenocarcino

ma

representshalfofintes8nalmalignanttumors,beingfrequentlylocatedinjejunumandileum.Ispresentedastumoralforma8onwithpolypoid,ulcera8veorannular-infiltra8ve

growing,withstenosingeffect.Mayhavedifferentdegreesofdifferen8a8onand

histologicalpointofviewcanbefoundseveralvariants:tubular,papillary,mucinouswith

signetringcellsetc.

Primi8ve

intes8nal

lymphoma

Mediterranea

n-type

occursinyoungmenlivinginpoorsocio-economiccondi8ons;affec8ngpredominantlyduodenum

andproximaljejunum,wherethetumorappearsasadiffuseinfiltra8onofthemucosaand

submucosawithlymphocytesofplasmocytoidtype.Prognosisisgood,butoenoccursasevere

malabsorp8onsyndrome.

Occidental

type

frequentlylocatedinileum,whereitappearsasapolypoid,ulcera8veordiffuseinfiltra8vegrowingtumoralforma8on.Histologicalmaybefounddifferentvariantsofnon-Hodgkin'slymphomas.The

prognosisissevere,withfrequentoccurrenceofintes8nalobstruc8onandperfora8on.

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Small

intes8ne

Cancer

Carcinoid

tumors

arederivedfromintes8nalneuroendocrinesystemcells(APUDsystem),beinglocatedmore

frequentlyintheileum,andespeciallyintheappendix.Tumormaypresentpolypoid,

ulcera8veorinfiltra8vegrowth.Microscopically,itconsistsofislands,cordsorroseesof

small,round,uniformcells;nucleiareequal,hyperchromeandpresentsraremitoses.Are

tumorswithmildevolu8onthatrarelymetastasize.Whendevelopssecondaryloca8onsin

theliver,canoccurso-calledcarcinoidsyndrome,causedbythesecre8onofvasoac8ve

substances,par8cularlyserotonin.

Large

Intes8ne

adenomatous

polyps

Benign,maypresentmul8plehistologicalaspects:

Tubularpolypsarethemostfrequentpolypsofthecolon.Areintheformofsmallnodules,withsmoothsurface,pedunculatedorsessile.Consistsofglandulartubes

rela8velyuniform,separatedbystromal8ssue.Malignancyisrare,theriskisdirectly

propor8onaltothesizeofpolyps.

Villouspolypsdeveloppredominatedinrecto-sigmoidregion;havelargersizesthantubularones,aresessile,conopidiformaspect.Microscopically,consistsofthin

digi8formeforma8ons,consis8ngofconjunc8ve-vascularaxiscoveredbymucous-

secre8ngcylindercells.Malignancyiscommon.

Tubulo-villouspolypswithmixedstructure.

Familialpolyposisisa

hereditarycondi8on

characterizedbythe

appearanceofalarge

numberofrecto-sigmoid

adenomatouspolyps.

Almostalwaysbecomes

malignant.

Large

intes8ne

Cancer

(usually

colon-

rectal)

Mucinous

adenocarcino

ma

Macroscopic,coloncancercanbepolypoid(commoninproximalcolon),infiltra8veannular-

stenosing(commoninthedistalcolon)orasanulceratedmass.

Mostofthemhaverectallocaliza8on(colorectalcancer)andaremucinous

adenocarcinomas,moreorlessdifferen8ated.Metastasa8onisdonebylympha8cpathin

thelocoregionallymphnodes,andbyvenouspathfrequentlyintheliver.

ecto-sigmoidlocaliza8on

havethemorereserved

prognosis,progress

dependsprimarilyontumor

stage(depthofinvasion)at

ini8aldiagnosis.

Liver

Cancer

Hepatocellular

Carcinoma

originatesinhepatocytecells;inthee8ologyareinvolvedhepa88swithBandCvirus,livercirrhosis,

exposuretoaflatoxinsandpolyvinylchloride.Macroscopically,neoplasmsmayappearasasingletumoralforma8on(carcinomain'orange'),asdisemniatemul8plemicronodularforma8ons

throughoutthehepa8careaorasdiffuseinfiltra8veform.Microscopically,thetumoriscomposedof

malignantcellswhichremembermoreorlessofhepatocytecells(varyingdegreesofdifferen8a8on),

arrangedincordsoracini,separatedbyapoorstroma.Scirrhoidformisrarelyencounteredwith

connec8vestromarichlyrepresented.

Metastasesaremostcommonlylocatedinthe

lungsandperiportallymph

nodes.

Colangiocarcin

oma

isanadenocarcinomaofthebileducts.Consistsofglandulartubescoveredwithcuboidalatypical

cellsthatdonotsecretebile,separatedbyadense,fibrousstroma.Hasabeerprognosisthan

hepatocellularcarcinoma.

Angiosarcoma

hasasstar8ngpointendotheliumofsinusoidscapillaryofliver.Appearasmul8plehemorrhagic

nodules,some8mesmerged.3


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Liver

Cancer

Hepatoblasto

ma

isararetumorthataffectschildrenunder5years.Appearsasalargetumor,composedof

embryonicandfetaltypelivercells.Prognosisisreserved.

Pancreas

(exocrine)

Cystadenomas

Benigntumorsoftheexocrinepancreasarerare,mainlylocalizedinthebodyandtailof

pancreas.Arerepresentedbyserousandmucinouscystadenomas,whichhavemalignant

poten8al

Adenocarcino

mas

Malignanttumorsoftheexocrinepancreasarerepresentedespeciallybyadenocarcinomas,developedatthelevelofglandularducts.Aremostcommonlocatedintheheadofthe

pancreas.Clinically,aremanifestedthroughuncharacteris8csigns(anorexia,epi-gastric

pain,throughmechanicaljaundice(duetotumoralcompressionofthecommonbileduct)

ormigratorythrombophlebi8s.Morphologically,thecancermayappearasamul8nodular

tumoralmassorasadiffuseinfiltra8vepancrea8cprocess.Histologicallymorecommon

formsaremucinousandscirrhoidadenocarinomas.Givemetastasisthroughtlympha8cpath

(inregionallymphnodes),vascularpath(splenicvein)orperineuralpath,hencethe

atrociouspaininthiscondi8on.

Pancreas

(Endocrine)

arerare,withoriginincomponentscellsofisletsofLangerhans.Arefunc8onalornon-func8onal,benignormalign,themostcommonformsare: Insulinomas,arebenigntumorsofbetacells.Neoplas8ccellsmaysecreteinsulin,whichcancauseseverehypoglycaemia. Gastrinomasaremalignanttumorswithsimilarstructuretointes8nalcarcinoidtumor.Maysecretegastrin,leadingtogastrichypersecre8onandthe

occurrenceofpep8culcers(Zollinger-Ellisonsyndrome).

Glucagonomasaremalignanttumorsofalphacells,secre8ngglucagon.Itcanmanifestclinicallybyslightlydiabetesassociatedwithskinerythema,anemiaandvenousthrombosis.

Somatosta8nomasaremalignanttumorsofdeltacells,clinicallyaremanifestedthroughslightlydiabetesassociatedwithcholelithiasis,steatorrheaandhypochlorhydria.

Hypophysis

Hyper-funconal

tumors

Prolac8nomaisthemostcommonpituitarytumor.Itisaccompaniedbyhyperprolac8nemiaand

producesamenorrheaandgalactorrheainwomen.

Somatotropeadenoma(acidophilicadenoma)ischaracterizedbyhypersecre8onofgrowthhormone.Occurinchildren,producesgigan8smandinadultsisaccompaniedbyacromegaly.Cangiveand

phenomenaofcompressionontheintracranialstructures.

Cor8cotropadenoma(basophilicadenoma)ismanifestedbyhypecor8cismduetoACTH

hypersecre8on.Clinically,thereissocalledCushing'ssyndromecharacterizedbyfacio-truncal

obesity,osteoporosis,muscleatrophy,arterialhypertensionetc.

Non-

funconal

tumors

Non-secre8ngpituitaryadenomaismanifestedbycompressionofsurroundingorgans(headache,

visualdisturbancesandsoon).

Craniopharyngioma(adaman8noma)isabenigntumorofthechild.Isnotatruepituitarygland

tumor,actuallydevelopsfromathke'sbagremnants.Microscopically,consistsofislandsofstra8fied

squamous8ssueincludedinapoorstroma,reminiscentofembryonicstructureoftoothbud.Cancauseatrophyofhypophysisoroftheop8cchiasm. 4


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Thyroid

Thyroidian

adenomas

appearasnodularforma8ons,solitaryormul8ple,well-defined,encapsulated,withgrowth

compressiveonthesurroundingthyroid8ssue.Theyareusuallynonfunc8onalbut

some8mescanbeaccompanyandbyhyperthyroidism.Fromhistologicalpointofviewcan

bedis8nguishseveralforms:follicularadenomas(micro-ormacro-follicular),papillary

adenomas,adenomasoffetalorembryonictype,andHurtlecelladenoma.Their

malignancyispossible.

Thyroidiancarcinomas

arethemostcommonmalignanttumorsoftheendocrineglands.Mayoccurona

preexis8nggoiter;usuallystartsinonethyroidianlobe,whereremainlong8melocalized,thatintheendtoinvadethewholeglandandsurroundingorgans.Fromhistologicalpointof

view,canbedescribedseveralthyroidiancarcinoma,mostcommonare:

Papillary Follicular Medullary Anaplas8c

Vulvar

Tumors

Vesbular

Papilloma

Itconsistsofacoreoffibro-vascular8ssuecoveredbyanonkera8nizedsquamous

epithelium.Maybesingleormul8ple,usuallysmall,lessthan5mm

papilifer

hydradenoma

withoriginintheapocrinesweatglands,whichappearsasaintradermallynodelocatedin

theinterlabialsulcus.Itconsistsoftubularandcys8c-papillarystructures,separatedbytwo

layersofcells:epithelialandmyoepithelial

Epidermoid

carcinoma

isprecededbythedevelopmentofdysplas8clesionsofthevulvarsquamousepithelium,currentlyembeddedinthetermvulvarintraepithelialneoplasia(VIN).Isoenassociated

withacuminatecondylomas.Macroscopicallymaypresentasexophy8cpapillomatousmass

or,morecommonly,asanendophy8culcer.Itisasolitarytumor,mostcommonlylocated

onlabia.Microscopicallyconsistsoflarge,polyhedralcellshowingvariousdegreesofatypia.

Themostcommonareepidermoidkera8nizedcarcinomas(spinocellular)withavariable

numberofkerato8cpearls.

Embryonal

rhabdomyosar

coma(botrioid)

isamalignanttumorofstriatedmuscleepithelium,thatoccursingirlsuptoage10.Appearsasa

polypoidforma8on,fleshy,locatedathymenlevel.Microscopicallyconsistsofamyxomatous

masscontainingmalignrhabdomyoblasts,coveredbyaflaenedsquamousepithelium.

Vaginal

Tumors

Stromalpolyp

(bening)

Itusuallyappearsasapedunculateforma8onwithadiameterof4cm,gray-white,developedon

thesidewallsofthevagina.Histologically,prolifera8oniscomposedofstromalconjunc8ve

8ssue,moreorlesscellrich,coveredbyaintactsquamousepithelium.

Otherbenigntumorsare:

leiomyoma,rhabdomyoma,

hemangiomaetc.

Epidermoid

carcinoma

usuallyprecededbyavaginalintraepithelialneoplasia(VAIN),macroscopicpresen8ngasa

ulceratednodularorexophy8cforma8on.Microscopicallyhavevaryingdegreesof

differen8a8on,nonkera8nisedformismostcommon.

Malignanttumorof

mesenchymaloriginoen

affec8ngvaginais

embryonic

rhabdomyosarcoma. 5


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Uterine

Cervix

Polyps

arethemostcommonbenigntumoralprolifera8onofthecervix.Macroscopicallyappears

aspediculatednodularforma8ons,oenunique,reddish-gray,hardorcys8cwithavariable

diameteronaverage2-3cm.

Cervical

Papilloma

havevirale8ology(HPV)andarerarelyencountered.Areresul8ngthroughexocervical

squamousepitheliumprolifera8on,makinganuniquetumor,vegetansandmicroscopic

appearanceofacuminatecondyloma.

Canbeaprecancerous

condi8on

Epidermoid

carcinoma

accountsforapproximately95%ofcervicalmalignancies.Basedonevolu8onaryand

prognos8ccriteriacanbeclassifiedintotwobroadcategories:microinvasiveandinvasive

cacinoma.Uterinecervixcarcinomadisseminatesbydirectextending,affec8ngsurrounding

organs(urinarybladder,ureters,rectum),vialympha8cpath(metastasesinparacervical,

hypogastricandexternaliliaclymphnodes),andrarelybyhematogenouspath.

Itisalongandboringstory

andclassifica8onwith

thousandsofuselessdetails

Idecidedtoforget.

Myometrium Leyomioma

arebyfarthemostcommontumorsofwomen,beingmorecommoninpremenopausal

period.Areestrogen-dependenttumorsthatgrowinvolumeduringpregnancyand

regressesaermenopause.Clinicallyaremanifestedbypainandpressuresensa8oninthe

pelvis,associatedwithabnormaluterinebleedings.Macroscopically,tumormayhavea

diffusegrowth,affec8ngwholethicknessofmyometrium,orcanhaveafocalaspect,withsingleormul8plenodules.Tumorsizevariesgreatly,fromafewmillimetersupto

impressivesizes(over30cen8meters),withphenomenaofcompressiononsurrounding

organs.Theirconsistencyishigh,pale-grayincolorandonsec8onhasafascicular

characteris8caspect

Endometriu

m

Adenocarcino

ma

Usuallyaffectspostmenopausalwomen,intheire8opathogenesisinterveningprolonged

estrogens8mula8onofmucosaoftheuterus.iskfactorsmorefrequentlyinvolvedare:

obesity,arterialhypertension,diabetes,andestrogenreplacementtherapy,endometrial

hyperplasiaetc.Interes8ngtonoteisthatsmokingreducestheriskofendometrialcancer.

Mostaffectedpartisthefundicuterineregion,endometriumappearedthickened,polypoid,withareasofnecrosisandhemorrhage.Atuterinecureageexpressesanabundant,

cerebroid,necro8cmaterial.

Ovarian

Ovarian

surface

epithelium

tumors

Serous Mucionus

Endometrioid Clearcell Brenner

Germcellstumors

Ovarianteratomasdevelopfromgermcellsthroughaprocessofparthenogenesis.Themostcommontumorinthiscategoryisdermoidcyst

Ovariandysgerminomaisamalignanttumorthatisthefemaleequivalentoftes8cularseminoma

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Ovaries

Tumorsof

stromalsex

cordons

Ovarianfibromaisabenignsolidtumorcomposedoffasciclesofelongatedcellsoffibroblas8ctype.Itisusuallyassociatedwithascitesandhydrothorax(Meigssyndrome)

Ovariantecomaisafunc8onalbenigntumor(estrogenhormonesecre8on)thatoccursaermenopause.Itconsistsoffasciclesoffibroblaststhatseparatesgroupsoflargecellswithvacuolar

cytoplasm,richinlipids.

Granulosatumorisestrogen-secre8ngtumor,usuallywithbenignevolu8on.Itconsistsofsmall,cuboidcells,aspectofcoffeebeans,reminiscentofgranulosacells.Some8mesthesecandelimit

smallfolliclesthatcontaineosinophilicmaterial(Call-Exnercorpuscle).

Arenoblastoma(androblastoma)isararetumor,usuallywithbenignevolu8on,characterizedbythesecre8onofandrogenhormoneswithmasculinizingeffect.

Fetal

throphobla

st

Gestaonal

choriocarcino

ma

malignanttumoroffetaltrophoblast.Mayoccuraerhyda8formmole,anabortedectopic

pregnancyor,lesscommonly,aeranormalpregnancytoterm.Clinicallyismanifestedby

abnormaluterinebleedingandamarkedincreaseofserumandurinarylevelofchorionic

gonadotropin.Some8mesthefirstsymptomsareduetolungorbrainmetastases,which

fortunatelyrespondfavorablytochemotherapy.Tumormaypresentasaforma8onwith

exophy8cgrowththatfillstheuterinecavityorendophy8cwithmyometriumthickness

development.Isfriable,imprecisedelimited,withareasofnecrosisandhemorrhage.

Benign

tumorsof

the

mammary

gland

Fibroadenoma

itisahormone-dependenttumorswithacceleratedgrowthduringpregnancyandregressioninmenopause.Itischaracterizedbytheappearance,oeninsupero-external

quadrantofthebreast,ofahardnodularforma8ons,elas8c,mobile,welldelimited,

diametergenerallyupto5cen8meters.Histologically,itisabi-8ssularprolifera8on:of

glandularstructuresandinters88almammaryfibrous8ssue.Dependingonthe

predominantneoplas8c8ssuecanbedescribedtwomicroscopicallyforms:

intracanaliculairefiboadenoma,withmarked

conjunc8veprolifera8on

pericanaliculaire

fiboadenoma,withlile

connec8ve8ssuearranged

inperiductalemantles.

Phylodes

tumor

isagiantfibroadenoma,withsizesupto20cen8meters.Itischaracterizedbyarich

myxomatousstromawithareasofnecrosis,hemorrhageandcys8cforma8onsonthe

sec8on.Conjunc8vecellspresentelementsofatypiaandmito8cac8vity,malignancyis

inevitable.

Intraductal

papilloma

isasmalltumor(2-4mm),developedinpreareolarsducts.Consistsofconjunc8ve-vascular

axescoveredbyadoublelayerofcells:glandularandmyoepithelialcells.uptureofthese

axescancausesmallhemorrhagicleaksinmamelon,makingclinicalpictureofhemorrhagic

breast.Intraductalpapillomaisnotapreneoplas8cstate.

Cancersof

Mammary

gland

Carcinomas

Itisthemostcommonmalignanttumorofwomen.Metastasisofmammarycarcinomasis

doneprimarilybylympha8cpath,inaxillarylymphnodes,internalmammaryand

supraclavicular,andlatebyhematogenouspathinlungs,liver,bonesetc.Prognosisofthese

cancersdependsonseveralfactors:tumorsizeatthe8meofini8aldiagnosis,histological

type,histologicalgrade,presenceofestrogenandprogesteronereceptorsetc.

Intermsofevolu8oncanbedescribednon-infiltra8ngandinfiltra8ngcarcinomas.7


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Tes8s

aremostlymalignant,withoriginingermcells.arelyareencounteredLeydigorSertolicelltumors.

Seminomaisthemostcommontes8culartumor,analoguetoovariandysgerminoma.Appearsaroundtheageof30,andmanifestsasanunilateralpainlesstes8cularswelling.Microscopically,thetumoriscomposedofgroupsofuniformroundcellswithwell-definedlimits,clear

cytoplasmandhyperchromicnuclei,groupsareseparatedbythinconjunc8vesepta,infiltratedwithlymphocytes.

Seminomaisaradiosensi8vetumorwithfavorableevolu8on. Embryonalcarcinomaisamalignanttumorcomposedofcompactplaquesoflargecellswithimpreciselimitsandfrequentmitoses.Itisavery

aggressiveneoplasmwithearlymetastasis.

Tes8cularteratomasaregermcelltumors,malignantgenerally,derivedfromtwoorthreeembryonicfoils.Containingmany8ssularvarie8essuchascar8lage,livercells,striatedmuscle,etc.Canbesubclassifiedintomatureandimmatureteratomas.

Prostate

Benign

prostac

hyperplasia

(nodularprosta8chyperplasia,prosta8cfibroleiomyoadenoma)definesabenigngrowthoftheprostate,thisbeingthe

equivalentofincorrectno8onofprostateadenoma.Itisaverycommoncondi8onaer60years.E8opathogenesisisnot

perfectlyelucidated,itisassumedthatthekeyroleintriggeringtheprocessithasincreasedestrogensynthesiswithage,

resul8nginincreasedsensi8vityofprosta8creceptorsforresidualdihydrotestosterone.Itsac8ondetermineshyperplasia

ofprosta8cstructures,eveninthecondi8onsoftestosteronelevelsdrop.Itisthemostcommoncauseofurinary

obstruc8on.Histologically,itisatri8ssularprolifera8oninvaryingdegrees:ofglandularepithelial8ssue,fibrous8ssue

andprosta8csmoothmuscle.Typicalforthebenignnatureoftheprocessisthathyperplasiedglandularaciniarebounded

byadoublelayerofepithelialcells.Oenintraglandularelimestonesdepositscanoccur(amylaceousbody)aswellasa

chronicinflammatoryinfiltrate.

adenocarcino

mas

accountsforapproximately9%ofmalignanttumorsatthislevel.Frequentlyaffectsmenwithadvancedage,illnesscan

oenremainsdormant.Diagnosiscanbeestablishedbyrectalexamina8on,acharacteris8cbeingandincreasedserum

levelofprostatespecifican8genandprosta8cacidphosphatase.Canceroftheprostateoenstartsintheperipheralzone

oftheprostate,especiallyinitsposteriorarea.Histologically,canbeiden8fiedseveraltypesofarchitectural

adenocarcinomas:withlargeandsmallacini,cribriform,papilliferousetc.Characteris8csisthatproliferatedaciniare

wallpapersbyasinglelayerofatypicalcuboidalcells.Thetumor,inevolu8on,invadessurroundingorgans,neuralspaces

andgivemetastasesonlympha8candhematogenouspath.Frequentlyisoccurrenceofskeletaldissemina8on(vertebrae,

ribs,pelvis).

Blood

Leukemias

aremalignantneoplasmsofleucoforma8vestructures(mul8potentstemcells),characterizedbyinfiltra8onofbonemarrowandperipheralbloodwithalargenumberofimmatureleukocy8ccells,atypical,nonfunc8onal.Inadvanced

stagesthesecellscaninfiltrateandother8ssue,withtheadventoftumoralmasseswithvarioussites(spleen,liver,lymph

nodes).Simultaneouslyareaffectedandhematopoiesisandthrombocytopoiesis,processesmanifestedclinicallyby

anemiaandhemorrhage,plussevereandrepeatedinfec8ousepisodes.

Acute

lymphocyc

leukemia

isexpressedbytheappearanceoflargenumbersofmalignantlymphoblasts.Thediseaseisthemostcommonmalignant

neoplasmofthechild,beingfortunatelytheformofacuteleukemiathatrespondsbesttotreatment.

Clinically,nonspecificsignsassociatedwithanemia(fa8gue,pallor)gumsandcutaneoushemorrhages,bacterial

infec8ons.Ongeneralexamina8ontherewasageneralizedlymphadenopathy,localizedpredominantlyatcervicallevelin

associa8onwithhepatosplenomegaly.Thebonemarrowishypercellularduetoaccumula8onoflymphoblaststhatgraduallyreplacenormalhematopoie8c8ssue.


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Blood

Acutemyeloid

leukemia

isalsoknownasacutenon-lymphoblas8cleukemiaoracutegranulocy8cleukemia.Occursmore

frequentlyinadults,andisexpressedbytheappearanceoflargenumbersofatypical

myeloblasts.Evolu8onisseverewithapoorresponsetotherapy.Clinically,intheearlystagesof

thedisease,generalnonspecificmanifesta8onsoccur,becauselaterappearhepato-

splenomegalyandlymphadenopathy.Thebonemarrowisusuallyhypercellular(thereare

normo-orhypocellularforms)withthemassivepresenceofmyeloblasts.

Chronic

lymphocyc

leukemia

Istheresultofneoplas8cprolifera8onoflymphocytes(mostoentypeB),withconsecu8vely

infiltra8onofbonemarrow,peripheralblood,liver,spleenandotherorgans.Proliferatedlymphocytesareimmunologicallyimmatureandfunc8onallyincompetent(unableto

differen8ateintoan8bodiessynthesizingplasmocytes).Thediseaseoenaffectsolder

men,havingaasymptoma8clong-termevolu8on,ofupto10-20years.Insevereformsappear

lymphadenopathy,hepato-splenomegalyandcomplica8onssuchasinfec8ousorhemoly8c

anemiatype.Bonemarrowcontainsahigherconcentra8onoflymphocytes(40%versus20%

normally),similarmorphologicallywithnormalperipheralblood,achievingatthisleveldiffuseor

nodularinfiltrates.

Chronic

myeloid

leukemia

alsocalledchronicgranulocy8cleukemiaischaracterizedbyneoplas8cprolifera8onofmature

cellsofthegranulocy8cseries.Characteris8cistheappearanceinkaryotypeofpa8entswiththis

diseaseofPhiladelphiachromosome(transloca8onofapor8onfromthechromosome9onchromosome22).Thediseasehasachronicevolu8on,prolonged,characterizedbygeneral

nonspecificmanifesta8ons,splenomegaly,andhemorrhagicorthrombo8cepisodes.Usually,at

theend,occuraturningtoacutemyeloidleukemiawiththeappearanceinbloodofmyeloblasts,

anemiaandseverethrombocytopenia.Thebonemarrowishypercellularduetohyperplasiaof

allcelllines.Hematopie8c8ssueextendsandintothebonemarrowoflongbones.

Central

NervousSystem

Gliomas

Astrocytomascanbeof4types,typeIV(glioblastomamul8forme)represen8ngthemostcommonintracranialneoplasm.Itisa

tumorwithhighmalignancyandrapidgrowththatoccursintheelderly,islocalizedinthecerebralhemispheres.

Oligodendrogliomaisaslow-growingtumordevelopedinthecerebralhemispheres.Macroscopicappearsasawell

circumscribedforma8on,withoutbreaksofcalcifica8onvisibleonthesec8on.Microscopicallythetumoriscomposedofcells

withlargeroundnucleussurroundedbyaclearhalo.

Ependymomaoccursmorefrequentlyinadolescence,locatedinthefourthventricle.Itisaslow-growingtumorbutwhich

producedisturbancesinCSFcircula8on(hydrocephalus).Macroscopichasapapiliferaspectandlowconsistency,composedof

cellsarrangedinroseesaroundbloodvessels.

CNS Others

Medulloblastomaisderivedfromprimi8venervecells;occursinchildren,withcerebellarlocaliza8on.Thetumorisso,friable,

consis8ngofsmallcellswithlilecytoplasmandhyperchromenucleus;mitosesarefrequent.

Meningiomasoriginateinmeningealarachnoidgranula8ons;areusuallyslow-growingbenigntumors;isthe3rdinfrequency

tumorofCNS.Mostoenitlocatesonbrainconvexity,intheregionparasagital.Tumorsappearaswelldelimited,solid,

sphericalorflaened.Fromthemicroscopicpointofviewcanbedescribedseveraltypesofmeningiomas:endotheliomatous,

psamomatous,angioblastetc.9

RenalTumorsarerare,andImtoosleepy:D------MaytheforcebewithYou-------AleMo6a

Morpho Table Tumors

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