Neoplasia introduction
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Transcript of Neoplasia introduction
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NEOPLASIANEOPLASIADr.CSBR.Prasad, M.D.,Dr.CSBR.Prasad, M.D.,
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• Metaplasia• Dysplasia• Anaplasia• Complication of chronic inflammation /
irritation
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Clinical examples of Neoplasia
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Nomenclature
• Neoplasia • Neoplasm• Tumor• Oncology• Clonal / Clonality• Benign• Malignant (Latin)• Cancer
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Neoplasia - Definition
• Neo = New
• Plasia = Growth Neoplasia = New growth• Tumor = Swelling• Cancer = Crab (L)
• Oncology = Study of tumor / Neoplasm (Oncos = Tumor)
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Nomenclature• Normal• Abnormal
– Non neoplastic• Hyperplasia• Metaplasia
– Precancerous (dysplasia / in situ carcinomas)
– Neoplastic• Benign
– Epithelial– Mesenchymal
• Malignant– Epithelial– Mesenchymal
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Cancer (L. Crab)• Any malignant growth of cells (clonal)• Nearly 7 lakh people die of cancer in
India (2015)
Gross features Microscopic featuresGross features Microscopic features
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Cancer (L. Crab)
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Cancer (L. Crab)
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The following figure shows how cancer cases have been progressively increasing from 2004 to 2010
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Definition• “Willis” definition of Neoplasia - (new growth)
abnormal mass of tissue, the growth of which exceeds and is uncoordinated with the normal tissues and continues to grow even after the cessation of the stimulus that evoked the initial response
• New Definition: (Robbins Path) a neoplasm can be defined as a disorder of cell growth that is triggered by a series of acquired mutations affecting a single cell and its clonal progeny
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Normal – Hyperplasia – Dysplasia – Carcinoma
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Neoplasm
The causative mutations give the neoplastic cells a survival and growth
advantage, resulting in excessive proliferation that is independent of
physiologic growth signals (autonomous)
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Makes an interesting reading…
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Neoplasia
• It is autonomous, purposeless• Proliferation is uncontrolled• Competes with normal cells for its needs• It is a clonal disorder• It is a genetic disorder
– In 95% of cases acquired genetic disorder– In 5% of cases inherited
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Nomenclature
• All tumors have two components– Parenchyma
• Represents tumor proper; the growth of the tumor is due to proliferation of these cells
– Stroma• Provides the framework, blood supply and nutrition
for the parenchymal cells
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ParenchymaParenchymaStromaStroma
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Desmoplasia
• Formation of abundant collagenous stroma• Stimulated by parenchymal cells
• Ex: Schirrous. ca of breast Linitus plastica (ca stomach) Carcinoma prostate
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Scirrhous carcinoma of breast
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Scirrhous carcinoma of breast
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Linitus plastica
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Nomenclature
• Tumors are designated by attaching suffix “–oma” to the cell or tissue of origin– Fibroma, chondroma, lipoma, osteoma etc– Benign tumor arising from glandular structure is called
adenoma– Benign tumor arising from epithelial surface having finger
like projections is called papilloma– Malignant tumor arising from epithelial tissue is called
Carcinoma– Malignant tumor arising from mesenchymal tissue is called
Sarcoma
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Papilloma / Polyp / Adenoma
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Papilloma / Polyp / Adenoma
Pedunculated polypSessile polyp
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Papilloma / Polyp / Adenoma
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Tissue of Origin Benign MalignantComposed of One Parenchymal Cell TypeTumors of mesenchymal originConnective tissue and derivatives
Fibroma Fibrosarcoma
Lipoma Liposarcoma Chondroma Chondrosarcoma Osteoma Osteogenic sarcomaEndothelial and related tissuesBlood vessels Hemangioma AngiosarcomaLymph vessels Lymphangioma LymphangiosarcomaSynovium Synovial sarcomaMesothelium MesotheliomaBrain Coverings Meningioma Invasive
meningioma
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Tissue of Origin Benign Malignant
Blood cells and related cells
Hematopoietic cells Leukemias
Lymphoid tissue Lymphomas
Muscle
Smooth Leiomyoma Leiomyosarcoma
Striated Rhabdomyoma Rhabdomyosarcoma
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Tumors of epithelial originStratified squamous
Squamous cell papilloma
Squamous cell carcinoma
Basal cells of skin or adnexa
Basal cell carcinoma
Epithelial lining of glands or ducts
Adenoma Adenocarcinoma
Papilloma Papillary carcinomas Cystadenoma Cystadenocarcinoma
Respiratory passages
Bronchial adenoma
Bronchogenic carcinoma
Renal epithelium Renal tubular adenoma
Renal cell carcinoma
Liver Cell Adenoma Hepatocellular carcinomaUrothelial cell Papilloma Urothelial carcinoma
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Placental epithelium Hydatidiform mole Choriocarcinoma
Testicular epithelium (germ cells)
Seminoma
Embryonal carcinoma
Melanocytic Tumors Nevus Malignant melanoma
More Than One Neoplastic Cell Type-Mixed Tumors, Usually Derived from One Germ Cell Layer
Salivary glands Pleomorphic adenoma (mixed tumor of salivary origin)
Malignant mixed tumor of salivary gland origin
Renal anlage Wilms’ tumor
More Than One Neoplastic Cell Type Derived from More Than One Germ Cell Layer-Teratogenous
Totipotential cells in gonads or in embryonic rests
Mature teratoma, dermoid cyst
Immature teratoma, teratocarcinoma
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Tissues with NO benign tumors
• Synovium• Mesothelium• Lymphoid tissue• Hematopoietic cells• Basal cells of skin or adnexa
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Nomenclature• Malignant tumor arising from epithelial
structures is called “Carcinoma”• Malignant tumor of the mesenchymal tissues
is called “Sarcoma”• Embryonal tumors usually have the suffix
“Blastoma”• Malignant lesions of the blood are called
“Leukemia”• Malignant lesions of the lymphoid tissue is
called “Lymphoma”
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Neoplasms of Totipotent Cells
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Neoplasms of Embryonic Pluripotent Cells
• Pluripotent cells can mature into several different cell types
• These neoplasms are generally called Embryomas or Blastomas
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Blastoma• All blastomas are childhood tumors• All blastomas are malignant tumors
Except: – Chondroblastoma– Osteoblastoma– Pulmonary blastoma
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Neoplasms of pluripotent embryonic-type cells (BLASTOMAs)
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Nomenclature of Neoplasms of Differentiated Cells
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Exceptions to These Rules
• Neoplasms That Sound Benign But Are Really Malignant
• Neoplasms That Sound Malignant But Are Really Benign
• Leukemias• Mixed Tumors• Neoplasms Whose Cell of Origin Is
Unknown
Lymphoma Plasmacytoma
Melanoma Glioma
Astrocytoma
OsteoblastomaChondroblastoma
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Nomenclature• Some malignant tumors named like benign
tumors– Melanoma, Hepatoma, Lymphoma
• Some benign tumors named like malignant tumors– Cystosarcoma phylloides, chondroblastoma
• Some unusual tumors– Mixed tumor of salivary gland (pleomorphic adenoma)– Teratoma
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Mixed tumor
• Tumors with single type of parenchymal cells that differentiates into many cell lines– Eg: Pleomorphic adenoma of salivary gland.
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Pleomorphic adenoma - Parotid
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Teratoma
• Tumor arising from totipotent cells (germ cells) showing differentiation towards tissues derived from all the three germ cell layers– Seen usually along the midline– Common sites
• Ovary, testis, sacro-coccygeal region, retro-peritoneum, mediastinum, base of the brain etc
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What are the common sites for teratomas ?
• Gonads• Mid line• Lines of fusion
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Along the lines of fusion
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Neoplasms of Totipotent Cells
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Sacrococcygeal teratoma
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Teratoma
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Teratoma
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Named tumors
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Hamartomas & Choristomas• A hamartoma is composed of tissues that are
normally present in the organ in which the tumor arises– Eg: a hamartoma of the lung consists of a disorganized
mass of bronchial epithelium and cartilage that may become so large that it presents as a lung mass. Its growth is coordinated with that of the lung itself
• A choristoma resembles a hamartoma but contains tissues that are not normally present in its site of origin– Eg: A orderly mass of pancreatic acini and ducts in the
wall of the stomach is properly called a choristoma.
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Sarcomas are very vascular -local rise of temperature
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Hamartoma• Definition - Jumbled mixture of tissue native to
the site / organ• Eg: Hamartoma of lung
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Choristoma• Definition – Normal organized tissue at an abnormal site (ectopic rest
of normal tissue)• Eg: adrenal cells under kidney capsule, pancreas in stomach
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A wrong decisionJohannes Fibiger Nobel prize winner in 1926
Katsusaburo Yamagiwa
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In 1915 Drs. Koichi Ichikawa and Katsusaburo Yamagiwa of the Hokkaido University, Japan painted coal tar on the ears of 101 rabbits every 2 or 3 days.
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In 1775, Dr. Percivall Pott, a British surgeon, reported one of the earliest observations on
environmental / occupational cancer
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Two common cancers in our country
in India, cancers of lung and mouth in men and cervix and breast in women are the biggest killers
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