NeoplasiaNeoplasiaLecture 1Lecture 1

Dr. Maha ArafahDr. Maha Arafah

NeoplasiaNeoplasiaUpon completion of these lectures, the student Upon completion of these lectures, the student

should:should: Define a neoplasm. Contrast neoplastic growth Define a neoplasm. Contrast neoplastic growth

with hyperplasia, metaplasia, and dysplasia.with hyperplasia, metaplasia, and dysplasia. Know the basic principles of the nomenclature of Know the basic principles of the nomenclature of

benign and malignant processes.benign and malignant processes. Define and use in the proper context:Define and use in the proper context:

Adenoma.Adenoma. Papilloma.Papilloma. Polyp.Polyp. Cystadenoma.Cystadenoma. Carcinoma.Carcinoma. Adenocarcinoma.Adenocarcinoma. Sarcoma.Sarcoma. Teratoma.Teratoma. Blastoma.Blastoma. Hamartoma.Hamartoma.

NeoplasiaNeoplasia

Cancer is one of the leading causes Cancer is one of the leading causes of death worldwide.of death worldwide.

Emotional and physical suffering by Emotional and physical suffering by the patient.the patient.

Different mortality rate …..Different mortality rate ….. Some are curable Some are curable Others are fatalOthers are fatal

NeoplasiaNeoplasia

Neoplasia = new growthNeoplasia = new growth Neoplasm = tumorNeoplasm = tumor Tumor = swellingTumor = swelling The study of tumors = OncologyThe study of tumors = Oncology

Oncos = tumor + ology = study of Oncos = tumor + ology = study of

NeoplasiaNeoplasia

Definition:Definition: is an abnormal mass of tissue, is an abnormal mass of tissue, the growth of which is uncoordinated with that of the growth of which is uncoordinated with that of

normal tissues, normal tissues, and that persists in the same excessive manner and that persists in the same excessive manner

after the cessation of the stimulus which evoked after the cessation of the stimulus which evoked the changethe change““

With the loss of responsiveness to normal growth With the loss of responsiveness to normal growth controlscontrols

Different from hyperplasia, metaplasia and Different from hyperplasia, metaplasia and dysplasiadysplasia..

NeoplasiaNeoplasia

Classification Classification

Benign Benign malignantmalignant

NeoplasiaNeoplasia

Benign tumors :Benign tumors : Will remain localizedWill remain localized Cannot spread to distant sitesCannot spread to distant sites Generally can be locally excisedGenerally can be locally excised Patient generally survives Patient generally survives

NeoplasiaNeoplasia

Malignant neoplasms:Malignant neoplasms: Can invade and destroy adjacent Can invade and destroy adjacent

structurestructure Can spread to distant sitesCan spread to distant sites Cause death (if not treated )Cause death (if not treated )

NeoplasiaNeoplasia

All tumors have two basic All tumors have two basic components:components: Parechyma: Parechyma: made up of made up of

neoplastic cellsneoplastic cells Stroma: Stroma: made up of non-made up of non-

neoplastic, host-derived neoplastic, host-derived connective tissue and blood connective tissue and blood vesselsvessels

The parenchyma:Determines the biological behavior of the tumorFrom which the tumor derives its name

The parenchyma:Determines the biological behavior of the tumorFrom which the tumor derives its name

The stroma:Carries the blood supplyProvides support for the growth of the parenchyma

The stroma:Carries the blood supplyProvides support for the growth of the parenchyma

NeoplasiaNeoplasia

NomenclatureNomenclature Benign tumors: Benign tumors:

prefix + suffixprefix + suffix Type of cell + (-oma)Type of cell + (-oma)

NeoplasiaNeoplasia

Examples:Examples: Benign tumor arising in fibrous tissue:Benign tumor arising in fibrous tissue:

Fibro + oma = FibromaFibro + oma = Fibroma

Benign tumor arising in fatty tissue:Benign tumor arising in fatty tissue:

Lipo + oma = lipomaLipo + oma = lipoma

NeoplasiaNeoplasia

Benign tumor arising in cartilageBenign tumor arising in cartilage

chondro + oma = chondromachondro + oma = chondroma Benign tumor arising in smooth Benign tumor arising in smooth

musclemuscle

Leiomyo + oma = leiomyomaLeiomyo + oma = leiomyoma Benign tumor arising in skeletal Benign tumor arising in skeletal

musclemuscle

Rhabdomyo + oma = rhabdomyomaRhabdomyo + oma = rhabdomyoma

NeoplasiaNeoplasia

epithelial benign tumors are epithelial benign tumors are classified on the basis of :classified on the basis of : The cell of origin The cell of origin Microscopic patternMicroscopic pattern Macroscopic patternMacroscopic pattern

NeoplasiaNeoplasia

Adenoma Adenoma : benign epithelial neoplasms : benign epithelial neoplasms producing gland pattern….OR … producing gland pattern….OR … derived from glands but not necessarily derived from glands but not necessarily exhibiting gland pattern exhibiting gland pattern

Papilloma Papilloma : benign epithelial : benign epithelial neoplasms growing on any surface that neoplasms growing on any surface that produce microscopic or macroscopic produce microscopic or macroscopic finger-like patternfinger-like pattern

Adenoma

Papilloma

NeoplasiaNeoplasia

PolypPolyp : a mass that projects above a : a mass that projects above a mucosal surface to form a mucosal surface to form a macroscopically visible structure. macroscopically visible structure.

e.g. - colonic polype.g. - colonic polyp

- nasal polyp - nasal polyp

Polyp

NeoplasiaNeoplasia

Examples : Examples : Respiratory airways: Bronchial Respiratory airways: Bronchial

adenomaadenoma Renal epithelium: Renal tubular Renal epithelium: Renal tubular

adenomaadenoma Liver cell : Liver cell adenomaLiver cell : Liver cell adenoma Squamous epithelium: squamous Squamous epithelium: squamous

papilloma papilloma

NeoplasiaNeoplasia

Malignant tumors:Malignant tumors: Malignant tumor arising in Malignant tumor arising in

mesenchymal tissue : SARCOMAmesenchymal tissue : SARCOMA From fibrous tissue: FibrosarcomaFrom fibrous tissue: Fibrosarcoma From bone : OsteosarcomaFrom bone : Osteosarcoma From cartilage : chondrosarcomaFrom cartilage : chondrosarcoma

OsteosarcomaOsteosarcoma

NeoplasiaNeoplasia

Malignant tumors arising from Malignant tumors arising from epithelial origin : CARCINOMAepithelial origin : CARCINOMA Squamous cell carcinomaSquamous cell carcinoma Renal cell adenocarcinomaRenal cell adenocarcinoma cholangiocarcinomacholangiocarcinoma

Carcinomas arising from any epithelium of the body that exhibit squamous differentiation are termed squamous cell carcinoma.

NomenclatureNomenclatureother descriptive terms may be added such as:

PapillaryPapillary CystCystadenoadenocarcinomacarcinoma of the Ovaryof the OvaryPapillaryPapillary CystCystadenoadenocarcinomacarcinoma of the Ovaryof the Ovary

NeoplasiaNeoplasiaExceptionsExceptions

Melanoma ( skin )Melanoma ( skin ) Mesothelioma (mesothelium )Mesothelioma (mesothelium ) Seminoma ( testis )Seminoma ( testis ) Lymphoma ( lymphoid tissue ) Lymphoma ( lymphoid tissue )

See table 6 – 1 ( Robbin’s )See table 6 – 1 ( Robbin’s )

NeoplasiaNeoplasia Based on the biological behavior : Based on the biological behavior :

Benign and malignantBenign and malignant

Based on the cell of origin : Based on the cell of origin : One neoplastic cell type : lipoma, adenocarcinomaOne neoplastic cell type : lipoma, adenocarcinoma More than one neoplastic cell type : fibroadenomaMore than one neoplastic cell type : fibroadenoma More than one neoplastic cell type derived from More than one neoplastic cell type derived from

more than one germ-cell layer: teratomamore than one germ-cell layer: teratoma Derived from embryonic tissue: blastoma Derived from embryonic tissue: blastoma

(could be benign e.g. osteoblastoma, or malignant e.g. (could be benign e.g. osteoblastoma, or malignant e.g. neuroblastoma)neuroblastoma)

Lipoma

Fibroadenoma

Teratoma

NeoplasiaNeoplasia

Teratoma:Teratoma: Teratoma contains recognizable Teratoma contains recognizable

mature or immature cells or tissues mature or immature cells or tissues representative of more than one germ-representative of more than one germ-cell layer and some times all three.cell layer and some times all three.

Teratomas originate from totipotential Teratomas originate from totipotential cells such as those normally present in cells such as those normally present in the ovary and testis.the ovary and testis.

NeoplasiaNeoplasia

Such cells have the capacity to Such cells have the capacity to differentiate into any of the cell types differentiate into any of the cell types found in the adult body. So they may found in the adult body. So they may give rise to neoplasms that mimic give rise to neoplasms that mimic bone, epithelium, muscle, fat, nerve bone, epithelium, muscle, fat, nerve and other tissues.and other tissues.

Most common sites are: ovary & testisMost common sites are: ovary & testis

NeoplasiaNeoplasia

If all the components parts are well If all the components parts are well differentiated, it is a benign (mature) differentiated, it is a benign (mature) teratoma.teratoma.

If less well differentiated, it is an If less well differentiated, it is an immature (malignant) teratoma. immature (malignant) teratoma.

Neoplasia nomenclature- historic eponyms – “first described by…”

Hodgkin’s disease

Malignant lymphoma (HL) of B Ly cell origin

Burkitt tumor NHL – B Ly cell in children (jaw and GIT)

Ewing tumor Bone tumor (PNET)

Grawitz tumor Kidney tumor - clear cell adenocarcinoma

Kaposi sarcoma

Malignant tumor derived from vascular epithelium (AIDS)

Brenner tumor Ovarian tumor derived from Brenner cells

Askin tumor Malignant chest wall tumor of PNET

Merkel tumor Skin tumor derived from Merkel cell

WHAT ARE HAMARTOMAS AND WHAT ARE HAMARTOMAS AND CHORISTOMA?CHORISTOMA?

HamartomaHamartoma: a mass composed of : a mass composed of cells native to the organcells native to the organ

e.g. pulmonary hamartoma.e.g. pulmonary hamartoma.

ChoristomaChoristoma: a mass composed of : a mass composed of normal cells in a wrong locationnormal cells in a wrong location

e.g. pancreatic choristoma in liver e.g. pancreatic choristoma in liver or stomach.or stomach.

Malformation and not neoplasm.Malformation and not neoplasm.

Pulmonary HamartomaPulmonary Hamartoma

Pancreatic choristoma in Pancreatic choristoma in gall bladder gall bladder

NeplasiaNeplasia

Hamartoma and ChoristomaHamartoma and Choristoma

They are distinguished from They are distinguished from neoplasms by the fact that they do not neoplasms by the fact that they do not exhibit continued growth. they are exhibit continued growth. they are group of tumor-like tissue masses group of tumor-like tissue masses which may be confused with which may be confused with neoplasmsneoplasms

Classification according to biological Classification according to biological behavior behavior

benign malignantborderline

NeoplasiaNeoplasia

Dysplasia : Dysplasia : Definiton: a loss in the uniformity of the Definiton: a loss in the uniformity of the

individual cells and a loss in their individual cells and a loss in their architectural orientation.architectural orientation.

Non-neoplasticNon-neoplastic Occurs mainly in the epitheliaOccurs mainly in the epithelia Dysplastic cells shows a degree of : Dysplastic cells shows a degree of :

pleomorphism, hyperchrmasia,increased pleomorphism, hyperchrmasia,increased mitosis and loss of polarity.mitosis and loss of polarity.

NeoplasiaNeoplasia

Dysplasia does not mean cancerDysplasia does not mean cancer Dyplasia does not necessarily Dyplasia does not necessarily

progress to cancerprogress to cancer Dysplasia may be reversibleDysplasia may be reversible If dysplastic changes involve the If dysplastic changes involve the

entire thickness of the epithelium it entire thickness of the epithelium it is called : is called :

CARCINOMA IN-SITUCARCINOMA IN-SITU

NeoplasiaNeoplasia

Carcinoma in-situCarcinoma in-situ Definition: an intraepithelial malignancy Definition: an intraepithelial malignancy

in which malignant cells involve the in which malignant cells involve the entire thickness of the epithelium entire thickness of the epithelium without penetration of the basement without penetration of the basement membrane.membrane.

Applicable only to epithelial neoplasms. Applicable only to epithelial neoplasms.

Dysplasia Features:Dysplasia Features:

Increased rate of multiplication.

Disordered maturation.

• Nuclear abnormality– Increased N/C ratio– Irregular nuclear

membrane– Increased chromatin

content

• Cytoplasmic abnormalities due to failure of normal

Dysplasia Dysplasia Uterine cervixUterine cervix

Mild Dysplasia

Sever Dysplasia

Dysplasia (cervical pap Dysplasia (cervical pap smear)smear)

DysplasiaDysplasia

Clinical significance:Clinical significance: It is a premalignant condition.It is a premalignant condition. The risk of invasive cancer varies The risk of invasive cancer varies

with: with: grade of dysplasia grade of dysplasia (mild, moderate, (mild, moderate,

sever)sever) duration of dysplasiaduration of dysplasia site of dysplasiasite of dysplasia

DysplasiaDysplasia

Differences between dysplasia and Differences between dysplasia and cancer.cancer.

lack of invasiveness.lack of invasiveness.

ReversibilityReversibility

Carcinoma in situCarcinoma in situ

A true neoplasm with all of the A true neoplasm with all of the features of malignant neoplasm features of malignant neoplasm except invasivenessexcept invasiveness

Displays the cytological features of Displays the cytological features of malignancy without invasion of the malignancy without invasion of the basement membrane.basement membrane.

CHANGES IN UTERINE CHANGES IN UTERINE CERVIXCERVIX

Squamous cell Squamous cell CarcinomaCarcinoma

Uterine Cervix Uterine Cervix

Dysplasia