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Neoplasia IIntroduction
Husni Maqboul, M.D.
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Terminology
Tumor : Pathologic disturbance of growth,
characterized by excessive and unnecessary
proliferation of cells
Galen (131 - 201 AD )
Swelling according to nature ( pregnancy )
Swelling exceeding nature ( Callus )
Swelling contrary to nature
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Terminology
Hamartoma : Excessive but focal
overgrowth of cells and tissues native to the
organ in which it occurs. Cellular elements
are mature, but do not produce normal
architecture
Hamartroma of lung
Angiomas
Pigmented nevi
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Terminology
Choristoma (Heterotopia) : Normal cells or tissues,
that are present in abnormal locations
Pancreatic cells in the wall of stomach or
intestine
Nests of adrenal cells in kidney , lung or ovaries
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Terminology
Neoplasms : Persistent , abnormal and
relatively autonomous proliferation of cells
occurring as a result of permanent cellular
defect that is passed to the progeny. Usually
develops due to a factor(s) , but once
developed , becomes independent of them.
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Types of neoplasms
Neoplasms
Parenchyma made up of neoplastic cells
Supporting host derived stroma
Benign: localized and amenable to surgicalremoval; patient usually survives
Malignant: invasive tumor capable ofdestroying structures and spread to distantsites (metastasis); may result in early deathof the patient
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Examples of benign tumors
Epithelial
Adenoma: benign glandular tumorPapilloma : benign surface epithelial tumors
Polyp : benign tumor projecting over mucosal
surface
Cystadenoma : benign epithelial tumor forming
hollow cystic mass
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Examples of benign tumors
Mesenchymal
Chondroma: benign cartilaginous tumor
Leiomyoma: benign smooth muscle tumor
lipoma: benign tumor of fat Fibroma: benign tumor of fibrous tissue
Mixed
Benign Mixed Tumor divergent differentiation of stem
cell (pleomorphic adenoma) Fibroadenoma neoplastic fibrous component
More than one germ cell layer
Benign teratoma mature components
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leiomyomas
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adenoma
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Examples of malignant tumors
Sarcoma (mesenchymal derivation: fibrosarcoma,
chondrosarcoma) Carcinoma (epithelial derivation: adenocarcinoma,
squamous cell carcinoma)
Squamous
Adeno Transitional
Lymphoma/leukemia
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adenocarcinoma
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carcinoma
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The terms benign and malignant
describe the biologic behavior of a tumor
The biologic behavior is characterized by
degree of differentiation of the tumor , rate
of growth (and rate of cell death) ,
infiltration of surrounding tissue, anddissemination to distant sites
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D
ifferentiation
Well-differentiated tumors contain cells that
resemble the normal cells of origin
Poorly-differentiated or undifferentiated
tumors contain cells that do not resemble
their normal counterparts (ancillary studies
may be needed to determine the cell oforigin)
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well-differentiated
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poorly-differentiated
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Benign tumors are composed of well-
differentiated cells.
Malignant tumors are characterized by a
wide range of cellular differentiation.
Anaplasia (cellular pleomorphism,
hyperchromatic nuclei, high N:C ratio, giantcells, bizarre nuclei) is a feature of
malignant tumors.
Differentiation
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anaplasia
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D
ysplasia denotes a loss of architectural organization
and a loss of cell uniformity in epithelium
pleomorphism and mitoses are moreprominent than in the normal
usually graded: mild, moderate, severe, and
carcinoma-in-situ mild to moderate dysplasia is potentially
reversible
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normal epithelium
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dysplasia
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D
ysplasia
Dysplasia is a non-neoplastic proliferation. Dysplasia may or may not progress to
cancer.
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R
ate of grow
th
In general, benign and well-differentiated
malignant tumors have a slower rate of
growth than moderately-differentiated and
poorly-differentiated malignant tumors.
There are exceptions. Blood supply, site,
and hormonal stimulation are factors thatcan affect the growth rate of tumors.
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I
nvasion
Benign tumors usually grow by slow
expansion.
Malignant tumors usually infiltrate and may
destroy surrounding tissue (cell surface and
the extracellular matrix play an important
role).
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F
unctional characteristics
Benign tumors are more likely to function
Epithelial tumors can produce mucin Hormonal production can be unregulated
Inappropriate production of hormones by
different type of cells Abnormal receptor and antigenic expression
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M
etastasis
indicates malignancy
a discontinuous spread of the tumor Methods of metastasis include: (1)seeding
of body cavities, (2) lymphatic spread, and
(3) hematogenous spread.
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metastatic ovarian carcinoma
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MRI: metastatic adenocarcinoma
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metastatic adenocarcinoma
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Grading and staging
Grading is based on the microscopic
features of the cells which compose a tumor
and is specific for the tumor type.
Staging is based on clinical, radiological,
and surgical criteria, such as, tumor size,
involvement of regional lymph nodes, andpresence of metastases. Staging usually has
more prognostic value.
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Morbidity and mortality
metastases
rupture into major vessels compression of vital organs
organ failure
infection
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meningioma
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basal cell carcinoma
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melanoma
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Diagnostic procedures
FNA (fine needle aspiration)
Cytological smears Biopsy
Frozen sections
Biochemical assays Molecular diagnosis
Flow cytometry
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cytology smear: adenocarcinoma
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Pap smearwith dysplasia
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frozen section
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staining a frozen section
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Ancillary studies
Immunohistochemistry
Cytogenetics Flow cytometry
Electron microscopy
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cytokeratin stain on a carcinoma
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AFPstain on a yolk sac tumor
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EM:neurosecretory granules
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EM: microvilli, tight junction in
an adenocarcinoma
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Biochemical assays
Tumor markers: sometimes diagnostic or
prognostic
Can be helpful in monitoring effectiveness
of therapy or in detecting
relapses/recurrences
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Summary
Neoplasia- an abnormal mass of tissue
which has lost its responsiveness to growth
controls
Benign neoplasms tend to be slow-growing,
well-differentiated tumors which lack the
ability to metastasize
Benign neoplasms, in general, remain
localized and are amenable to surgery
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Summary
Malignant neoplasms tend to be fast-
growing lesions which invade normal
structures
Malignant neoplasms vary in the degree of
differentiation and some show anaplasia
Malignant neoplasms are capable ofmetastasis
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Summary
The prognosis of a patient with any type of
neoplasm depends on a number of factors
including: the rate of growth of the tumor,
the size of the tumor, the tumor site, the cell
type and degree of differentiation, the
presence of metastasis, responsiveness totherapy, and the general health of the
patient.