Neoplasm Case Study PDF

Neoplasm Hamda Al-Thawadi ,MD, PhD Associate Professor-Molecular Biology Problem 5: Save My Neck A 58-year-old female Lump in the neck X 3 months. Progressively increase in size with no pain. O/E: Prominent firm and non-tender mass in the RT side of the neck Ultrasound: 5.2 cm X 5.0 X 6.8 cm in the...

Neoplasm Hamda Al-Thawadi ,MD, PhD Associate Professor-Molecular Biology Problem 5: Save My Neck A 58-year-old female Lump in the neck X 3 months. Progressively increase in size with no pain. O/E: Prominent firm and non-tender mass in the RT side of the neck Ultrasound: 5.2 cm X 5.0 X 6.8 cm in the RT lobe of thyroid gland. Thyroid funct. Test: Normal The Dr was thinking about requesting tumor markers FNAB: Well-differentiated papillary carcinoma Further invest. revealed no metastasis Immediate surgical near-total thyroidectomy followed by radiotherapy 2 yrs later: Pt developed severe low back pain and weight loss of 5 kg X 2 months O/E: Enlarged lymph node in the LT side of the neck with a mass Radio. inves.: osteolytic destructive changes in vertebrae and pelvis FNAB of enlarged lymph node: presence of malignant cells Pt developed metastasis, so was started on Rx Objectives Identify different cellular changes Define Neoplasm and its characteristics Compare between benign and malignant neoplasm Explore tumor spread: – Invasion – Metastasis – Angiogenesis Identify the diagnostic approach in neoplasm Describe grading and staging of neoplasm List the paraneoplatic syndromes Cellular Changes Atrophy( Hypertrophy( Hyperplasia( Normal(Cell( Metaplasia( Dysplasia( Cellular Changes Atrophy: Cell size is less than normal Hypertrophy: Increase in cell size Hyperplasia: Increase in cell number Metaplasia: Replacement of cell type to another (Reversible) Dysplasia: Abnormal changes in cell size, shape and organization as a result of a genetic changes. Also known as premature neoplastic progression (Irreversible) Cellular changes: Neoplasm Normal Cell Normal Cell Normal Cell Normal Cell Neoplasm Well differentiated Anaplasia Abnormal differentiation Poorly differentiated Pleomorphism Terms used in Neoplasm Neoplasia: The process of new growth of cells. The growth of which exceeds that of normal tissues Neoplasm: Descriptive term to describe the growth of new and abnormal tissue. Can be benign or malignant Cancer: common term of all malignant tumors Anaplasia: Lack of differentiation; cells morphological characteristics of mature cells losing the Pleomorphism: Descriptive term used in histopathology to describe variability in the size, shape and staining of cells and their nuclei Cellular Changes Normal histology of bronchial Chronic injury or irritation epithelium (Squamous Metaplasia) Pseudostratified columnar ciliated epithelium Persistent sever injury or irritation (Dysplasia) Cellular Changes Normal histology of bronchial Chronic injury or irritation (Squamous Metaplasia) epithelium Pseudostratified columnar ciliated epithelium Persistent sever injury or irritation (Dysplasia) Cellular Changes Normal histology of bronchial Chronic injury or irritation (Squamous Metaplasia) epithelium Pseudostratified columnar ciliated epithelium Persistent sever injury or irritation (Dysplasia) Benign and Malignant Neoplasm Nomenclature of Neoplasm Cell of origin -suffix Histogenetic Origin Biological Behavior Cell type of origin e.g. Glandular tissue (adeno-) Benign: -oma Malignant: -sarcoma: Parenchymal origin -carcinoma: Epithelial origin Benign: Adenoma Malignant: Adenocarcinoma Nomenclature of Neoplasm (-oma) (-sarcoma) (-oma) (-sarcoma) (-oma) (-sarcoma) Nomenclature of Neoplasm (-oma) (-carcinoma) Neoplasm (Gross Features) Benign Suffix: -oma Shape: Well-defined, encapsulated Rate of growth: slow Size: Usually small Cut surface: no hemorrhage, no necrosis Malignant Suffix: -sarcoma, -carcinoma Shape: Ill-defined, not capsulated Rate of growth: Rapid Size: Usually large Cut surface: hemorrhage and necrosis Types of Lesion Margin (Gross Features) Well-defined Margin Ill-defined Margin Neoplasm (Histologic/Microscopic Features) Benign -Growth by compression of surrounding tissue -Well differentiated, resembles normal tissue -Surrounded by fibrous capsule Malignant -Growth by invasion of surrounding tissue (Metastasis) -Usually poorly differentiated, don't resemble the normal tissue (anaplasia) -Pleomorphism -More mitotic activity Neoplasm (Benign vs. Malignant) Normal Tissue Adenoma Adenocarcinoma Benign Neoplasm A B Capsule Cut section of fibroadenoma of the breast. A. Gross appearance: Well-defined mass, encapsulated small tumor, tan-colored. B. Microscopic appearance: Fibrous capsule (Top) delimits the tumor from the surrounding tissue. Malignant Neoplasm A B Cut section of invasive ductal carcinoma of the breast. A. Gross appearance: Ill-defined mass 4.5 cm in size with hemorrhagic spots in the margin and necrotic area seen in the middle. B. Microscopic appearance: Invasion of breast stroma and fat by pleomorphic cells. The absence of a well-defined capsule should be noted. Metastasis (Malignant Tumor) Metastasis Primary)Site) Cancer)Cell) Epithelial)Cell) Basement) Membrane) Stromal)Cell) Endothelial) Cell) Invasion: 1. CCs squeeze in between ECs, carcinoma in situ (Basement membrane is intact). 2. CCs degrade the ECM (basement membrane + stromal cells) by MMP7 and MMP9. 3. MMPs-CCs loosen the adhesion (Breaking E-cadherin) between stromal cells. Blood) Vessel) *CCs=Cancer Cells *ECs=Epithelial Cells *MMP=Matrix Metalloprotinease *ECM=ExtraCelullar Matrix Secondary)Site) Metastasis Primary)Site) Cancer)Cell) Epithelial)Cell) Basement) Membrane) Stromal)Cell) Metastasis: 1. CCs enter the blood vessel (or lymphatic vessel) 2. Immune system try to attack 3. Blood stream takes CCs to other body part (Secondary Site) 4. CCs start to invade the new area Endothelial) Cell) Blood) Vessel) Secondary Site Secondary)Site) *CCs=Cancer Cells *ECs=Epithelial Cells Metastasis Primary)Site) Cancer)Cell) Epithelial)Cell) Basement) Membrane) Stromal)Cell) Angiogenesis: 1. CCs induce generation of new blood vessels by secreting VEGF. 2. New blood vessels formed and bring nutrients and O2 to the site of CCs. 3. CCs proliferate more and increase in size. Endothelial) Cell) Blood) Vessel) Secondary Site *CCs=Cancer Cells *ECs=Epithelial Cells *VEGF= Vascular Endothelial Growth Factor Secondary)Site) Common sites of Metastasis Diagnostic Approach for Cancer Tumor Markers Produced by cancer OR by other cells of the body in response to cancer Found in the blood, urine, stool, tumor tissue, or other tissues Used to detect, diagnose, and manage some types of cancer Common Tumor Markers Thyroid Cancer CEA, Thyroglobulin Biopsy Performed to examine tissue or cells extracted from part of the body to detect the presence of disease. Done by cutting or scraping a small piece of the tissue or by withdrawing a sample of tissue with a needle and syringe. Biopsy Abnormal) Incision) Normal) Incisional biopsy Sample of tissue is removed during bronchoscopy or endoscopy Excisional biopsy The entire mass removed Fine Needle Aspiration biopsy Fluid or sample of tissue is removed by a needle. Guided by radiology Biopsy 1. The sample 4. Impeded in paraffin wax 2. Fixation (Formaldehyde) 3. Sliced (4mm) thick; cassette 5. Sliced (4 um) thick by microtome 6. Placed on slide and stained Grading and Staging Grading and Staging Used for solid tumor (not applicable for lymphoma and leukemia) Measure behavior of tumor and it’s spread Help in defining the proper treatment Estimates patient’s prognosis; outcome and survival rate Each system in the body has a specific criteria of grading and staging Grading of Neoplasm Grading: Reflects CCs differentiation which is assessed microscopically. Gx: Can’t be assessed G1: Well differentiated G2: Moderately differentiated G3: Poorly differentiated G4: Undifferentiated *Each system in the body has a specific criteria of grading and staging American Joint Commission on Cancer and other bodies Staging of Neoplasm Staging: Measure the spread of tumor by using TNM international system. T: Tumor Size Tx: can’t be assessed Tis: Carcinoma in situ T1: < 2 cm T2: 2-4 cm T3: > 4 cm T4: > 4 cm with muscle or bone involvement N: Nodes Nx: can’t be assessed N0: no regional nodes N1: 1-2 regional nodes are involved N2: 3-6 nodes are involved N3: ≥ 7 nodes are involved *Each system in the body has a specific criteria of grading and staging M: Metastasis Mx: can’t be assessed M0: no metastasis M1: distant metastasis Staging of Neoplasm Stage TNM Classification *Each system in the body has a specific criteria of grading and staging Stage and Grade of the patient in the problem of this week …… ! Paraneoplastic Syndromes Paraneoplastic Syndromes A group of signs and symptoms caused by a substance that is produced by a tumor. Divided into: – Endocrine syndromes – Nerve and muscle syndromes – Dermatological syndromes – Osseous, articular and soft tissues syndromes – Vascular and hematological syndromes Paraneoplastic Syndromes Paraneoplastic Syndromes Thank you