Neoplasia I Lecture PDF

Neoplasia I I lias N i k as Learning Pathology I: Our Schedule ◆1st Part ◆2nd Part ❑ ❑ ❑ ❑ ✓ Neoplasia ❑ Musculoskeletal Neoplasms ❑ Hematopathology ❑ Gastrointestinal System ❑ Endocrine System ❑ Final Exam Introduction to Pathology Cellular Reaction to Injury Inflammation and Repair Midterm...

Neoplasia I I lias N i k as Learning Pathology I: Our Schedule ◆1st Part ◆2nd Part ❑ ❑ ❑ ❑ ✓ Neoplasia ❑ Musculoskeletal Neoplasms ❑ Hematopathology ❑ Gastrointestinal System ❑ Endocrine System ❑ Final Exam Introduction to Pathology Cellular Reaction to Injury Inflammation and Repair Midterm Exam Neoplasia Outline •Basic Principles •Epidemiology and Screening •Pathogenesis •Diagnosis and Prognosis Neoplasia Outline •Basic Principles •Epidemiology and Screening •Pathogenesis •Diagnosis and Prognosis Basic Principles • Neoplasia = “new growth” • This “new growth” persists after the initiating stimulus has been removed (unlike e.g. hyperplasia) • Neoplasia is uncontrolled, irreversible, and monoclonal (unlike e.g. hyperplasia, repair) • Neoplastic cells derive from a single precursor cell (monoclonal) • Neoplasms are Benign or Malignant Basic Principles • Benign neoplasms: remain localized and do not metastasize • Malignant neoplasms (cancer): invade locally (they breach basement membrane and invade nearby structures) and have the potential to metastasize (spread to discontinuous sites) • Borderline neoplasms: some ovarian neoplasms Benign Tumors – Localized, well-circumscribed Not metastasizing Image adapted, with permission, from the Iowa Virtual Slidebox */www.mbfbioscience.com/iowavirtualslidebox) From UCM Gross Pathology, University of Chicago; https://grosspathologysites.uchicago.edu/page/uterus-benign Malignant Tumors: Local Invasion Image acquired from: Robbins & Cotran Pathologic Basis of Disease, 9th Edition Image obtained, with permission from http://library.med.utah.edu/. Copyright © 1994-2017 by Edward C. Klatt MD , Savannah, Georgia, USA. All rights reserved worldwide Malignant Tumors: Metastasis Lung Cancer Metastasis to the right adrenal gland http://staginglungcancer.org/stages/IV-M1bAdrenal Metastatic Cancer from other organs to the Lung Tumor Normal Lung Image obtained, with permission from http://library.med.utah.edu/ . Copyright © 19942017 by Edward C. Klatt MD , Savannah, Georgia, USA. All rights reserved worldwide Basic Principles All neoplasms, benign and malignant, have 2 basic components: ✓ Parenchyma: neoplastic component that determines the biological behavior ✓ Stroma: non-neoplastic supportive tissue ➢ The words “neoplasm” and “tumor” are commonly used interchangeably (although the word “tumor” means “swelling”) ➢ Neoplasms can be either benign or malignant but Cancers are always malignant!!! Neoplasm: Parenchyma and Stroma https://www.karger.com/Article/FullText/452757 Basic Principles: Differentiation • Differentiation: how the neoplasm looks under the microscope (e.g. resemblance to normal parenchymal cells/elements) ✓ Well-Differentiated (good resemblance) ✓ Poorly-Differentiated (poor resemblance) • Benign tumors are generally well-differentiated • Malignant tumors can show any level of differentiation • Differentiation is a term only applied for neoplasms!!! ➢ Anaplasia: lack of differentiation (can only be seen in Malignant Neoplasms!!!) Well-Differentiated Malignant Tumor Production of Keratin http://link.slidehosting.com/@65031/view.apml Anaplasia – Poorly-Differentiated/Undifferentiated Malignant Neoplasm Image adapted, with permission, from the Iowa Virtual Slidebox (http://www.mbfbioscience.com/iowavirtualslidebox) Basic Principles: Dysplasia • Disordered cellular growth but NO CANCER YET; most often means “pre-cancer” • Dysplasia only applies to epithelial cells! • Arises from: ✓Pathologic Hyperplasia (e.g. endometrial hyperplasia) ✓Metaplasia (e.g. Barrett Esophagus; squamous metaplasia in cervix) • Dysplasia might (but NOT ALWAYS!!!) progress to cancer if the stress persists Cervical Dysplasia Normal Cervix Images adapted, with permission, from the Iowa Virtual Slidebox (www.mbfbioscience.com/iowavirtualslidebox ) Basic Principles: Dysplasia • Microscopy: architectural and cellular ATYPIA, but NO INVASION • Carcinoma in situ: dysplasia that involves the full thickness of the epithelium, but the lesion does not penetrate the basement membrane Basic Principles: Nomenclature Based on the: • Tissue of origin ✓Epithelial ✓Mesenchymal (fibrous, cartilage, bone, muscle etc.) • Biologic behavior ✓Benign ✓Malignant Nomenclature: Benign Neoplasms • From Epithelial Tissues: ✓ Adenoma ✓ Papilloma: tumor with finger-like projections ➢ Polyp: a mass that projects above a mucosal surface (can be benign, malignant or even non-neoplastic!!!) • Polyp is an endoscopic, rather than a microscopic term Benign Tumors – Thyroid Adenoma Image adapted, with permission, from the Iowa Virtual Slidebox (http://www.mbfbioscience.com/iowavirtualslidebox) Papilloma http://www.papilloma-virus.com/oral-papillomapictures_18.html Image adapted, with permission, from the Iowa Virtual Slidebox (www.mbfbioscience.com/iowavirtualslidebox ) Polyp Author: Emmanuelm at en.Wikipedia; this file is licensed under the Creative Commons Attribution 3.0 Unported license Nomenclature: Benign Neoplasms • From Mesenchymal tissues: (prefix: tissue of origin; suffix: -oma ) ✓ ✓ ✓ ✓ ✓ ✓ ✓ Fibrous: fibroma Cartilage: chondroma Bone: osteoma Adipose tissue: lipoma Smooth muscle: leiomyoma Skeletal muscle: rhabdomyoma Blood vessels: angioma Nomenclature: “-oma” Exceptions Exceptions regarding the suffix “- oma”: • Malignant tumors: ✓ Lymphoma, Multiple Myeloma, Melanoma, Mesothelioma, Seminoma, most of Gliomas!!! • Non-neoplastic processes: Granuloma, Hematoma Basic Principles: Benign Neoplasms • Are generally well-differentiated (microscopically resemble the corresponding normal parent tissue) • Are generally encapsulated (one exception: uterine leiomyoma) • Grow slowly • Do not invade and do not metastasize Benign Tumors: Encapsulated Image acquired from: Robbins & Cotran Pathologic Basis of Disease, 9th Edition Benign Tumors - Fibroadenoma Image acquired from: Robbins & Cotran Pathologic Basis of Disease, 9th Edition Image adapted, with permission, from the Iowa Virtual Slidebox (http://www.mbfbioscience.com/iowavirtualslidebox ) Benign Tumors - Lipoma Image adapted, with permission, from the Iowa Virtual Slidebox (http://www.mbfbioscience.com/iowavirtualslidebox) Benign Tumors – Thyroid Adenoma Image adapted, with permission, from the Iowa Virtual Slidebox (http://www.mbfbioscience.com/iowavirtualslidebox) Benign Tumors - Leiomyoma of Uterus No Capsule Image adapted, with permission, from the Iowa Virtual Slidebox */www.mbfbioscience.com/iowavirtualslidebox) From UCM Gross Pathology, University of Chicago; https://grosspathologysites.uchicago.edu/page/uterus-benign Nomenclature: Malignant Neoplasms • ✓ ✓ ✓ From Epithelial tissues: CARCINOMA Adenocarcinoma Squamous cell carcinoma Transitional cell (urothelial) carcinoma • ✓ ✓ ✓ ✓ ✓ ✓ ✓ From Mesenchymal Tissues: SARCOMA Fibrous: fibrosarcoma Cartilage: chondrosarcoma Bone: osteosarcoma Adipose: liposarcoma Smooth muscle: leiomyosarcoma Skeletal muscle: rhabdomyosarcoma Blood vessels: angiosarcoma Nomenclature: Malignant Neoplasms • Hematolymphoid: Leukemia, Lymphoma • Nervous: Glioma • Exceptions regarding the suffix “- oma”: ✓ Lymphoma, Melanoma, Mesothelioma, Seminoma, most of Gliomas are Malignant!!! Quiz: Benign or Malignant? • Fibroadenoma • Fibrosarcoma • Seminoma • Lymphoma • Carcinosarcoma • Urothelial carcinoma • Angiomyolipoma • Anaplastic carcinoma • Benign • Malignant • Malignant • Malignant • Malignant • Malignant • Benign • Malignant Basic Principles: Malignant Neoplasms • Have a variable degree of differentiation (might be well or poorly-differentiated); they look really bad when lack of differentiation (anaplasia) • Have a variable growth rate, which correlates with the degree of differentiation (poorly-differentiated tumors have a faster growth rate) • Invade locally (histologic evidence of invasion present!) • Have the potential to metastasize (Hallmark of Malignancy) Malignant Tumors: Local Invasion Image acquired from: Robbins & Cotran Pathologic Basis of Disease, 9th Edition Image obtained, with permission from http://library.med.utah.edu/. Copyright © 1994-2017 by Edward C. Klatt MD , Savannah, Georgia, USA. All rights reserved worldwide Malignant Tumors: Local Invasion Image acquired from: Robbins & Cotran Pathologic Basis of Disease, 9 th Edition Image adapted, with permission, from the Iowa Virtual Slidebox (http://www.mbfbioscience.com/iowavirtualslidebox) Basic Principles: Squamous Cell Carcinoma • Originates from stratified squamous epithelium or areas of squamous metaplasia • Well-differentiated forms are characterized by: ✓Keratin pearls (formation of keratin like the epidermis) ✓Intercellular bridges (desmosomes) • Poorly-differentiated forms (NO keratin pearls or bridges): diagnosed with the aid of Immunohistochemistry Squamous Cell Carcinoma - Keratin Pearls Image from http://www.cytopath.co.uk (http://www.cytopath.co.uk/caseofmonthFeb2011.html) Squamous Cell Carcinoma - Intercellular Bridges Author: Yale Rosen; This file is licensed under the Creative Commons Attribution-Share Alike 2.0 Generic license Basic Principles: Adenocarcinoma • Most common type of carcinoma!!! • Well-differentiated forms are characterized by the formation of a glandular pattern and/or malignant cells filled with mucin • Poorly-differentiated forms (no gland formation) are diagnosed with the aid of Immunohistochemistry • Often associated with Desmoplasia (fibrous tissue growth around the neoplasm); Desmoplasia is the reason we feel some neoplasms hard during palpation (e.g. breast cancer)!!! Adenocarcinoma - Gland Formation Image adapted from Pathology Outlines Website: http://www.pathologyoutlines.com/topic/lungtumoradenocarcinoma.html Adenocarcinoma - Gland Formation Image adapted, with permission, from the Iowa Virtual Slidebox (http://www.mbfbioscience.com/iowavirtualslidebox ) Adenocarcinoma – Mucin production Papanicolaou Stain (Lung Cytopathology) Adenocarcinoma – Desmoplasia https://www.karger.com/Article/FullText/452757 Basic Principles: Anaplasia • Anaplastic Neoplasms: very poorly-differentiated malignant neoplasms!!! • Microscopic picture: ✓ Hyperchromatic nuclei, with bizarre shapes (dark nuclei) ✓ Giant cells (these are Malignant!!!; dd from giant cells in granulomas) ✓ Increased nuclear/cytoplasmic ratio (N/C ratio) ✓ Abnormal Mitoses Malignant Neoplasm: presence of Anaplasia Image adapted, with permission, from the Iowa Virtual Slidebox (http://www.mbfbioscience.com/iowavirtualslidebox) Anaplasia: notice the Abnormal Mitoses https://library.med.utah.edu/WebPath/NEOHTML/NEOPL044.html Basic Principles: Teratoma ✓ More than one germ cell layers (sometimes all 3) ✓ May contain structures such as skin, bone, cartilage, teeth, and epithelium ✓ May be either benign or malignant ✓ Usually arises in the ovaries, testes, and mediastinum Image acquired from: Robbins & Cotran Pathologic Basis of Disease, 9th Edition Image adapted, with permission, from the Iowa Virtual Slidebox (http://www.mbfbioscience.com/iowavirtualslidebox ) Thank you for your attention!