Neoplasia
Basic Concepts
Prof. Dr. Azza AbdelAziz Ali
[email protected] [email protected] Learning Outcomes
By the end of the lecture, you will be able to:
▪ Identify the basic components of any neoplasm
▪ Classify neoplasms according to clinical behavior and origin
▪ Differentiate between Benign, Malignant neoplasms &
locally malignant
▪ Define & describe terms of differentiation, anaplasia and
cytologic criteria of malignancy
▪ Recognize different methods of spread of malignant tumors
▪ Differentiate between Carcinoma & Sarcoma
Agenda
▪ Classification of neoplasms according to clinical behavior
and cell of origin
▪ Differentiation between Benign, Malignant neoplasms &
locally malignant
▪ Definition of differentiation, anaplasia and cytologic
criteria of malignancy
▪ Methods of spread of malignant tumors
▪ Differentiate between Carcinoma & Sarcoma
Neoplasia
Def.
Neo=new, Plasia= proliferation…….New growth
Oncology= Study of tumors
Abnormal mass of tissue:
➢the growth of which exceeds and is uncoordinated
with normal tissue.
➢Uncontrolled by the normal growth control.
➢Competes with normal cells for metabolic needs
=Autonomous new growth
Neoplasia
General features
➢ Named by suffix oma which means mass
➢ Originate from any cell
➢ Result from mutation of genes that regulate:
▪ Cell growth……Excessive
▪ Apoptosis……..Defective
▪ DNA repair…….Defective
➢ Composed of cells and stroma
➢ Classified according to cell of origin and behavior
Neoplasia
Structure
Neoplasia
Structure
-Parenchyma; proliferating neoplastic cells, starts
monoclonal. determine tumor type and behavior.
-Supportive stroma; connective tissue and blood
vessels, derived from host
Neoplasia
Classification
Classified according to:
Biological behavior into: Tissue of origin into:
▪ Benign ▪ Epithelial( ….oma - Carcinoma
▪ Malignant ▪ Mesenchymal (….oma - Sarcoma
▪ Locally malignant ▪ Miscellaneous
Component neoplastic cells into:
▪ One Parenchymal Cell Type
▪ Mixed Tumors, Usually Derived From One Germ Cell Layer
as fibroadenoma of breast
▪ Derived From More Than One Germ Cell Layer as teratoma
Neoplasia
Nomenclature
Surface epithelium
Benign Malignant Transitional Benign Malignant
Squamous
Sq. Papilloma Trans. Papilloma
Sq.Carcinoma Trans.Carcinoma
Neoplasia
Nomenclature
Glandular epithelium
Benign Malignant
Adenoma
AdenoCarcinoma
Neoplasia
Nomenclature
Mesenchymal tissue
Benign Malignant Cartilage Benign Malignant
Fat
Lipoma Chondroma
Liposarcoma ChondroSarcoma
Neoplasia
Nomenclature
Mesenchymal tissue
Benign Malignant Skletal ms Benign Malignant
Smooth ms
Lieomyoma Rhabdomyoma
LieomyoSarcoma RhabdomyoSarcoma
Neoplasia
Nomenclature
Epithelial Mesenchymal
Benign
Malignant Benign Malignant
…Papilloma
…Carcinoma ...oma …Sarcoma
Adenoma
Exceptions:
* Nonneoplastic lesions ending in ….oma as: hematoma,
granuloma, hamartoma
* Malignant tumors ending in ….oma as: melanoma,
lymphoma, seminoma, glioma, hepatoma.
* Leukaemia
Neoplasia
Benign Vs Malignant
Locally
Benign Malignant
Malignant
☆ Rate of growth
☆ Mode of growth.
☆ Gross appearance No., size , capsule, consistency,
C/S .. vascularity and secondary changes.
☆ Microscopic appearance.. Cytology, histology,
stroma, secondary changes.
☆ Spread
☆ Prognosis
Case scenario, A lady with 2
breast masses ǃǃǃǃ
A female patient 50 years old has felt 2 bilateral
breast masses. After medical consultation, she was
submitted for surgical excision of these 2 masses.
Grossly, the left side mass was capsulated, grayish
white whereas the right one was uncapsulated, had
irregular margin, and it was firm.
A. What is the type of each breast mass?
B. What do you expect to see under microscope from
each mass?
C. Which mass do you expect to recur after removal?
Neoplasia
BENIGN TUMOR MALIGNANT TUMOR
1. Definition
A single mass formed of mature tissue, A mass formed of imperfectly mature
slowly growing and remains localized. tissue, grows rapidly, and invades the
surrounding structures, lymphatic and
blood vessels to form 2ry (metastatic)
tumors.
2. Origin
Normal cells( de novo). De novo or from premalignant lesion.
3. Rate of growth
Slow. Rapid.
4. Mode of growth
Expansion (pushing the surrounding Expansion and infiltration (destroy and
normal tissue without invasion). invade the surrounding normal tissue).
Neoplasia
Mode of growth
Benign Malignant
Capsule
Expansion Expansion +
Infiltration
Neoplasia
BENIGN TUMOR MALIGNANT TUMOR
5. Gross features
a.Number: single. a.Number: begin single and metastasize.
b.Size: usually small. b.Size: reach a large size within a short
time.
c.Capsule: capsulated. (Surface c.Capsule: absent, noncapsulated.
epithelial benign tumors, leiomyoma and
osteoma are exceptions).
d.Cut section: uniform, no hemorrhage d.Cut section: usually solid vascular,
or necrosis. shows secondary changes as hemorrhage
and necrosis.
Neoplasia
BENIGN TUMOR MALIGNANT TUMOR
5. Gross features
e. Shape: according to the site; e. Shape: according to the site;
• Inside solid organ or connective • Inside solid organ, as irregular
tissue, it is globular or ovoid noncapsulated mass.
surrounded by fibrous capsule. • In connective tissue; it is coarsely
nodular mass
• Arise from surface epithelia, it • Arise from surface epithelia, takes
forms a noncapsulated polyp different forms;
(papilloma). 1. Polypoid fungating mass
2. Ulcerative pattern (malignant ulcer)
3. Infiltrative growth pattern (annular)
Thyroid adenoma
Meningioma
Adenomatous polyp
Gross:
▪ Number: start single
▪ Size: Large over short duration
▪ Site: mensenchymal T, solid organs, surface epithelium
▪ Shape:
Irregular
Coarsly fixed Fungating
nodular mass
mass ulcerating
infiltrating
Coarsly
nodular Fungating
mass
ulcerating
Irrigular
fixed
mass infiltrating
Neoplasia
BENIGN TUMOR MALIGNANT TUMOR
6. Microscopic features
1. Cytology: the cells are mature, 1.Cytology: the cells show cytologic
resemble mother cells minimal mitoses. criteria of malignancy (cellular anaplasia)
2. Histology (the pattern of 2. Histology (the pattern of
arrangement): arrangement):
Similar to the tissue of origin e.g. depends on the tumor grade.
thyroid adenoma is formed of thyroid Tumor Grade: the degree of resemblance
acini similar to the normal thyroid acini. of the tumor to the mother tissue
3. Stroma: 3. Stroma:
Well formed with few blood vessels. Poor, with prominent vascularity.
2ry changes may occur. The secondary changes are common.
No hemorrhage or necrosis. Hemorrhage and necrosis are common.
Lipoma
Capsule
- In benign tumors mature
Individual cells are fat
mature. cells
- They resemble the
mother cell of origin.
– Minimal mitoses.
- Few well formed blood
vessels.
- Minimal secondary
changes
▪ Pleomorphism = variability in size& shape of cells and
nuclei.
▪ Hyperchromatism = increased D.N.A. inside the
nucleus for cell division----- stain more with
heamatoxylin.
▪ Increased N/C ratio to1/2 (N = 1/4 )
▪ Prominent nucleoli
▪ Increased mitotic figures typical and
atypical(abnormal) mitoses.
▪ Tumor giant cells nuclear division without the
cytoplasm- leads to tumor giant cells.
▪ Loss of polarity
Typical Atypical
Mitosis Mitosis
Differentiation
-The extent to which parenchymal cells of the tumor
resemble comparable normal cells, both morphologically and
functionally (degree of resemblance to the tissue of
origin).
-Well differentiated tumors, composed of cells resembling
mature tissue
-Poorly differentiated , undifferentiated tumors have
primitive appearing, unspecialized cells.
- Benign tumors are all well differentiated
- Malignant tumors range from well differentiated,
moderately differentiated, poorly differentiated to
undifferentiated
Differentiation
If cells LOOK GOOD, they are probably going to
BEHAVE GOOD
Differentiation
If cells LOOK BAD, they are probably going to
BEHAVE BAD!
-The extent to which parenchymal cells of the tumor
resemble comparable normal cells, both morphologically
and functionally (degree of resemblance to the tissue
of origin).
-Well differentiated tumors = Grade I (GI)
-Moderately differentiated tumors = Grade II (GII)
-Poorly differentiated tumors = Grade (GIII)
-Undifferentiated tumors = Anaplastic tumors
Complete loss of differentiation = Anaplasia
The more the growth rate the less the differentiation
the worse the behavior
Well = GI Moderate = GII
Normal
Poorly = GIII Anaplastic
BENIGN TUMOR MALIGNANT TUMOR
7. Behavior & Prognosis
1. Don’t spread. 1.Spread.
2. Don’t recur if well excised. 2.Recur.
3. Don’t endanger patient life
3.Endanger patient life due to:
except in the following a. Local organ destruction due to
direct spread.
conditions: b. Destruction of distant organs by
a. Located in vital organ. distant spread.
b. Located in tubular organ c. Obstruction of hollow organs.
(obstruction). d. Anaemia.
e. Cachexia.
c. Produce hormones.
d. Change malignant.
Spread of tumors
▪ Benign tumors do not spread.
▪ Malignant tumors spread
- the most reliable feature that differentiates malignant from
benign tumors.
- The major cause of morbidity and mortality
- Malignant tumors spread by:
*Local (Invasion)
*Distant (Metastasis):
- Lymphatic
- Blood (common sites: Liver, Lung, Brain, Bone, Adrenal)
-Transcoelomic (through serous sacs)
Now,
can you answer the following?
The commonest site of metastasis in patients with
carcinoma is:
A. Lung
B. Liver
C. Lymph nodes
D. Brain
E. bone
Carcinoma Sarcoma
Malignant tumor of the surface Malignant tumor of
epithelium as Squamous cell mesenchymal tissue as
carcinoma, adenocarcinoma liposarcoma, chondrosarcoma
More common Less common
Middle and old age young age
Slower rate of growth Rapid
Infiltration more than expansion Expansion more than
infiltration
Spread: early by lymphatics late, Spreads early by blood
by blood.
Carcinoma Sarcoma
Gross
Irregular Fungating Coarsly
fixed Ulcerating nodular
mass Infiltrating mass
Microscopic
Stroma ---- abundant, separate Stroma ---- scanty, separate
the sheets, groups & acini (no individual tumor cells
stroma between individual cells)
Tumors which infiltrate locally but don’t the capacity to
send distant metastases.
▪ Growth: Slow
Examples:
▪ Mode of growth: infiltrative
▪ N/E: noncapsulated ▪ Basal cell carcinoma of skin.
▪ M/E: cells are malignant ▪ Giant cell tumor of bone
▪ Spread: local only, No metastasis
▪ Prognosis:
*Recur after incomplete excision
*May turn malignant (metastasizing)
Staging
- Reflects degree of spread of a tumor, for an individual
cancer patient
- Assigned at the time of diagnosis, may be updated as
patient progresses
- 2 systems:
*TNM
*American joint
committee (AJC)
TNM
T 1, 2, 3,4 Tumor characters
(Size or local spread)
N 0,1, 2,3 Nodal involvement
M 0,1 Metastasis
Now,
can you answer the following?
In this breast specimen:
1.The arrow points to
2.The prognosis of the lesion
is ………..
Now,
can you answer the following?
1. Urinary bladder lesion is…..
(diagnosis)
Discussion & Feedback
References & recommended readings
1. Robbins & Cotran Pathologic Basis of Disease,
(Robbins Pathology), 2018 ISBN: 978-0-323-35317-5,
Edition: 10th
2. Webpath:
https://webpath.med.utah.edu/webpath.html
https://www.pathologyatlas.ro/index.php
Thank you
