Neoplasia: Characteristics and Nomenclature of Tumors
NEOPLASIA (New growth)
NEOPLASIA (New growth)
DR.AYSER HAMEED
LEC.1
Abnormal mass of tissue
, characterized
by followings:-
1.
Its
growth is uncoordinated & exceeded
with that of the normal tissues.
2.
Neoplasm
persist its growth after the
cessation of stimuli which cause the
change.
3.
Loss of responsiveness to normal growth
controls (Autonomous).
4.
Tumors
increase local size regardless of
their local environmental & nutritional
status of the host.
Neoplasia mean tumors
Oncology
: is the science that studies the
tumors.
Oncology
divided tumors
according to
their behavior
into (
Benign &
Malignant
).
Nomenclature of Tumors:
All tumors (benign & malignant) have two
basic parts:
1.
Parenchymal Part:
Formed by
neoplastic
cells.
2.
Supporting part
: Made up of
blood vessels
& connective tissue.
Parenchymal Part:-
Determine the clinical behavior of tumors
.
Derived the name of tumors.
Naming of Benign tumors:
(Cell of origin of
tumor + Suffix
Oma
),
l
ike:-
Fibroma
(benign tumor of fibrous tissue).
Chondroma
(benign tumor of cartilage).
The tumor has lobules of
benign-looking chondrocytes
Chondroma
Certain Benign Tumors or lesions
1. Adenoma:
benign epithelial neoplasm
producing glandular pattern or benign
neoplasm derived from glands
e.g
.
Renal
Adenoma,
follicular adenoma of thyroid
.
2. Papilloma:
Any
benign neoplasm growing
on any surface that produce microscopic or
macroscopic finger like fronds
, as in the skin.
3. Polyp:
is a
mass that projects above a
mucosal surface, as in the
gut.
Some malignant tumors appear as Polyp
(mainly in the colon).
4. Cystadenoma:
are
hollow cystic
masses
, typically seen in the
ovary
.
A portion of another follicular adenoma consisting of small (micro) follicles.
Follicular adenoma thyroid
This multilayered benign-looking squamous
epithelium is arranged in a finger-like projections,
each having a core of vascularized connective
tissue. The Rt. Photo is a higher power showing the
squamous epithelium cover of one of the papillae.
Squamous cell papilloma larynx
O
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a
Lt, a cystadenoma seen as a unilocular,
thin-walled cyst with smooth inner &
outer surfaces.
Rt, papillary cystadenoma having
similar gross features to cystadenoma
except for the presence of multiple
yellowish, warty projections sprouting
from the inner surface.
Naming of Malignant Tumors
1.
Malignant neoplasm arising in mesenchymal
tissue
or its derivatives are called
Sarcoma
,
e.g.
Fibrosarcoma
(malignant neoplasms of
fibrous tissue).
Chondrosarcoma
(malignant neoplasm of
cartilage).
Osteosarcoma
(malignant neoplasm of
bone).
2. Malignant neoplasms of epithelial cells
origin
are called
Carcinoma
.
These epithelia are derived from germ layers,
e.g. renal cell carcinoma (Mesoderm),
Squamous cell carcinoma (ectoderm).
So mesoderm can give rise to
carcinoma as well as Sarcoma.
Sometime
the type of malignant
epithelia gives the name of malignant
tumor
, like
1.
Squamous cell carcinoma
: tumor cells
resemble stratified squamous epithelium.
2.
Adenocarcinoma
: tumor cells grow in
glandular pattern.
Sometime
the tissue of origin can
identify by the name of tumor
, like
1.
Renal cell carcinoma.
2.
Hepatocellular carcinoma.
Tumors can be divided according to
their origin:
1.
Monoclonal tumor
: Malignant tumor in
which the cells are derived from
single
progenitor cells (single germ layer).
2.
Mixed tumors
: tumors in which the
stem
cells may undergo divergent
differentiation,
like
pleomorphic
adenoma of parotid gland
which
contain two parts (
epithelial part &
fibromyxoid part
).
Another example of mixed tumor is
fibroadenoma of breast
which consist of
two parts (
Adenoma & fibroma
).
M
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X
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D
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(
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)
Two clinical examples of parotid pleomorphic adenomas. These tumors classically present as
preauricular swelling. In the early stages the tumor is small but it may progressively increase in size if
left untreated. The Rt. Photo is an usually large pleomorphic adenoma. The only way of establishing
the diagnosis & excluding malignancy is through microscopic examination of sections from the excised
tumor. This has revealed features of pleomorphic adenoma in these two examples.
M
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(
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)
Sheets of epithelial/myoepithelial cells with glandular arrangement. There are several nodules of
cartilaginous tissue composed of chrondrocytes within a bluish background. The capsule of the tumor
is to the Lt.
3. Teratoma:
A tumor contains recognizable mature or
immature cells or tissues, which are
derived from more than one germ layer
(sometime from three germ layers).
These teratomas are arising from
totipotential cells
mainly in the ovary &
testis.
May contain:-
Bone, muscle, fat, hair
(these are mesoderm derivatives).
Epithelia
(respiratory,
intestinal), this is endoderm derivative.
Nerve
(ectoderm
derivatives).
If all components of teratoma are benign,
is called mature teratoma typically seen in
ovary.
If these components are immature, this is
called immature teratoma (Malignant
potential), typically seen in testis.
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(
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)
Well-developed teeth in ovarian mature cystic teratoma.
Tumor like lesions
1.
Hamartoma:
is a malformation that
present as a mass of disorganized tissue
indigenous to the particular site.
e.g.
Hamartoma of lung
.
2.
Choristoma
: is a congenital anomaly, it
is
heterotopic rest of cells
.
e.g. small nodule of
pancreatic tissue
may be found
in the submucosa of
stomach, duodenum & small intestine.
Pulmonary hamartoma. The lesion
is subpleural, is well circumscribed,
and has a glistening cut surface.
P
U
L
M
O
N
A
R
Y
H
A
M
A
R
T
O
M
A
A mixture of cartilage,
respiratory epithelium and fat
Ectopic pancreas wall of jejunum (arrow)
Important note:
Lymphoma, melanoma, mesothelioma &
meningioma, although they are end with
suffix oma, they are malignant tumors.
Characteristics of Benign & Malignant
tumors:
Characteristics of differentiation between
benign & malignant tumors are:-
1.
Differentiation &
a
naplasia.
2.
Rate of growth.
3.
Local invasion.
4.Metastasis
.
I. Differentiation &
a
naplasia:
Parenchymal part of tumor is responsible
for differentiation & anaplasia of tumors,
while the stromal part of tumors is
important for growth of tumor because it
contains blood supply of tumors.
Differentiation
of Parenchymal cells
refers to the
extent to which the tumor
cells resemble their normal original tissue
morphologically & functionally.
Sections from a leiomyoma show interlacing bundles of benign
smooth muscle cells that simulate very closely their native
counterparts.
L
e
i
o
m
y
o
m
a
Benign tumors
composed of well
differentiated cells
(closely resemble their
normal counterpart),
e.g. Lipoma (consist of mature adipose
cells).
Chondroma (consist of mature
chondrocytes).
Mitosis is extremely rare in number in
benign tumors.
Malignant tumors
characterized by wide
range of parenchymal cell differentiation
(
from well differentiated to undifferentiated
&
a
naplasia
).
L
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p
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m
a
(
s
m
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l
l
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t
e
s
t
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n
e
)
The tumor cells are strikingly similar to normal squamous epithelial
cells, with intercellular bridges and nests of keratin pearls (arrow).
Well-differentiated squamous cell carcinoma of the skin
Anaplasia
:
means loss of structural &
functional differentiation of normal cells.
Characteristics of anaplastic cells:
1.
Pleomorphism
(variation in the size &
shape of cells).
2.
Large
hyperchromatic nuclei
.
3.
Increase Nucleus/ Cytoplasm (N/C)
ratio
(1:1),
normally it is (1:4 or 1:6).
4.
Anisonucleosis
(variation in the size of
nucleus) &
poikilonucleosis
(variation in
the shape of nucleus).
5. Chromatin is coarse,
large prominent
nucleolus
.
6. Numerous, atypical mitosis
.
7. Loss of normal orientation of cells
(loss of gland formation).
According to degree of differentiation
:
three grade of differentiation of malignant
tumors,
1.
Well differentiated malignancy
(like
normal tissue).
2.
Moderately differentiated malignancy
.
3.
Poor differentiated, undifferentiated,
anaplastic malignancy
.
Important notes
:
Usually benign & well differentiated cancer
have
functional capacity
e.g. like well
differentiated malignancy of endocrine
glands secrete hormones resemble the
normal endocrine cells
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Normal
adenoma
carcinoma
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Pleomorphic
rhabdomyosarcoma
showing prominent
pleomorphism,
frankly malignant
nuclei & malignant
multinucleated giant
cells.
Dysplasia:
It is non-neoplastic growth disorder; mainly
occur in epithelia (not stroma).
It is a loss of uniformity of the individual cells
& a loss in their architectural orientation.
Characteristics of dysplastic cells:
1.
Pleomophism.
2.
Large,
hyper chromatic cells.
3.
Mitosis more than normal
(mitosis not
restricted to the basal layer, it involves the
all layers).
4.
Loss of normal maturation of cells
e.g. loss
of maturation of squamous epithelium.
When
dysplastic changes
involve the
entire thickness of the epithelium
, they
are called
Carcinoma in Situ
or
preinvasive stage of cancer
.
However; foci of carcinoma in situ can
present adjacent to area of cancer.
Dysplasia does not necessarily progress
to cancer & dysplasia not involve full
thickness may be reversible.
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There is failure of
normal
differentiation,
marked nuclear and
cellular
pleomorphism, and
numerous mitotic
figures extending
toward the surface.
The intact basement
membrane (below) is
not seen in this
section.
THANKS
Neoplasia, or new growth, is characterized by uncoordinated growth exceeding that of normal tissues, persistent growth independent of stimuli, loss of responsiveness to growth controls, and local expansion regardless of host environment. Tumors are classified into benign and malignant categories in oncology based on behavior. The nomenclature of tumors includes parenchymal and supporting parts, with benign tumors named based on cell origin and the suffix "-oma." Specific benign tumors like chondroma, adenoma, papilloma, polyp, and cystadenoma have distinct characteristics.
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Presentation Transcript
NEOPLASIA (New growth) DR.AYSER HAMEED LEC.1
Abnormal mass of tissue, characterized by followings:- 1.Its growth is uncoordinated & exceeded with that of the normal tissues. 2.Neoplasm persist its growth after the cessation of stimuli which cause the change. 3.Loss of responsiveness to normal growth controls (Autonomous). 4.Tumors increase local size regardless of their local environmental & nutritional status of the host.
Neoplasia mean tumors Oncology: is the science that studies the tumors. Oncology divided tumors according to their behavior into (Benign & Malignant).
Nomenclature of Tumors: All tumors (benign & malignant) have two basic parts: 1.Parenchymal Part: Formed by neoplastic cells. 2.Supporting part: Made up of blood vessels & connective tissue. Parenchymal Part:- Determine the clinical behavior of tumors. Derived the name of tumors. Naming of Benign tumors: (Cell of origin of tumor + Suffix Oma), like:- Fibroma (benign tumor of fibrous tissue). Chondroma (benign tumor of cartilage).
Chondroma The tumor has lobules of benign-looking chondrocytes
Certain Benign Tumors or lesions 1. Adenoma: benign epithelial neoplasm producing glandular pattern or benign neoplasm derived from glands e.g. Renal Adenoma, follicular adenoma of thyroid. 2. Papilloma: Any benign neoplasm growing on any surface that produce microscopic or macroscopic finger like fronds, as in the skin. 3. Polyp: is a mass that projects above a mucosal surface, as in the gut. Some malignant tumors appear as Polyp (mainly in the colon). 4. Cystadenoma: are hollow cystic masses, typically seen in the ovary.
Follicular adenoma thyroid A portion of another follicular adenoma consisting of small (micro) follicles.
Squamous cell papilloma larynx This multilayered benign-looking squamous epithelium is arranged in a finger-like projections, each having a core of vascularized connective tissue. The Rt. Photo is a higher power showing the squamous epithelium cover of one of the papillae.
Ovarian cystadenoma and papillary cystadenoma Lt, a cystadenoma seen as a unilocular, thin-walled cyst with smooth inner & outer surfaces. Rt, papillary cystadenoma having similar gross features to cystadenoma except for the presence of multiple yellowish, warty projections sprouting from the inner surface.
Naming of Malignant Tumors 1.Malignant neoplasm arising in mesenchymal tissue or its derivatives are called Sarcoma, e.g. Fibrosarcoma (malignant neoplasms of fibrous tissue). Chondrosarcoma (malignant neoplasm of cartilage). Osteosarcoma (malignant neoplasm of bone). 2. Malignant neoplasms of epithelial cells origin are called Carcinoma. These epithelia are derived from germ layers, e.g. renal cell carcinoma (Mesoderm), Squamous cell carcinoma (ectoderm).
So mesoderm can give rise to carcinoma as well as Sarcoma. Sometime the type of malignant epithelia gives the name of malignant tumor, like 1.Squamous cell carcinoma: tumor cells resemble stratified squamous epithelium. 2.Adenocarcinoma: tumor cells grow in glandular pattern. Sometime the tissue of origin can identify by the name of tumor, like 1.Renal cell carcinoma. 2.Hepatocellular carcinoma.
Tumors can be divided according to their origin: 1.Monoclonal tumor: Malignant tumor in which the cells are derived from single progenitor cells (single germ layer). 2.Mixed tumors: tumors in which the stem cells may undergo divergent differentiation, like pleomorphic adenoma of parotid gland which contain two parts (epithelial part & fibromyxoid part). Another example of mixed tumor is fibroadenoma of breast which consist of two parts (Adenoma & fibroma).
MIXED PAROTID TUMOR (Pleomorphic Adenoma) Two clinical examples of parotid pleomorphic adenomas. These tumors classically present as preauricular swelling. In the early stages the tumor is small but it may progressively increase in size if left untreated. The Rt. Photo is an usually large pleomorphic adenoma. The only way of establishing the diagnosis & excluding malignancy is through microscopic examination of sections from the excised tumor. This has revealed features of pleomorphic adenoma in these two examples.
Mixed salivary gland tumor (Pleomorphic adenoma) Sheets of epithelial/myoepithelial cells with glandular arrangement. There are several nodules of cartilaginous tissue composed of chrondrocytes within a bluish background. The capsule of the tumor is to the Lt.
3. Teratoma: A tumor contains recognizable mature or immature cells or tissues, which are derived from more than one germ layer (sometime from three germ layers). These teratomas are arising from totipotential cells mainly in the ovary & testis. May contain:- Bone, muscle, fat, hair (these are mesoderm derivatives). Epithelia (respiratory, intestinal), this is endoderm derivative. Nerve (ectoderm derivatives).
If all components of teratoma are benign, is called mature teratoma typically seen in ovary. If these components are immature, this is called immature teratoma (Malignant potential), typically seen in testis.
Ovarian Cystic Teratoma (Dermoid cyst) Well-developed teeth in ovarian mature cystic teratoma.
Tumor like lesions 1. Hamartoma: is a malformation that present as a mass of disorganized tissue indigenous to the particular site. e.g. Hamartoma of lung. 2. Choristoma: is a congenital anomaly, it is heterotopic rest of cells. e.g. small nodule of pancreatic tissue may be found in the submucosa of stomach, duodenum & small intestine.
PULMONARY HAMARTOMA Pulmonary hamartoma. The lesion is subpleural, is well circumscribed, and has a glistening cut surface. A mixture of cartilage, respiratory epithelium and fat
Important note: Lymphoma, melanoma, mesothelioma & meningioma, although they are end with suffix oma, they are malignant tumors. Characteristics of Benign & Malignant tumors: Characteristics of differentiation between benign & malignant tumors are:- 1.Differentiation & anaplasia. 2.Rate of growth. 3.Local invasion. 4.Metastasis.
I. Differentiation & anaplasia: Parenchymal part of tumor is responsible for differentiation & anaplasia of tumors, while the stromal part of tumors is important for growth of tumor because it contains blood supply of tumors. Differentiation of Parenchymal cells refers to the extent to which the tumor cells resemble their normal original tissue morphologically & functionally.
Leiomyoma Sections from a leiomyoma show interlacing bundles of benign smooth muscle cells that simulate very closely their native counterparts.
Benign tumors composed of well differentiated cells (closely resemble their normal counterpart), e.g. Lipoma (consist of mature adipose cells). Chondroma (consist of mature chondrocytes). Mitosis is extremely rare in number in benign tumors. Malignant tumors characterized by wide range of parenchymal cell differentiation (from well differentiated to undifferentiated & anaplasia).
Well-differentiated squamous cell carcinoma of the skin The tumor cells are strikingly similar to normal squamous epithelial cells, with intercellular bridges and nests of keratin pearls (arrow).
Anaplasia: means loss of structural & functional differentiation of normal cells. Characteristics of anaplastic cells: 1.Pleomorphism (variation in the size & shape of cells). 2.Large hyperchromatic nuclei. 3.Increase Nucleus/ Cytoplasm (N/C) ratio (1:1), normally it is (1:4 or 1:6). 4.Anisonucleosis (variation in the size of nucleus) & poikilonucleosis (variation in the shape of nucleus).
5. Chromatin is coarse, large prominent nucleolus. 6. Numerous, atypical mitosis. 7. Loss of normal orientation of cells (loss of gland formation). According to degree of differentiation: three grade of differentiation of malignant tumors, 1.Well differentiated malignancy (like normal tissue). 2. Moderately differentiated malignancy. 3.Poor differentiated, undifferentiated, anaplastic malignancy.
Important notes: Usually benign & well differentiated cancer have functional capacity e.g. like well differentiated malignancy of endocrine glands secrete hormones resemble the normal endocrine cells
Degrees of differentiation Normal adenoma carcinoma
Undifferentiated (Anaplastic) Cancer Complete loss of differentiation (primitive cells). Frequent mitoses including abnormal ones Cells/nuclei show marked pleomorphism/sometimes multinucleated tumor giant cells Extreme nuclear hyperchromasia Marked nuclear enlargement N:C may reach 1:1 (instead of 1:4 or 1:6) The chromatin is coarsely clumped and irregularly distributed Usually large, prominent nucleoli
Rhabdomyosarcoma Pleomorphic rhabdomyosarcoma showing prominent pleomorphism, frankly malignant nuclei & malignant multinucleated giant cells.
Dysplasia: It is non-neoplastic growth disorder; mainly occur in epithelia (not stroma). It is a loss of uniformity of the individual cells & a loss in their architectural orientation. Characteristics of dysplastic cells: 1.Pleomophism. 2.Large, hyper chromatic cells. 3.Mitosis more than normal (mitosis not restricted to the basal layer, it involves the all layers). 4.Loss of normal maturation of cells e.g. loss of maturation of squamous epithelium.
When dysplastic changes involve the entire thickness of the epithelium, they are called Carcinoma in Situ or preinvasive stage of cancer. However; foci of carcinoma in situ can present adjacent to area of cancer. Dysplasia does not necessarily progress to cancer & dysplasia not involve full thickness may be reversible.
Cervix uteri severe dysplasia amounting to carcinoma in situ There is failure of normal differentiation, marked nuclear and cellular pleomorphism, and numerous mitotic figures extending toward the surface. The intact basement membrane (below) is not seen in this section.
