Neoplasia

Never let the competition define you. Instead, you have to define yourself based on a point of view you care deeply about.
Tom Chappel

Shashi-Dec-13

Pathology of Neoplasia
Dr. Venkatesh M. Shashidhar.
Senior Lecturer in Pathology Fiji School of Medicine

Neoplasia

Introduction:
Inflammatory,

Neoplastic Growth Increase in size due to synthesis of tissue components. Proliferatation- Cell division. Differentiation: functional and structural maturity of cells. Tumor Swelling / new growth / mass
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Degenerative &

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Controls of Growth:
Cytokines:

Cyclins, Cyclin dependent kinases (CDK). Growth factors PDGF, FGF Growth Inhibitors. Cancer suppressor genes p53 Oncogenes c-onc, p-onc, v-onc etc.

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Non-Neoplastic Proliferation:
*Controlled & Reversible
Hypertrophy

Size Hyperplasia Number Metaplasia Change Dysplasia Disordered

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Neoplastic Proliferation:
Uncontrolled & Irreversible* Benign
Localized, non-invasive.
Malignant

(Cancer)

Spreading, Invasive.

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Neoplasia:
Progressive,

Purposeless, Pathologic, Proliferation of cells characterized by loss of control over cell division. DNA damage at growth control genes is central to development of neoplasm. Carcinogens Chemical, physical & genetic DNA damage Neoplasm.
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Willis Definition:
Neoplasm

is an abnormal mass of tissue the growth of which exceeds and is uncoordinated with that of normal tissue and persists in the same excessive manner after cessation of the stimuli which evoked the change

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Pathogenesis of Neoplasia:
Normal Hyperplasia Metaplasia (DNA damage) Dysplasia (DNA damage) (DNA damage) Anaplasia (DNA damage) Infiltration (DNA damage) Metastasis. Progressive DNA Damage features of neoplasia.

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Pathogenesis of Neoplasia:

Non lethal DNA Damage leading to uncontrolled cell division.

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Mechanism of Neoplams
Normal Adaptation Benign Malignant

Non-Neoplastic
(Polyclonal)
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Neoplastic
(Monoclonal)

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Structure of Neoplasm:
Neoplastic

cells parenchyma. Non-neoplastic - stroma (Connective tissue & BV)

Fast

growth less stroma Less stroma more necrosis,

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Biology of Neoplasm:
Cell

of origin Rate of growth Differentiation Local Invasion Metastasis

Lung

cancer Grade - low, high Well, Mod, P, Un. Staging Staging

Lung cancer: Squamus cell carcinoma. Poorly differentiated, high grade, stage 4, Liver+
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Benign
Slow

Malignant:
Fast

growing, capsulated, Non-invasive do not metastasize, well differentiated, suffix oma eg. Fibroma.
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growing, non capsulated, Invasive & Infiltrate Metastasize. poorly differentiated, Suffix Carcinoma or Sarcoma

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Nomenclature: Cell of origin +

Suffix - oma Fibroma Osteoma Adenoma Papilloma Chondroma

Suffix

Carcinoma / Sarcoma Fibrosarcoma Osteosarcoma Adencarcinoma Squamous cell carcinoma Chondrosarcoma

Exceptions: Leukemia, Lymphoma, Glioma,

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Grading & Staging of Tumor

Grading

Cellular Differentiation (Microscopic) Staging Progression or Spread (clinical)

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TNM: Staging of tumor:

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Pathways of Spread:
Direct

Spread Body cavities Blood vessels Lymphatic vessels

Lungs

Systemic Venous blood Liver GIT venous return, nutrition. Brain End arteries.
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Tumor Diagnosis:
History

and Clinical examination Imaging - X-Ray, US, CT, MRI Tumor markers Laboratory analysis Cytology Pap smear, FNAB Biopsy - Histopathology, markers. Molecular Tech Gene detection.

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Bilateral Cystadenoma Ovary:

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Lipoma Intestine:

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meningioma

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Lung carcinoma

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Hepatic Adenoma:

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Carcinoma Breast:

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Carcinoma Lung:

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Osteo - sarcoma:

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CT: metastatic adenocarcinoma

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Biopsy Slide preparation

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staining

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Colon Polyp:

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Hepatic Adenoma:

Normal

Adenoma

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Anaplasia in Sarcoma:

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Anaplasia:

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Hepatic Adenocarcinoma:

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Hepatic Adenocarcinoma:

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Liver Metastasis:

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Clinical Features.
Tumor

Impingement on nearby structures

Pancreatic ca on bile duct Obst. Jaund.

Ulceration/bleeding

Colon, Gastric, and Renal cell carcinomas

Infection

(often due to obstruction)

Pneumonia, Urinary inf.

Rupture

or Infarction

Ovarian, Bladder, colon,

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Cancer Cachexia
Progressive

weakness, loss of appetite, anemia and profound weight loss (>20%) Often correlates with tumor mass & spread Etiology includes a generalized increase in metabolism and central effects of tumor on hypothalamus Probably related to macrophage production of TNF-a
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Paraneoplastic Syndromes
Due to Products released by tumor Cushings Syndrome Adrenal, Lung Ca ACTH Inappropriate ADH syndrome (Hyponatremia) lung ca Hypothalamic tumors (vasopressin) Hypercalcemia Ca is the common cause. lung. Hypoglycemia - insulin or insulin like activities Fibrosarcoma, Cerebellar hemangioma.

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Skull in Myeloma:

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summary
neoplasia-

uncontrolled cell division non responsive to growth controls. Benign and Malignant Naming Cell of origin + Suffix Oma, Carcinoma, Sarcoma benign slow-growing, welldifferentiated, localized, do not metastasize, amenable to surgery.
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summary
malignant

neoplasms tend to be fastgrowing lesions which invade normal structures malignant neoplasms vary in the degree of differentiation and some show anaplasia. malignant neoplasms are capable of infiltration, invasion & metastasis.
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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 to therapy, and the general health of the patient.

Shashi-Dec-13

NEOPLASM

Uncontrolled cell Division

(DNA abnormality)

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Self Assessment Questions:

What is a neoplasm? Write two special characters? What is a papilloma, adenoma What is dysplasia, Metaplasia, Anaplasia Hyperplasia? Mention examples? Mention major classes of neoplasms with five differentiating features? Mention three features of malignant tumor?

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Self Assessment Questions:

What

is carcinoma-in-situ? What is grading? And staging? How are neoplasms named? What is CIN? Classify What are the common routes of cancer spread? How do we diagnose cancer? Brief note of tumor markers?
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Dont fight a battle if you dont gain anything by winning.

George S. Patton

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To be a great champion you must believe you are the best. If youre not, pretend you are.!
Muhammad Ali

Shashi-Dec-13

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Learning is the beginning of wealth. Learning is the beginning of health. Learning is the beginning of spirituality. Learning is where miracles begin.
Jim Rohn

Shashi-Dec-13