TUMOR SISTEM

ALIMENTARI
 Reparative lesion:
EPULIS

Excessive reparative process

-Granulomatous epulis
-Fibromatous epulis
-Giant cell epulis
-Haemangioform epulis
-Pregnancy epulis
LEUKOPLAKIA
- white patches of keratosis
- premalignant lesion
- hyperkeratosis, hyperplasia of the squamous epithelium
- dysplastic changes

SQUAMOUS CELL CARCINOMA

Pleomorphic adenoma (parotid)
Pleomorphic adenoma (parotid)
Pleomorphic adenoma (gross)
Pleomorphic adenoma
Pleomorphic adenoma
 Warthin tumor

Benign tumor mostly occur in parotid gland

 Warthin tumor

Cystic spaces lined by double-layered eosinophilic epithelium,

and all embedded in lymphoid stroma
 Oncocytoma

Mostly in parotid gland

 Oncocytoma

Large granular appearing, eosinophilic-staining epithelial cells

Adenoid cystic carcinoma

Minor salivary gland

Adenoid cystic carcinoma
 Adenoid cystic carcinoma

Most characteristic appearance consists of cribriform pattern

with masses of small, dark-staining cells arrayed arround
cystic spaces
Adenoid cystic carcinoma
Mucoepidermoid tumor
(Palatal gland)

Mostly in parotid gland

 Mucoepidermoid tumor
(Low grade)

Comprised of mucus-producing and epidermoid omponents

and cells intermediate between the two
Mucoepidermoid tumor
(moderate grade)
Mucoepidermoid tumor
(High grade)
Perforation of the cheek:
cancer of the tongue
 III. Diseases of the Esophagus
F.2. BARRETS ESOPHAGUS

Columnar metaplasia (often of intestinal type with prominent goblet cells) of

esophageal squamous epithelium.
Complication of long-standing gastroesophageal reflux, to be a well-known
precursor of esophageal adenocarcinoma
 III. Diseases of the Esophagus
G.1. Squamous Cell Carcinoma

Arises most frequently in the upper and middle thirds

of the esophagus
 III. Diseases of the Esophagus
G2. Adenocarcinoma

Arises most frequently in the lower third, and mostly from

aberrant gastric mucosa or Barrets esophagus
STOMACH
ATROPHIC
GASTRITIS
H.pylori
Helicobacter pylori (gastric mucosa)
(silver stain) x 300
H. PYLORY AND CHRONIC GASTRITIS
Intestinal metaplasia: stomach
(alkaline phosphatase) x 50
 OTHER GASTRITIS

Eosinophyillic gastritis: food allergy ?

Granulomatus gastritis: tuberculosis,
syphilis, sarcoidosis, fungi, Crohn
disease
Reflux gastritis: duodenal and bile
reflux
Menetrier disease (giant hypertrophic
gastritis)
Menetrier disease (HYPERTROPHIC GASTROPATHY)
Severe hyperplasia of mucosal layer
cells + glandular atrophy extreme
enlargement of gastric rugae
Hypertrophic gastropathy + hyper-
secretion: mucosal cells, parietal and
chief cells hyperplasia.
Gastrinoma excessive gastrin
excretion gastric glandular
hyperplasia (Zollinger-Ellison
syndrome)
Sometimes with severe loss of plasma
proteins from the altered mucosa
Risk of peptic ulcer
TRIGER FACTORS OF PEPTIC ULCER
 Cylindric epithelia

Necrotic debris

Granulation tissue with lymphocytic infiltration

Glands hyperplasia

Edema

PEPTIC ULCER
 I. Diseases of the stomach
D. Tumors of the stomach (benign)

POLYP
- Polypoid mass
>90% non neoplasm (inflammatory/
hyperplasia)
Sessile / pedunculated
20-25% multiple
Mostly occur in chronic gastritis
No malignant potential
ADENOMA
neoplasm 5-10% of gastric polyp
Sessile / pedunculated
distal antrum predominant
Six decade, Male: female = 2:1
Some cases origin from chronic gastritis with
intestinal metaplasia
 I. Diseases of the stomach

D. Tumors of the stomach (malignant)

90-95% of gastric malignancy
High incidence: japan, Chili, Costa Rica, China
Location: - 40-50% pylorus/anthrum; 25% cardia
- 40% minor curvature; 12% c. major
- Etiology:
- Diet
- Chronic atrophic gastritis
- H. pylori infection
- partial gastrectomy
- Gastric Adenoma
- Genetic : A blood group, family factor
 GASTRIC CANCER
Invasion
Early ( mucosa and sub- mucosa)

Advanced (invade the sub- mucosa)

Macroscopic growth
Exophytic

flat/ depressed

Excavation

Linitis plastica tumor cells diffusely infiltrate

gastric wall leather bottle appearance
Histology
intestinal gland type

Diffuse: signet-ring cell

 The differences between a
benign and a malignant ulcer
Benign or malignant?
 Answer :
Benign.
Clear, sharp, punched out borders.
No neoplastic mass present. Benign
peptic ulcer.
Benign or malignant?
 Answer :

Malignant.
Large ulcer. The margins are
irregular and you can see the mass
under the ulcer.
The Growth of Gastric Cancer
 Sessile adenoma

Dysplasia: characterized by a flat lesion

 Other gastric tumors
MALIGNANT LYMPHOMA
40% malignant lymphoma of GIT
5% of gastric malignancy
B cell type predominant, MALT origin
CARCINOID TUMOR Carcinoid syndrome
Low grade malignancy
Metastasis to the liver
Multiple lesions
LEIOMYOMA
SECONDARY TUMORS (METASTASIS)
rare
Mostly from leukemia or general
lymphoma
From breast / lung cancer diffuse
linitis plastica
Early Gastric Carcinoma
Early Gastric Carcinoma

Scanning power view of histologic section

Early Gastric Carcinoma

Scanning power view of histologic section

 Gastric
Carcinoma
 Gastric
Carcinoma
 Gastric
Carcinoma
 Gastric
Carcinoma
 Gastric
Carcinoma

Signet ring cells

Signet ring cells (PAS +)

Gastric Carcinoid Tumor
Gastric Carcinoid Tumor
Gastric Carcinoid Tumor
Gastric Carcinoid Tumor
Gastric Carcinoid Tumor
Gastric Carcinoid Tumor
Gastro-Duodenal junction

Stomach: Glandular
arrangement

Pyloric sphincter

Duodenum: villous
arrangement

Brunners gland

Circular muscle

Longitudinal muscle
 Duodenum
Villi

Mucosa

Submucosa
Muscularis
mucosae

Circular layer

Longitudinal layer Brunners gland

Duodenum

Villi

Crypt of Lieberkuhn

Lamina propria

Muscularis mucosa

Submucous

Glands
 Duodenum
(PAS staining)

Goblet cells

Brunners gland
Duodenum
Small Intestine

Mucosa

Villi

Peyers patches

Plicae circulares

Vascular submucosa

Muscularis mucosae

Circular muscle layer

Longitudinal muscle

Serosa
Small Intestine
Villi

Lamina propria

Crypt of Lieberkuhn

Muscularis mucosae
 Ileocecal Junction

Lymphoid tissue

Small intestine Muscularis propria Large intestine

II. Diseases of the Small Intestine

A. Peptic Ulcer
B. Crohn Disease
C. Meckel Diverticulum
D. Malabsorption syndrome
E. Tumors of the Small Intestine
 Colon

Lymphoid
aggregates

Circular layer

Longitudinal
layer
Colon
Colon
Colon
Recto-anal Junction

The junction

Squamous epithelia

Rectal mucosa
Adenomatous polyp
Colon adenoma
What kind of polyp is this?
 The answer :
tubulovillous adenoma
 What kind of polyp is this?
This is a gross morphologic term and does
not describe the histopathologic features of
the lesion.
It could be adenomatous or a simple type of
polyp.
A correct diagnosis of a polyp can only be
given after a histologic examination.
Ulcerative Colitis
Familial Adenomatous Polyposis
Polyposis of the colon
ULCUS CARCINOMATOSA
Ulcerating carcinoma of the colon
Adenocarcinoma of the colon
Colon Carcinoma
Adenocarcinoma of the colon
(PAS) x 100
Mucinous carcinoma of the colon
Signet-ring cell carcinoma of the colon
(HE) x 100
Adenocarcinoma, NOS
CEA: carcinoma of the colon
(IH) x 50
Peritoneal carcinosis: metastatic
rectal carcinoma
Dukes Stage
 ASTLER -
COLLER
Five-year survival rate
A tumor terbatas di mukosa 100%
B1 sampai dengan muskularis propria,

belum sampai ke limfonodi 67%

B2 menembus muskularis propria,

belum sampai ke limfonodi 54%

C1 sampai dengan muskularis propria,

sudah sampai limfonodi 43%

C2 menembus muskularis propria,

sudah sampai limfonodi 22%

D metastasis jauh sangat rendah
SINDROM CARCINOID
DIARRHOEA
FLUSHING --------- > CYANOSIS
HYPOTENSION
DYSPNEU
EDEMA / ASCITES
STENOSIS OF TRICUSPID OF PULMONARY VALVES
Carcinoid of the appendix
(HE) x 75

(IH; chromogranin) x 75