Cdsa Neoplasia(2)

SITUATIONAL ANALYSIS NEOPLASIA

Prepared by EMMANUEL R. DE LA FUENTE, M.D.

This program is the exclusive property of the Department of Pathology of the Faculty of Medicine and Surgery of the University of Santo Tomas programmed and prepared by Dr. Emmanuel R. de la Fuente. This presentation is exclusively for the students of the above Faculty for the school year 2004-2005 Unauthorized use is prohibited by your Conscience.

Objectives 2.To recognize the essential morphologic features of benign and malignant neoplasms 3.To correlate the molecular biology of benign and malignant neoplasms with their morphology 4.To correlate the situational events with the tumor morphology

SITUATION NO. 1 A 34 year-old man had a warty growth on his neck. It was diagnosed by his physician as a benign skin growth caused by a virus. The lesion was excised.

Slide 1. Two microscopic sections of the skin. Which of the two is consistent with the diagnosis of the physician? Identify the lesion and describe.

1.Give the proper nomenclature of this lesion. 2.Briefly discuss the etiopathogenesis of this lesion, including the genetic aspects. 3. Study of demonstration glass slide no. V-1

SITUATION NO. 2 A 62 year-old woman had a routine paps smear. The smear was interpreted by the pathologist as squamous cell carcinoma.

Slide 1. 3 paps smears are shown. Which of the 3 reflects the interpretation of the pathologist? Explain why and describe.

1.Correlate the morphology of the cells in all the pictures with their biological aspects. 2.Study of demonstration slide illustrating normal and malignant squamous cells

SITUATION NO. 3 A hysterectomy was subsequently done on the woman in situation no. 1.

Slide 1. Hysterectomy specimen with the cervix prominently shown. Identify the lesion and described. What gross features favors malignancy?

Slide 2. Two microscopic lesions of the cervix (A & B). C is a high power view of B. Which of the two is more consistent with the gross lesion? Explain why. Describe.

A

B

C

1.Give the proper nomenclature of these lesions. 2 Briefly discuss the pathogenesis of each lesion, including the biomolecular aspects. 3.Is there a relationship between the two lesions? 4. Actual study of demonstration slides illustrating similar lesions: CE-3 and CE-4

SITUATION NO. 4 A 36 year-old woman has experienced prolonged menstrual bleeding accompanied by vague abdominal pain. An ultrasound of the uterus disclosed well-circumscribed masses in the myometrium measuring from 1 x 1 cm to 2 x 2 cm. She was loss to followup. Four years later, with persistence of the same sign and symptom, she again had another ultrasound. The same masses were larger, the largest measuring 3 x 2.5 cm. A hysterectomy was done.

Slide 1. The hysterectomy specimen. Do the lesions appear malignant or benign? Explain why and describe.

Slide 2. Two microscopic sections of uterine lesions. Describe each lesion. Which of the 2 is more consistent with the gross and history of the patient. Explain why.

1.Give the proper nomenclature for each lesion. 2.Briefly discuss the pathogenesis of each lesion, including the biomolecular aspects. 3.Is there a relationship between these two lesions? 4.Actual study of slides M-2 and M-5

SITUATION NO. 5 A 63 year-old woman had a right breast mass measuring 4 x 3 cm. The mass was described as hard and fix with poorly defined margins. The right axillary lymph nodes were enlarged. A right modified radical mastectomy was done. The pathology of the mass was described as follows:

“Sections of the tumor disclose a malignant neoplasm composed of invasive nests and sheets of polygonal to oval-shaped cells in areas forming tubules. The cells are large with increased nucleo-cytoplasmic ratio. The cytoplasm is scanty. The nuclei are enlarged and pleomorphic with increased chromatin, most showing prominent nucleoli. Increased mitotic activity is noted. In areas, dilated ducts are filled with large round cells with similar nuclear characteristics as described earlier but confined within the basement membrane. The stroma is fibrous in areas showing moderate amount of lymphocytic infiltrates. Occasional blood vessels are filled with tumor cells.”

Slide 1. Mastectomy specimen. Indicate the lesion and describe the features that favor malignancy.

In the following microscopic sections from the different areas of the tumor identify the following: 2. Invasive sheets and cords of malignant cells in areas forming acini 3. Increased nucleo-cytoplasmic ratio 4. Enlarged and pleomorphic nuclei with increased chromatin 5. Increased mitotic activity 6. Moderate stromal lymphocytic infiltrates 7. Dilated ducts filled with tumor cells confined to the basement membrane 8. Blood vessels partially filled with tumor cells

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1.Give the proper nomenclature of this tumor 2.Discuss briefly the pathogenesis of each lesion, including the biomolecular aspects. 3.Correlate these lesions with the situational events. 4.Actual study of glass slides illustrating these lesions.

NEOPLASIA IS A DECLARATION OF INDEPENDENCE BY A GROUP OF DISORDERED CELLS.