Logy Course 6

.

r"eopl6ia mems anewlhsue srouhi it h m abnomal tGsue Frolileraron

. .

-

pesistenl

ucodinated*ith

the sDdobdine n$ues does not stop even aierelininarion $e induced the prclifention rhe

grofrl

stinllDs, qhich

BIOLOGYOF MALINGNANT CELLS

Acquned diseas€ (rypes or

. .

ctum ca {i talad

subslricet

mcroba (vfa aqed$

d sease (geneticdefech) - nherled . PornGis cd > cooncadenomas

Carcinogenesrs .

t.:

. .

ce It \s]brnt on dr s bYaLrdrigrhe cell senome Di'ls the aciion olfte rol varidus reent = unor cLoDe (ir 'ial seDddion

orralfmed ell:

Prolifua(ion oltanslomld celh: formarion ora rDmor inas(P.n.1roL, Tdfl., progre$ror aidnnor ietrorcn rr' 0rrogretrron) linial y l *. mon$romr Gte e gfle

Ln!L'pLelddjLo.e4emuljoN)= bmrreai@. iilasion,

'

netMis,

Loelinvbior arddishnr .rarasg

Mechan sms of local invaslon and metastasis

rlri {l

Robbins and Kundr t€rlbo0k orPal[olos] des.riptior ofthe procds progre$ion and netastasis

orn,lignart

CLASSIFICATION OF NEOPLASMS

.

The main classification of neoplasm

according with its biologic behaviour

'

.

-

BENIGN MALIGNANT

TurnoLrrs can also be classified according io

the cel of orlginl 1 EP THEL AL NEOPLASIVS 2 IVESENCHYMAL NEOPLASMS

D,pas or neoplasm3

matisuinr

ird adlr@nr1$ues .

€i

neoptis (cane4

spread (md:slases) in

Terminology of the neoplastic diseases ma$ G

.

For d€fiinq rhe

na si:rtlumoul

swen ns

!$!e)

Neoplasm morphology .

Any ben q^ lumor (TB)and maignanlluhor (1M)has 2 componedls:

p:,ei.,yma=slhem*sorn@pasrcce tmor stina 6m ds or

G) luno, (b)

s

' df&dnDna cFn@bfttn'la rhe imp

asl c

g.ovih requnes de6o

Morphological characteristics of distinguishing between TB and TM

. .

.

Differentiation and anaplasLa The rate of groMh Local invasion

.lvletasiasis

Hsioogi.a leaturs ofdifferenlialion

of the n€prasms

mdsmaityolneopaslt.elswlh

w.

6ed j.ms 16!)b dne€dded (ND)c,anap'ai.r..ns

I'i :..,

!i

t t

The rate of growth -TBs

-IMs

slow groMh .hlthm Epid growth lh!,thm

The raie oitlmor grosnh is corielaied wilh the deg€e of diiferenUalion: TM-WD=lhey grow more srowy TM-PD=they srow rapdy

non

Local i nvaslon ,.iain

no atrhe oace or

oiqii or IMs sjod Gpsy nvadiiq

adra.edi$!es

rBs laGsrcwne

s owy)

atrd causng

ine(

deveop

N.r arTBs areencapsu aled bd

aG.i€dr ddned dar nen

ex-ot

and

nq

seprErd

hsanqyoma

nvasoi h a.haBcldrsiicieal!rc

Local invasion infiltrative feature

Metastasis smsdbssinares away rrcn Loca sprcad direcllumo'

fierP (!

spled iadj

e nyperprasra

o4a I idn,Lro,oou+ v4deneo.ao e"p.ur{

'

aio o d{.'"

e po_:r rhe pra@ord qh

dpai

ofhepimary rlmoD

l/letastastatic ways of tumor cells

l0

Visceral metastases

The eftects ol benign and rnaligfanl lumors ir the body

LocalEffects Compress ng of the tissues -TB become c ln.aly manLfesied

'

Systemlc Effects

-

Cachexia (TM)

overinfecion (TB, T[I) 'TMpaGneoptasrcsdr

iTB

Tlr,1)

tl

TUMOUR CELL PRODUCTS Sofre lumour cells pbduce secrerions

.<4. @lote r'tr. rhmurcgobdh5.4mdiP|emy€on

Morphological diagnosis '

Evarualon oftumorsradins

.

Eva u.rion

.f

lLmof sias

is

14 -

(4

tl

Neoplasm algorithm diagnosis

laboraLa . q/tolosical

' Histologlcal :!! Pteq-

B€nig. rnd malisoant epith€lial tuBoB

,

Bflign epiinelal rmos (TEB) de @nposd of dilleendated epnhelal

- epidemoid nucou nmbtues - gladuld epithelim . Cbsincation (2 subt$et: papilloms -

rissu€s

Papilloma

Squamocellulrf p.pillona . Tunool epithelial prolifedlion with odsi! in epidemis

-

vegorarive lunor ptojecrins on fie sli. suda.c ldious dinensions (l-2 cn) ltree b6is of inrl&tation and o idegultu $nlrce

Squamous papilloma

3sa suppon and

n ieil

'1. !,:,

t5

Skin papilloma as e evited skin res ons r'tr dh

eo'lhe um trh ch oft€n slro$ hy pe*erarosis on the su rlac€

m! rp

e

rnqeF te Pb.Jed ons

gqedon.onlanmg

a

@'e ol

Cutaneous warts vulga swarts-skin papilloma caused bY human papiloma virus (HPV)

-

Ml- skin papiloma wiih

-

MA-pjgmenied smail vegetalion localized on

l6

Epidermoid mucols PaPr loma {condiloma accuminatuml

l7

Adenoma Adefoma is a TEB wiih ongin

n

glandllarepitheLum

' p'ore!o or9l.-d-l4eplre'Ftol o.fa,o pae /-a exod ne and endocaie o€ans pm le,ali.i or duotular epilhelium

c assfcaton 3Vpes oiadenomas (after macroscopic appeahnce aid p ace oiorigin)

-

adenon.s deveoped ts@ s andurar pa€nchyma

-

adenoma d€v€ oped in cav lary organs

'

madospcappea€neoipor'!hdicdardfodue)o, ,daidh,oG po yp (PA)

. ovaiai.ydadeiohd - (cA)

EXOCnne Otano aoenoamas

.

. .

Exocrine glaidular aoenoamas common y oeverops In mammary glands, salivary glands

mammary slands (FA) Mixed iumof, homonol'/A-nodulaf solid. touqh. -oncapsllated. sm: | (1-2

l8

Fibro-adenoma of mammary glands

" *rt\

I cttr

tT

I

(a) 6pdh€liar (b) rha

dpoianl

is

mde

up

of

conndve omponedis@mpo

Endocrine g landular aoenomas Endocrine gland adenomas are accomoaried by charadenst c endocfl ne synoromes:

-

Thyrc d: excess oJ ihyroxine (tireotoxicosis) PaEthyroid: hypercal€emia

. . . .

Codi@! adrenal lhat ecrels st€ro ds (Conn & Cushinq Medular adcnalthat

(ph@mmeylm.)

*reis

catheco amine

Etcesof ACTH

(sdr. Cushing) Ex@ss ot sTH {acrmegaly in younq lfe and giganismin

t9

Thyrod

g andu ar adenoma

Td

s

ilir..

:li, [i:ti

Parathyroid aoenoma

20

Pheocromocitoma

4sryry

2l

adenohalous lub! ar poLyps

m!

(a)

lLo e

-sh

shod baseoT

pedt e whch s@vtr€d d'

(b) qiobd

'

e4'emi/ornodulr,

(c)mscdar aye,orrhem@osa6

villous .

N,lA'sess eveqetalvellmor,

vilh shod and thick ped ds and iiegura su{ece dueb$e pGse.ce oi iumemus

(a)

6

emP.sed ol

v'l

vr

denten

bY

and cov€red bv a PrdileEted surrace eo thel um ookno

normaloiDP wlh €ducad

b)

musceleye.olrhemlcosa is

22

tubulo-villous polyps .

[,1A-rtrnorrook nq ad.rescenr

sl'ucl!rc consstnq

ot

vil

.

lvl llretubulov ousPoLYP G) s oompced oi a ir* ke ped cle oo a n nq nunerous covered by nuh€rousvm

{b)nscre

Laye,

otrhehumsa

s

colonic adenomaious PoIYP

Go$vnodu|eamonedbyapedidem4ilrnqqF* . MM,s

nrudue P h mdd $wE +hd€idFPaa

tl

Precancerous lesion progression to neoplasia Prc.ancerous Lesons most onen encounl€red

. . . . ' '.

EndDnel a hyperp 3sa end ofmammary s and c allr.oplr c s.slr hs w 1rr nleslrna merapras a and dysp as a Adenomatouscoonporyp

chroi

coron c dyspasia n ulcechemoiihag c co

$s

cffoncautoimmunedseases+ LMNFl Ce acdiseaser nresinal ymphoma Auio mmune thyodl s+ lhynd lymphoma

Siages ofdeveopment oineopasia afd progess:on oflhe DPio neopasia

-cldqyh.adF*dDo4rDbgc lsDodanqe[slbj&iennD!{r M] mdqdqi

l{

in situ squamous cafcinoma

MALIGNENT EPITHELIAL TUMORS (cARCTNOMAS) malignant epthellal tumors lurnorderlved from epilhe a Ussles -a'.9na1r epirheliar tu-o s are characler zed by: - are common in adulls aid eiderY - o,ag-osrs > eslaol ,r n srage 0 C S\ '00o; I edlr g f.equenlly g ve lymphaiic melaslases

classlflcaiion of carcinomasl

)5

EPIDERN,lOID CARCINOAI!1A

(scuAN,4ocELULLAR CARCINOAIVIA

.

Origin:

-

.

)

mucous eprdermord eo demoid areas oisclamous metaplasra (plLf slfaif ed gut ep thelium)

Localion:

-

i,4ucous epdermod membrares: lip, longue. pliarvnx |arynx, exoco , vag na l\4u@us membranes wlh ies ons ol epidemoid

meiaprasia ex. bronchial eptheium (smoking)i biliara channel (calcu ous)

Precancerous lesions '

There are 2iypes of dysplasic lesions:

doca

ore otten on the hands (ski^ etposed io sun iolit)

. Vi paq,e,o'cm r "tr -0" . M -celLs f6m haLl lMr pad of the €p demis

l4e, salp

presents atvp a

and ma*ed dyspa$a Int€epdem ccarcioma (carcinonal^

situ epld€moid)c S - .V"p'|neace5M1,'ydala'|eod6-a'a/AFl1lo''

,nd deomofim) MB s iiacl pb eminenl. €d broM

.

DasnosG shou d be m.de ln

cls

P

aques w lh roca

stas€

)6

Invasive carcinomas

2l

na^ .1.:.:1o:'1i1!]!ele1€r&qe5ddfferedJon

' .

'

:;

; " ;::"i . :i:T"*:;:i::T#;fl;:i*.':;"

;!is"i^',",S'i?"",'"1?i',*";'i3."i::sb

!E

j'-

dlre i,,'.-'

epehrt ruo$ . e (

-".s"

MD

rni!:r

q

v

bv'vmpria,"

m

"

WD invasive scuamous carcinoma

28

MD invasive scuarnous carclnoma (no keraUnization)

scuarnous carcinoma -lymph node rnetastasis

19

Basal cell carcinoma (CBC) s a Part culal lorm oriain: basal ayer of lhe ep6ermis and hair fo licle MacroscoP!cary: ulceraiile €rc noma

wh

I carclnoma NoduLar and ulcerated basal ce

(ulcus rodens)

t0

Basal cell carcinoma of the skin

':,

3t

Adenocarcinoma Aoenocarcino'na (ADC) is a tumor wth ongin in the olandular eoithelium from caviiary organs (stohach, colon) ot parenchymalolgans (lung

3)

Adenocarcinomas

,.'g-, \".,

.'':|t

,j)

niacroscop ca! lypes or aarc.omas

il

Adenocarcinoma-M

I

eds lr!b*) aid dhvpE

rmdersdh

Particular forms of ADC

-

MA

b;d

d

-i ** iso c*th"

;!:;s.-d.!et

bt

d

"

[email protected]*)

ce &re

l4

WD gastric adenocarcrnoma

colonrc invasive adenocafcinoma

l5

coloid and ing cell gastrjc carclnorna

Garcinoma metastases A. Lyniph nodes metastas s

-

Macosc.pcaly l\rl

B

-

.b*od€

- rymph nodes are

ly- lunor ce s nvade

VisceraL metasiasis:

M

crcsccpicaly

ncr$s ng

n

rymprr node atea

Adenocaac noma

hepatic

i7