Neoplasia

Neoplasia
Neoplasia
• Definitions
• Classification
• Nomenclature
• Characteristics of benign and malignant neoplasm
• Epidemiology
Neoplasia
• Cancer is 2nd most common leading causes of
death worldwide.
• Emotional and physical suffering by the
patient.
• Different mortality rate …..
– Some are curable
– Others are fatal
Neoplasia
• Neoplasia = new growth
• Neoplasm = tumor
• Tumor = swelling
• The study of tumors = Oncology
– Onco = tumor + logy = study
Neoplasia
• Definition:
– is an abnormal mass of tissue,
– the growth of which is uncoordinated with that of normal
tissues,
– and that persists in the same excessive manner after the
cessation of the stimulus which evoked the change
– there is loss of responsiveness to normal growth controls
Classification of Neoplasia
• Based on the biological behavior :
– Benign and malignant
• Based on the cell of origin :
• Based on tumor parenchyma
– One neoplastic cell type - Simple tumors :
e.g., lipoma, adenocarcinoma
– More than one neoplastic cell type – Mixed tumors – usually
derived from one germ cell layer:
e.g., fibroadenoma
– More than one neoplastic cell type derived from more than
one germ-cell layer – Compound tumors - Teratogenous:
e.g., teratoma
TISSUE OF ORIGIN BENIGN MALIGNANT
COMPOSED OF ONE PARENCHYMAL CELL TYPE
Tumors of Mesenchymal Origin
Connective tissue and derivatives Fibroma Fibrosarcoma
Lipoma Liposarcoma
Chondroma Chondrosarcoma
Osteoma Osteogenic sarcoma
Endothelial and Related Tissues
Blood vessels Hemangioma / Angioma Hemangiosarcoma / Angiosarcoma
Lymph vessels Lymphangioma Lymphangiosarcoma
Synovium Synovial sarcoma
Mesothelium Mesothelioma
Brain coverings Meningioma Invasive meningioma
Blood Cells and Related Cells
Hematopoietic cells Leukemias
Lymphoid tissue Lymphomas
Muscle
Smooth Leiomyoma Leiomyosarcoma
Skeletal / Striated Rhabdomyoma Rhabdomyosarcoma
Tumors of Epithelial Origin
Stratified squamous Squamous cell papilloma Squamous cell carcinoma
Basal cells of skin or adnexa Basal cell carcinoma
Epithelial lining of glands or ducts Adenoma Adenocarcinoma
Papilloma Papillary carcinomas
Cystadenoma Cystadenocarcinoma
Respiratory passages Bronchial adenoma Bronchogenic carcinoma
Renal epithelium Renal tubular adenoma Renal cell carcinoma
Liver cells Liver cell adenoma Hepatocellular carcinoma
Urinary tract epithelium (transitional) Transitional-cell papilloma Transitional-cell carcinoma
Placental epithelium Hydatidiform mole Choriocarcinoma

Testicular epithelium (germ cells) Seminoma
Embryonal carcinoma
Tumors of Melanocytes Nevus Malignant melanoma
MORE THAN ONE NEOPLASTIC CELL TYPE—MIXED TUMORS, USUALLY DERIVED FROM ONE GERM CELL LAYER
Salivary glands Pleomorphic adenoma (mixed tumor of salivary origin) Malignant mixed tumor of salivary gland origin
Renal anlage Wilms tumor

MORE THAN ONE NEOPLASTIC CELL TYPE DERIVED FROM MORE THAN ONE GERM CELL LAYER—TERATOGENOUS
Totipotential cells in gonads or in embryonic rests Mature teratoma, dermoid cyst Immature teratoma, teratocarcinoma
Neoplasia
Classification
Most common method of classification of tumor is
based on the biological behavior of tumor.
– Benign
– malignant
Neoplasia
• Benign tumors :
– Will remain localized
– Cannot spread to distant sites
– Generally can be locally excised
– Patient generally survives
• Malignant tumors:
– Can invade and destroy adjacent structure
– Can spread to distant sites
– Cause death (if not treated )
Neoplasia
All tumors have two basic components:
– Parenchyma: made up of neoplastic cells.
* It determines the biological behavior of the tumor
* From which the tumor derives its name
– Stroma: made up of non-neoplastic, host-
derived connective tissue and blood vessels
* It carries the blood supply
* It provides support for the growth of the parenchyma
Neoplasia
• Nomenclature
– Benign tumors:
• prefix + suffix
• Type of cell + oma
Neoplasia
Benign mesenchymal tumors are classified on the basis
of :
The cell of origin
Examples:
* Benign tumor arising in fibrous tissue:
Fibro + oma = Fibroma
* Benign tumor arising in fatty tissue:
Lipo + oma = lipoma
* Benign tumor arising in cartilage
chondro + oma = chondroma
* Benign tumor arising in smooth muscle
Leiomyo + oma = leiomyoma
* Benign tumor arising in skeletal muscle
Rhabdomyo + oma = rhabdomyoma
Neoplasia
Benign epithelial tumors are classified on the basis of
– The cell of origin
– Microscopic pattern
– Macroscopic pattern
Neoplasia
– Adenoma : benign epithelial neoplasms
producing gland pattern….OR … derived from
glands but not necessarily exhibiting gland pattern
Neoplasia
– Papilloma : benign epithelial neoplasms
growing on any surface that produce microscopic
or macroscopic finger-like pattern
Neoplasia
• Polyp : a mass that projects above a
mucosal surface to form a macroscopically
visible structure. e.g. - colonic polyp , - nasal
polyp
Neoplasia
• Examples of benign epithelial tumors
– Respiratory airways: Bronchial adenoma
– Renal epithelium: Renal tubular adenoma
– Liver cell : Liver cell adenoma
– Squamous epithelium: squamous papilloma
Neoplasia
• Malignant tumors:
– Malignant tumor arising in mesenchymal
tissue is K/A SARCOMA
• From fibrous tissue: Fibrosarcoma
• From bone : Osteosarcoma
• From cartilage : Chondrosarcoma
Osteosarcoma
Neoplasia
• Malignant tumor arising in epithelial tissue
is K/A CARCINOMA
– Squamous cell carcinoma
– Renal cell adenocarcinoma
– cholangiocarcinoma
Neoplasia
Especial named tumors
• Melanoma ( skin )
• Mesothelioma (mesothelium )
• Seminoma ( testis )
• Lymphoma ( lymphoid tissue )
Neoplasia
Characteristics
of benign and malignant neoplasms
• Differentiation and anaplasia

• Rate of growth
• Local invasion
• Metastasis
1 = Differentiation and anaplasia
Differentiation means : the extent to which the

parenchymal cells of the tumor resemble their
normal counterparts morphologically and
functionally
• Well differentiated = closely resemble their normal counterparts
• Moderately differentiated
• Poorly differentiated
• Undifferentiated ( Anaplasia )
• Benign tumors = are usually well differentiated
• Malignant tumors = may be
- well differentiated
- Moderately differentiated
- Poorly differentiated
- Undifferentiated ( Anaplastic )
• In histological examination of a tumor
you should look for :
– Pleomorphism : variation in size
– High nuclear/ cytoplasm ratio ( N/C ratio)
– Hyperchromasia ( dark cell )
– Mitosis …. ? abnormal one
2 = Rate of growth:
– Benign tumors:
• grows slowly
• are affected by blood supply, hormonal effects ,
location
– Malignant tumors :
• grows faster
• Correlate with the level of differentiation
3 = Local invasion
– Benign tumors :
• Remain localized
• Cannot invade
• Usually capsulated
– Malignant tumors :
• Progressive invasion
• Destruction
• Usually not capsulated
4 = Metastasis
– Definition : the development of secondary

implants discontinuous with the primary tumor,
possibly in remote tissues
– Cancers have different ability to metastasize
– Approximately 30% patients present with clinically
evident metastases.
– Generally, the more anaplastic and the larger the
primary tumor, the more likely is metastasis
Pathways of metastasis
• Three pathways
– Lymphatic spread :
– Hematogenous spread :
– Seeding of the body cavities:
* pleural,
* peritoneal cavities and
* cerebral ventricles
Lymphatic spread :
* Favored by carcinomas
* Breast carcinoma  axillary lymph nodes
* Lung carcinomas hilar lymph nodes
Hematogenous spread :
* Favored by sarcomas
* Also used by carcinomas
* Veins are more commonly invaded
* The liver and lungs are the most frequently
involved secondary sites
Teratoma
• Teratoma contains recognizable mature or immature cells or
tissues representative of more than one germ-cell layer and
some times all three.
• Teratomas originate from totipotential cells such as those
normally present in the ovary and testis.
• Such cells have the capacity to differentiate into any of the cell
types found in the adult body. So they may give rise to
neoplasms that mimic bone, epithelium, muscle, fat, nerve and
other tissues.
• Most common sites are: ovary, testis
• If all the components parts are well differentiated, it is a benign
(mature) teratoma.
• If less well differentiated, it is an immature (malignant) teratoma.
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Neoplasia

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Neoplasia

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Neoplasia

Placental epithelium Hydatidiform mole Choriocarcinoma

Renal anlage Wilms tumor

• Differentiation and anaplasia

Differentiation means : the extent to which the

– Definition : the development of secondary

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