Antonio Martinez, M. D.

amartine@utmem.edu
Tumor = Originally swelling or enlargement of any kind
(tumor is one of the cardinal signs of inflammation).
Currently the term is synonymous with neoplasm
Cancer= From the Greek karkinos (crab); strictly speaking
malignant tumor of epithelial cells. In practice is often used
for any malignant tumor.
Neoplasm = Literally new growth (also Neoplasia)
Oncology= From the Greek onkos (swelling, mass)
equivalent to the Latin tumor. The study of neoplasia
There is no satisfactory definition of neoplasm
A heritably (from tumor cell to tumor cell) altered, relatively
autonomous growth of tissue
General properties of tumors are:
Their growth is unrelated to the needs of the organism
They tend to be atypical (cells are structurally and functionally
abnormal)
They tend to be autonomous (escape growth controls)
They tend to be aggressive; either displace (benign) or invade
(malignant) the host tissues


Since neoplasms are new growths it may be appropriate to review some
concepts:
Hyperplasia (pathological)
Increase in the number of cells. Usually due to a chronic stimulus (hormone
or injury). Chronically hyperplastic tissues have an increased likelihood of
developing neoplasia. Hyperplasia is a reversible change
Metaplasia
A change from a differentiated tissue to another, usually in the same broad
class, but often less well specialized. Tissues with chronic metaplasia have
a higher likelihood of developing neoplasia. Metaplasia is a reversible
change
Dysplasia
Disorderly development or differentiation. Often there is increased mitotic
rate and cellular atypia. Dysplasia can progress to malignancy and many
of the characteristic changes of dysplasia are common to malignant cells

Although usually discussed with tumors (they are tumors in the
old sense of swelling), hamartomas and choristomas are not
neoplasias (new growths) but masses resulting from
developmental anomalies
Hamartoma= A nodule or mass composed of cells and tissues
normally present in the organ but lacking the proper
organization
Choristoma = A nodule or mass composed of cells and tissues
NOT normally present in the organ

The classification of neoplasms is as confusing and untidy as can
be expected from mixing 2,000 year old terms with those of
molecular biology, sprinkled with eponyms, macroscopic,
microscopic, clinical, and surgical names

In general (with exceptions, of course!), tumors are named
according to the predominant cell type. Sometimes according
to the cell of origin (real or imaginary, sometimes according to
a secretory product of the tumor cells). In the future, it is likely
that tumors will be named according to gene mutation,
chromosome rearrangement, or microarray pattern)

Two major classes:
Benign = Tumors without metastatic potential
Malignant = Tumor with metastatic potential
metastases = The secondary growth of a tumor at a site separate from the
primary
The ending (suffix) oma means tumor (as itis means
inflammation)
The exceptions are granuloma, atheroma, glaucoma, and neuroma (tumors
only in the sense of swelling)
In general, benign tumors are designated compounding the cell type with -
oma (e.g. fibroma, astrocytoma).
Malignant tumors are designated as carcinoma (if epithelial) or sarcomas
(if mesenchymal).
There are exceptions; Melanoma is a malignant tumor (melanocarcinoma)
of melanocytes (to avoid confusion malignant melanoma should be
used); sometimes hepatocellular carcinoma is called (improperly!)
hepatoma; Lymphomas are malignant neoplasias of lymphoid cells.
Myelomas are malignant neoplasias of plasma cells. Some malignant
tumors are called malignant as malignant ependymoma
The suffix blastoma is used for neoplasms thought to be arising (usually
in childhood) from pluripotent cells (embryonic remnants?). e.g.
hepatoblastoma, retinoblastoma. These tumors may contain a mixture
of epithelial and mesenchymal elements
Epithelial tumors can arise from glands or from surface linings
Tumors arising from glands (Greek = adn) are called adenomas
or adenocarcinomas. Adenomas with multiple cavities or cysts
are called cystadenomas (or cystadenocarcinomas)
Tumors arising from surfaces have earned more fanciful names
A finger-like or club-like tumor rising from a surface with a stalk is called
a polyp; Greek Polypus (many feet)= octopus (just eight feet);
If the stalk is relatively long is called a pedunculated polyp
If the tumor has a small or no stalk it is called a sessile polyp (Latin
sessilis= sitting)
If the polyp has glandular elements, it is called an adenomatous polyp
If the tumor has multiple finger-like projections, it is called a papilloma

Neoplastic cells share many characteristics with
normal cells but, obviously, there are some differences.
Although there is no single characteristic common to all
neoplastic cells, they have several features separating
them from normal cells
Structural
Behavior in culture
Behavior upon transplantation
Functional
Less differentiation
The tumor counterparts of ciliated cells will have fewer, or no, cilia;
the counterpart of secretory cells will have less secretion. Tumor
cells, generally have a haphazard arrangement. In general, benign
tumors are better differentiated than malignant ones. This concept is
summarized in the term:
Anaplasia = lack of, incomplete, or defective differentiation. The
term dedifferentiation is also used, it sort of implies that a
differentiated cell went back. The current concept is that of
pluripotential, undifferentiated (stem) cells are the target of the
oncogenic stimulus and because of the oncogenic changes, they fail
to fully differentiate.
Normal Malignant Benign
In general, benign tumors grow faster than normal
tissue, and malignant tumors grow faster than benign
ones (these statements are broad generalizations with
significant exceptions). Common features of fast
growing cells are:
Increased basophilia (more RNA and therefore more active protein
synthesis)
More and larger nucleoli (nucleoli synthesize RNA)
Increased glycogen content (anaerobic glycolysis common to
embryonic and tumor cells)
Atypia= not corresponding to the normal type
Atypia tends to parallel the degree of malignancy
Abnormal size and shape with variability
Irregular and larger nuclei
Increased frequency of mitosis and some may be abnormal (tripolar,
tetrapolar)
Abnormal secretion
Random abnormalities (intracellular lumina, increased microvilli,
crystalloids)
A
B
C D
The study of neoplastic cells in culture has been very informative
(in tissue culture studies malignant cells are often referred to as
transformed cells)
Immortality. Cultured malignant cells grow forever (not individual cells
but the progeny)
Anchorage independent. Malignant cells do not need a surface to grow on;
they can grow in a fluid medium
Loss of contact inhibition. Malignant cells continue to grow and pile up
on top of each other
Decreased requirement for exogenous growth factors (they produce their
own and use them in an autocrine fashion)
Malignant cells transplanted to immunotolerant animals grow and
metastasize
Motility. Many neoplastic cells are motile (even if the normal
counterparts are not) with ameboid movements
Secretion of enzymes not made by the normal counterparts

Decreased adhesion between cells
Decreased intercellular communication
Changes in cell-surface carbohydrates
Multiple and variable (no rules) differences in protein
synthesis and secretion as a consequence of multiple
gene changes (gene repression, enhancement,
amplification, etc)
We distinguish two components in all tumors:
Neoplastic cells (tumor parenchyma)
Non-neoplastic stroma composed of blood vessels and
supporting connective tissue (fibroblasts, myofibroblasts,
and extracellular matrix)
Parenchyma (Greek origin) is used to designate the cells or tissues distinctive or
specific to an organ (e.g. thyroid parenchyma, renal parenchyma)
Stroma (Greek origin related to the English word straw) is applied to the supportive
framework of an organ. It can be viewed as the bed for the parenchyma
The vascularized stroma is supplied by the host but it is
induced by the tumor. The ability of tumors to induce new
blood vessels (angiogenesis) is essential for tumor survival.
Therapies attempting to block angiogenesis are part of
current treatment of several malignancies
In general:
Benign tumors tend to have sharply defined edges and a capsule
Benign tumor
Capsule
Parenchyma
Malignant tumor
Capsule
Non-neoplastic Parenchyma
In general:
Malignant tumors, if they have a
capsule, it is often incomplete
and the tumor often breaks
though it at several points.
Rapidly growing tumors may
have a surrounding layer of
atrophic and/or dead host
parenchymal cells that, grossly,
may appear as a capsule. This
layer is often called a
pseudocapsule