Neoplasia
- new growth - It is defined as abnormal mass of tissue, the growth of which exceeds and is uncoordinated with that of the normal tissue and persists in the same manner after cessation of stimuli which evoked the change
- Cancer- common term to all malignancies - All neoplasms utimately depends on the host for their nutrition and vascular supply. - Two basic components of Neoplasia : 1. proliferating neoplastic cell-parenchyma 2. supportive stroma- connective tissue and blood vessels.
Nomenclature
Parenchyma
Proliferating neoplastic cells
Stroma
Connective tissue and blood vessels
Classification of Neoplasms
A. Site B. Biologic Behavior benign, borderline, malignant C. Cell ( tissue of origin ) D. Embryologic derivation E. Differentiation potential of cell of origin totipotent cell F. Etiology
Tumors
NOMENCLATURE
Benign Tumors suffix oma Malignant Tumors 2 broad categories: Carcinomas - epithelial cells sarcomas - mesenchymal tissues Some tumors with more than one parenchymal cell type: mixed tumors & teratomas Two non-neoplastic lesions bear the names that are deceptively similar to tumors: choristomas &
hamartomas
Hamartoma: mass of disorganized but mature specialized cells or tissue native to the particular site
Cell of origin + OMA Fibroma, chondroma, osteoma Adenoma: derived from glands/ glandular pattern Tubular adenoma, colon
Benign Tumors
Malignant tumors: differentiation and anaplasia dysplasia Rapid rate of growth Widespread invasion metastases
1. Anaplasia
Lack of differentiation Hallmark of malignant transformation Numerous morphologic changes
Abnormal nuclear morphology: hyperchormatic (abundant DNA), increased N:C ratio (normal 1:4- 1:6)
Loss of polarity
Benign
Malignant Fibrosarcoma Liposarcoma Chondrosarcoma Osteogenic sarcoma Angiosarcoma Lymphangiosarcoma Synovial sarcoma Mesothelioma Invasive meningioma Leukemias Lymphomas
Hemangioma Lymphangioma
Meningioma Hematopoietic Muscle Epithelial Leiomyoma Rhabdomyoma Squamous papilloma Adenoma Papilloma Cystadenoma Bronchial adenoma Renal tubular adenoma Liver cell adenoma Transititonal cell papilloma Hydatiform mole
Leiomyosarcoma Rhabdomyosarcoma SCC or epidermoid CA BCC Adenocarcinoma Papillary carcinoma Cystadenocarcinoma Bronchogenic carcinoma Renal cell carcinoma Transitional cell carcinoma Choriocarcinoma Seminoma Embryonal CA
More than one neoplastic cell- MIXED Salivary gland Renal Teratogenous ( from more than one germ cell layer Totipotential cells Mature teratoma/ dermoid cyst Immature teratoma, teratocarcinoma Pleomorphic adenoma Malignant mixed tumor of salivary gland origin Wilms tumor
At MOLECULAR LEVEL , neoplasia is defined as disorder of growth regulatory genes ( proto-oncogenes and tumor suppressor genes ). Origin of Neoplasia: 1. Monoclonal Origin 2. Field Origin
factors, receptors, and signal-relay or transcription factors which act in concert to control entry into the cell cycle.
Tumor suppressor Genes (anti-oncogenes) which serve to down-regulate the cell cycle. note: a net increase in the production of stimulatory (promoter) factors, a decrease in inhibitory (suppressor) growth factors may lead to uncontrolled cell growth.
Cancer-Suppressor Genes
Protein Products of Tumor Suppressor Genes Gene amplifications p53 BRCA-1 and BRCA-2 APC gene NF-1 gene cell surface receptors WT-1
bcl-2
gatekeeper genes - APC, NF-1, and Rb caretaker genes - DNA repair genes
Protooncogenes
Mechanism
Associated Tumor
Activation is the functional concept whereby the normal action of growth regulation is diverted into oncogenesis. Mechanisms of Occurrence : 1. Mutation 2. Translocation 3. Insertion
Neoplasia Associated with Constant Genetic Abnormality: a. Philadelphia Chromosome- CML b. Retinoblastoma-Rb gene c. Wilms Tumor-WT-1 d. Familial Polyposis Coli-APC
Tumor Angiogenesis
CARCINOGENIC SITES
Chemical Carcinogenesis
Initiation Promotion
DNA
alkylating agents, aromatic hydrocarbons, azo dyes etc
Carcinogenic Chemicals
CARCINOGENIC SITES
Radiation Carcinogenesis
DNA Viruses
(1) HPV, Epstein-Barr virus (EBV) and Hepatitis B virus (HBV) (HTLV-1)
Immunosurveillance
Increased frequency of cancers in patients with congenital or acquired immunodeficiency increased susceptibility to EBV infections and EBVassociated lymphoma in boys with X-linked immunodeficiency
endocrinopathies Hypercalcemia Acanthosis nigricans clubbing of fingers and hypertrophic osteoarthopy thromboembolic diatheses
Paraneoplastic syndromes
Histologic and Cytologic Methods Fine-Needle Aspiration Cytologic (Papinacolaou Smears) Immunohistochemistry DNA Probe Analysis Flow Cytometry Tumor Markers
Grading
grades I to IV with increasing anaplasia imperfect because
(1) the differentiated parts of the same tumor may display different degrees of differentiation (2) the grade of tumor may change as the tumor grows
Staging
anatomic extent of the tumor TNM
Information Provided by Pathologic Diagnosis: 1. Type of Neoplasm - name of the neoplasm 2. Biologic Behavior- benign or malignant 3. Histologic Grade degree of differentiation 4. Degree of Invasion- depth 5. Staging - size of the mass/depth of involvement - involvement of nodes - +/- metastasis
Treatment of Neoplasms:
A. Benign surgical removal B. Malignant - surgery ( radical, wide excision, palliative surgery ) - Lymph node removal - Palliative : a. Chemotherapy b. Radiotherapy c. Immunotherapy
PNEUMONIA CACHEXIA RENAL FAILURE BLEEDING SEVERE ANEMIA, THROBOCYTOPEINA INFECTIONS HYPERCOAGULABILITY DIC PAIN MORE OF DEVASTATING SYMPTOM THAN A
COMPLICATIONHAS TO BE CONTROLED