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Tumors of Intestines. Introduction Overall, colorectal cancer ranks second only to bronchogenic carcinoma among the cancer killers. Overall, colorectal.

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Presentation on theme: "Tumors of Intestines. Introduction Overall, colorectal cancer ranks second only to bronchogenic carcinoma among the cancer killers. Overall, colorectal."— Presentation transcript:

1 Tumors of Intestines

2 Introduction Overall, colorectal cancer ranks second only to bronchogenic carcinoma among the cancer killers. Overall, colorectal cancer ranks second only to bronchogenic carcinoma among the cancer killers. Adenocarcinomas constitute the vast majority of colorectal cancers and represent 70% of all malignancies arising in the gastrointestinal tract. Adenocarcinomas constitute the vast majority of colorectal cancers and represent 70% of all malignancies arising in the gastrointestinal tract.

3 Terminology A polyp is a tumorous mass that protrudes into the lumen of the gut; traction on the mass may create a stalked or pedunculated polyp. A polyp is a tumorous mass that protrudes into the lumen of the gut; traction on the mass may create a stalked or pedunculated polyp. Alternatively the polyp may be sessile, without a definable stalk. Alternatively the polyp may be sessile, without a definable stalk. Non-neoplastic PolypsNon-neoplastic Polyps abnormal mucosal maturation, abnormal mucosal maturation, inflammation inflammation do not have malignant potential (excl.Peutz-Jeghers) do not have malignant potential (excl.Peutz-Jeghers) Neoplastic Polyps:Neoplastic Polyps: adenomatous polyps, or adenomas, adenomatous polyps, or adenomas, precursors of carcinoma. precursors of carcinoma.

4 Non-neoplastic (benign) Polyps Hyperplastic polyps Hyperplastic polyps Hamartomatous polyps Hamartomatous polyps Juvenile polyps Juvenile polyps Peutz-Jeghers polyps Peutz-Jeghers polyps Inflammatory polyps Inflammatory polyps Lymphoid polyps Lymphoid polyps

5 Neoplastic epithelial lesions Benign lesions: Benign lesions: Neoplastic polyp Neoplastic polyp Adenoma Adenoma Malignant lesions: Malignant lesions: Adenocarcinoma Adenocarcinoma Carcinoid tumor Carcinoid tumor Anal zone (anorectal) carcinoma Anal zone (anorectal) carcinoma Mesenchymal lesions (benign/malignant) Mesenchymal lesions (benign/malignant) Lymphoma Lymphoma

6 Non-neoplastic (benign) Polyps Common Common Hyperplastic polyps Hyperplastic polyps Adults Adults Rectosigmoid Rectosigmoid Multiple Multiple Nipple-like, Nipple-like, Small protrusions (5 mm) Small protrusions (5 mm) Abundant crypts. Abundant crypts. Juvenile polyps Juvenile polyps Children Rectum Single Round mass 1-3 cm Dilated cystic glands.

7 Polyps Hyperplastic polyp Juvenile polyp

8 Sessile Pedunculated

9 Adenomas Small-pedunculated; large-sessile Small-pedunculated; large-sessile Colon Colon Familial predisposition Familial predisposition Risk of carcinoma Risk of carcinoma Subtypes: Subtypes: Tubular Tubular Villous Villous Tubulovillous Tubulovillous Malignancy: Malignancy: Rare: tubular adenoma less than 1 cm High: sessile villous adenomas more than 4 cm Dysplasia: villous adenomas.

10 Tubular adenomas: Tubular adenomas: Colon (rectosigmoid) Colon (rectosigmoid) Small-sessile; large- pedunculated Small-sessile; large- pedunculated Stalk is covered by normal mucosa Stalk is covered by normal mucosa Tumor is composed of neoplastic epithelium Tumor is composed of neoplastic epithelium Intramucosal Ca or invasive Ca. Intramucosal Ca or invasive Ca. Villous adenomas: Villous adenomas: Rectum/rectosigmoid Larger than tubular Sessile Cauliflower-like Dysplasia  Ca. Tubulovillous adenomas: Tubulovillous adenomas: Peduculated or sessile Mix of tubular and villous patterns Dysplasia Malignancy.

11 Adenoma

12 Familial polyposis syndromes Peutz-Jeghers Syndrome Peutz-Jeghers Syndrome Multiple polyps (polyposis coli) Multiple polyps (polyposis coli) large, firm polyps with a tree-like structure large, firm polyps with a tree-like structure distinctive freckles on the lips, palms, and genitals distinctive freckles on the lips, palms, and genitals risk for colon cancer. risk for colon cancer. Turcot's syndrome Turcot's syndrome Multiple polyps Multiple polyps brain tumors. brain tumors. Gardner's syndrome Gardner's syndrome Multiple polyps minor birth defects risk for other tumors (notably mesenchymal). Cowden's syndrome Cowden's syndrome Multiple polyps Risk of tumors of: Thyroid Breast Uterus Skin.

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14 Part One Tumors of Small Intestine

15 Small Intestine tumors: Small intestine -75% but tumors – 3-6% Small intestine -75% but tumors – 3-6% Benign tumors (common) Benign tumors (common) Adenoma(25%), lipoma & leiomyoma. Adenoma(25%), lipoma & leiomyoma. Malignant tumors (rare; <1%) Malignant tumors (rare; <1%) Adenocarcinoma of Duodenum or Jejunum, Carcinoid, Lymphoma, Sarcoma Adenocarcinoma of Duodenum or Jejunum, Carcinoid, Lymphoma, Sarcoma Present at late stage, 70% 5 year survival. Present at late stage, 70% 5 year survival.

16 Classification Non neoplastic polyps Non neoplastic polyps Hyperplastic, lymphoid & hamartomatous Hyperplastic, lymphoid & hamartomatous Inflammatory Inflammatory Neoplastic – epithelial Neoplastic – epithelial Benign – Adenoma (ampulla of Vater) Benign – Adenoma (ampulla of Vater) Malignant – Adenocarcinoma, carcinoid Malignant – Adenocarcinoma, carcinoid Neoplastic – Mesenchymal Neoplastic – Mesenchymal Benign - Lipoma, leiomyoma, neuroma, angioma Benign - Lipoma, leiomyoma, neuroma, angioma Malignant – Leiomyosarcoma, liposarcoma. Malignant – Leiomyosarcoma, liposarcoma. Lymphoma Lymphoma

17 Benign tumors: Lipoma Most common Most common Mature adipose tissue Mature adipose tissue

18 Adenocarcinoma Napkin-ring or polypoid Napkin-ring or polypoid Duodenum (ampulla of Vater’s) Duodenum (ampulla of Vater’s) Spreading: Spreading: Regional lymph nodes Regional lymph nodes Liver Liver Obstructive jaundice. Obstructive jaundice.

19 Tumors of Colon & Rectum

20 Colorectal carcinoma Adenocarcinomas (98%) Adenocarcinomas (98%) often arises in one of the benign neoplastic colonic polyp often arises in one of the benign neoplastic colonic polyp risk factors risk factors (1) mild hereditary defects in anti-oncogenes lost in colon cancer, (1) mild hereditary defects in anti-oncogenes lost in colon cancer, (2) years of eating the typical western diet. (2) years of eating the typical western diet. Low content of vegetables Low content of vegetables High content of refined carbohydrates High content of refined carbohydrates High content of fat (animal) High content of fat (animal) Low content of micronutrients (vitamins A, C, E). Low content of micronutrients (vitamins A, C, E).

21 Morphology Proximal colon tumors: polypoid Proximal colon tumors: polypoid Cecum and ascending colon: exophytic Cecum and ascending colon: exophytic Distal colon: napkin-ring Distal colon: napkin-ring Progression: slow (years) Progression: slow (years) Types: Types: Gut: Adenocarcinoma Gut: Adenocarcinoma Mucin production Mucin production Anal zone: Squamous cell carcinoma Anal zone: Squamous cell carcinoma Spreading: Spreading: Regional lymph nodes Regional lymph nodes Liver Liver

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23 Carcinoid Tumors 2% of colorectal malignancies. 2% of colorectal malignancies. Origin: Neuroendocrine cells (paracrine, Kulchitsky, enterochromaffin, neurosecretory, chromaffin) Origin: Neuroendocrine cells (paracrine, Kulchitsky, enterochromaffin, neurosecretory, chromaffin) Location: Location: gut (common in appendix) gut (common in appendix) pancreas or peripancreatic tissue, pancreas or peripancreatic tissue, lungs, lungs, biliary tree biliary tree liver. liver. Rectal and appendiceal carcinoids almost never metastasize Rectal and appendiceal carcinoids almost never metastasize The classic carcinoid syndrome (serotonin) The classic carcinoid syndrome (serotonin) (1) wheezing (asthmatic); (2) flushing (vasomotor); (3) fibrosis (cardiac, pulmonic, pleural, pelvic); (4) intestinal hypermotility.

24 Midgut carcinoids: Midgut carcinoids: small intestinal, small intestinal, appendiceal, appendiceal, most colonic carcinoids. most colonic carcinoids. These are usually argyrophil (hormonally active). These are usually argyrophil (hormonally active). Foregut carcinoids: Foregut carcinoids: lung, duodenal, biliary carcinoids. These are almost never argyrophil (hormonally inactive).

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26 Gastrointestinal lymphoma Less common than carcinomas Less common than carcinomas Western lymphomas are usually familiar B-cell lymphomas Western lymphomas are usually familiar B-cell lymphomas Mediterranean lymphomas usually feature plasmacytoid differentiation (a subset is alpha-heavy chain disease). Mediterranean lymphomas usually feature plasmacytoid differentiation (a subset is alpha-heavy chain disease). Sprue-associated lymphoma exhibits T-cell markers Sprue-associated lymphoma exhibits T-cell markers

27 Lymphoma

28 THANK YOU THANK YOU


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