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Kristine Krafts, M.D. | September 30, 2013 Neoplasia II: Tumor Characteristics.

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Presentation on theme: "Kristine Krafts, M.D. | September 30, 2013 Neoplasia II: Tumor Characteristics."— Presentation transcript:

1 Kristine Krafts, M.D. | September 30, 2013 Neoplasia II: Tumor Characteristics

2 Neoplasia Outline Tumor nomenclature Tumor characteristics Epidemiology Cancer pathogenesis

3 Neoplasia Outline Tumor nomenclature Tumor characteristics Differentiation and anaplasia Rate of growth Local invasion Metastasis

4 Neoplasia Outline Tumor nomenclature Tumor characteristics Differentiation and anaplasia

5 Differentiation and Anaplasia Differentiation = how much the tumor cells resemble their cells of origin well-differentiated – closely resembles moderately-differentiated – sort of resembles poorly-differentiated – doesn t resemble Benign tumors are usually well-differentiated Malignant tumors can show any level of differentiation

6 Thyroid adenoma (well-differentiated)

7 Squamous cell carcinoma, well-differentiated

8 Squamous cell carcinoma, moderately-differentiated

9 Squamous cell carcinoma, poorly-differentiated

10 Intercellular bridges

11 Differentiation and Anaplasia Literally, to form (-plasia) backwards (ana-) Misnomer! Cells don t de-differentiate. Just means cells are very poorly-differentiated Almost always indicates malignancy Anaplasia = a state of complete un-differentiation

12 Differentiation and Anaplasia Pleomorphism Hyperchromatic, large nuclei Bizarre nuclear shapes, distinct nucleoli Lots of mitoses, and atypical mitoses Architectural anarchy Anaplastic cells show:

13 Anaplastic carcinoma

14 Abnormal mitoses

15 Differentiation and Anaplasia Dysplasia is used to describe disorderly changes in non-neoplastic epithelial cells. Graded as mild, moderate or severe. Mild-moderate: usually reversible Severe: usually progresses to carcinoma in situ (CIS). Next step after CIS: invasive carcinoma. Dysplasia = disorderly (dys-) growth (-plasia)

16 Differentiation and Anaplasia Dysplastic cells show: Pleomorphism Hyperchromatic, large nuclei Lots of mitoses Architectural anarchy

17 Q. Wait a minute, dysplasia sounds suspiciously similar to differentiation – what s the difference?

18 Q. Wait a minute, dysplasia sounds suspiciously similar to differentiation – what s the difference? A. Both terms describe whether cells look normal or not! But: differentiation is only used with neoplastic cells, and dysplasia is only used with non-neoplastic cells! dysplasia is only used with epithelial cells, but differentiation can apply to any cell type.

19 mild dysplasia moderate dysplasia severe dysplasia well- differentiated moderately- differentiated poorly- differentiated anaplastic carcinoma in situ Non-neoplastic epithelial cells Neoplastic cells

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21 Dysplasia

22 Normal glands

23 Normal gland

24 Mild dysplasia

25 Moderate dysplasia

26 Severe dysplasia

27 Normal squamous epithelium Moderate dysplasia Severe dysplasia

28 Normal epitheliumDysplastic epithelium

29 Invasive squamous cell carcinoma

30 Neoplasia Outline Tumor nomenclature Tumor characteristics Differentiation and anaplasia Rate of growth

31 Rate of Growth Malignant tumors grow faster than benign ones. Poorly-differentiated tumors grow faster than well-differentiated ones. Growth is dependent on: Blood supply Hormonal factors Emergence of aggressive sub-clones Generalizations

32 Rate of Growth Age of tumor Early on (subclinical), GF high. Later (clinically detectable), GF low. Type of tumor Leukemias, lymphomas, small-cell lung cancer: high GF Breast, colon cancer: low GF Important for treatment High GF tumor: treat with chemotherapy/radiation Low GF tumor: treat by debulking Growth fraction = cells that are actively dividing

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35 Tumor cells undergoing apoptosis

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39 Neoplasia Outline Tumor nomenclature Tumor characteristics Differentiation and anaplasia Rate of growth Local invasion

40 Local Invasion Benign tumors Stay where they are. Can t invade or metastasize. Usually encapsulated. Malignant tumors Infiltrate, invade, destroy surrounding tissue. Then metastasize to other parts of body. Not encapsulated.

41 Malignant tumor invading kidney

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44 Neoplasia Outline Tumor nomenclature Tumor characteristics Differentiation and anaplasia Rate of growth Local invasion Metastasis

45 Carcinoma in situ

46 Invasive carcinoma

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48 Metastasizing carcinoma

49 Liver with multiple metastases

50 Metastasis Metastasis = development of secondary tumor implants in distant tissues Half of all patients with malignancies have mets at the time of diagnosis!! Metastasis depends on: Type of tumor Size of tumor Degree of differentiation of tumor

51 Metastasis Seeding Lymphatic spread Hematogenous spread Three ways tumors metastasize

52 Metastasis Seeding Tumor invades body cavity Bits break off and implant on peritoneal surfaces Ovarian cancer Three ways tumors metastasize

53 Liver seeded with metastatic ovarian carcinoma

54 Metastasis Seeding Lymphatic spread Tumor spreads to local lymph nodes Sentinel lymph node first Moves through thoracic duct Empties into subclavian vein Three ways tumors metastasize

55 Tumor in lymphatic

56 Tumor in lymph node

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59 Metastasis Seeding Lymphatic spread Tumor spreads to local lymph nodes Sentinel lymph node first Moves through thoracic duct Empties into subclavian vein Carcinomas like to spread this way Three ways tumors metastasize

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61 Metastasis Seeding Lymphatic spread Hematogenous spread Veins are easier to invade than arteries Liver and lungs are most common metastatic destinations Some tumors like other sites better: prostate bone most lung cancers adrenals, brain Sarcomas like to spread this way (but so do carcinomas) Three ways tumors metastasize

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63 Sarcoma metastatic to lung

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