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Chapter 5 Neoplasia. Background The tumor is a common disease all over the world. In many countries especially developed countries, malignant tumor has.

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Presentation on theme: "Chapter 5 Neoplasia. Background The tumor is a common disease all over the world. In many countries especially developed countries, malignant tumor has."— Presentation transcript:

1 Chapter 5 Neoplasia

2 Background The tumor is a common disease all over the world. In many countries especially developed countries, malignant tumor has become the first or second leading cause of death. Although many research works focused on oncology and great progress has been made in understanding tumors in the past decades, the morbidity and mortality rate of malignant tumor is increasing. The underlying causes include air pollution, pressure, excess weight, unhealthy lifestyle, ageing population and so on.

3 Contents Definition Structure Characteristics of Tumors Nomenclature Differentiation and Anaplasia Growth, Local Invasion and Metastasis Difference Between Benign and Malignant tumors Effects of Tumors on the Hosts Precancerous Lesions, Dysplasia, and Carcinoma in situ Brief Introduction of Common Neoplasms

4 Definition of Neoplasm A neoplasm is an abnormal mass of tissue, it’s growth exceeds and is uncoordinated with that of the normal tissue and persist in the same excessive manner after cessation of the stimuli which evoke the change. (Dr. RA Willis)

5 Definition of Neoplasm At molecular level, neoplasm is disorder of growth regulatory genes ( the activation of proto- oncogenes and the inactivation of tumor suppressor genes ). It develops in a multistep fashion, such that different neoplasms, even of the same histological type, may show different genetic changes.

6 Features of Neoplasm 1.Excessive cellular proliferation; 2.Lack of responsiveness to control mechanisms; 3.Lack of dependence on the continued presence of the stimulus.

7 Structure Characteristics of Tumors The gross appearance of tumor is varied. It is usually related to histogenesis, site and biologic behavior.

8 Structure Characteristics of Tumors Gross appearance of tumor-shape: a.polypoid b.papillary c.nodular d.lobulated e.cystic f.fungating g.ulcerated

9 Structure Characteristics of Tumors lipoma Hepatocellular carcinoma Color of tumor:

10 Structure Characteristics of Tumors Two basic components of all the tumors: 1.Parenchyma – the parenchyma is made up of proliferating neoplastic cells and largely determines the biologic behavior of the tumor. In addition, the classification, nomenclature and histological diagnosis are also made according to the parenchymal cells. 2.Supporting stroma – the supporting stroma is made up of connective tissue, blood vessels, and possibly lymphatics.

11 parenchyma supporting stroma

12 Nomenclature Basic principle: Neoplasms are named according to binomial system denoting their histogenic origin of the parenchymal component and the biologic behavior.

13 Nomenclature Benign tumors: “ ~ oma”, e.g., fibroma; lipoma Malignant tumors: “ ~ carcinoma, ~ sarcoma”

14 thyroid adenomacolonic adenoma leiomyoma of uterus fibroadenoma of breast

15 heptocellular carcinoma Squamous cell carcinomaadenocarcinoma of colon osteosarcoma of bone

16 Differentiation and Anaplasia Neoplasm differentiation denotes the degree to which a neoplasm cell resembles the normal mature cells of the tissue both morphologically and functionally. What is neoplasm differentiation?

17 Differentiation and Anaplasia Benign tumors are usually well differentiated. They resemble closely their normal counterpart. Malignant tumors, on the other hand, show variable degree of differentiation. Malignant tumors that are composed of undifferentiated cells are said to be “anaplastic”,that means no morphological resemblance to normal tissue.

18 Differentiation and Anaplasia lack of differentiation; literally means ‘to form backward,’ implying a ‘reverse differentiation’ of mature normal cells. For cancers, it does not represent reverse differentiation. It means lack of differentiation. What is anaplasia?

19 Growth, Local Invasion and Metastasis The growth rate of neoplastic cells varies greatly and is one of its chief factors that serves to distinguish benign from malignant. In a general rule, the degree of malignancy of a neoplasm is correlated with its growth rate: the more rapid the growth, the more malignant the neoplasm. Rate of growth and malignancy:

20 Growth, Local Invasion and Metastasis Nearly all benign tumors grow as cohesive expansile masses that remain localized to their site of origin. a.Benign tumors grow slowly and usually develop a fibrous capsule keeping the tumor as a discrete, readily palpable and easily movable mass that can be excised. b.When a benign tumor arises in a epithelial or mucosal surface, the tumor grow away from the surface, often forming a polypoid. Invasion ( Infiltration)

21 Lipoma Here is a benign lipoma on the serosal [si'rəusəl] surface of the small intestine. It has the characteristics of a benign neoplasm: it is well circumscribed, slow growing, and resembles the tissue of origin (fat).

22 Growth, Local Invasion and Metastasis The growth of cancers, in contrast, is accompanied by infiltration, invasion, and destruction of the surrounding tissue. a.In general, malignant tumors are lack of a well defined cleavage plane and usually exhibit local invasiveness or infiltration that make it difficult to be excised. b.Malignant tumors on epithelial or mucosa surface may form a protrusion in the early stages, but eventually invade the underlying normal tissue. Invasion ( Infiltration)

23 Squamous cell carcinoma of lung Malignant neoplasms are also characterized by the tendency to invade surrounding tissues. Here, a lung cancer is seen to be spreading along the bronchi into the surrounding lung.

24 hepatic adenoma hepatocellular carcinoma Here is a small hepatic adenoma that shows how well- demarcated an benign neoplasm is. In contrast, this hepatocellular carcinoma is not as well circumscribed (note the infiltration of tumor off to the lower right) nor as uniform in consistency. It is also arising in a cirrhotic (nodular) liver.

25 Metastasis Metastasis is to form a second neoplastic mass through transfer of the neoplastic cells from the first neoplasm to a distant site on separate from the original tumor. What is metastasis of neoplasms?

26 Metastasis 1.Lymphatogenous metastasis - The most common pathway for initial dissemination of carcinomas, but sarcomas may also use this route. 2.Hematogenous metastasis - This route is typical of sarcomas but is also seen with carcinoma.. 3.Metastasis in body cavities ( seeding ) - Direct seeding of body cavities or surface (exfoliation and implantation on peritoneum, pleura, subarachnoid) Routes of metastasis

27 characteristics BenignMalignant DifferentiationWell differentiatedRange from well differentiate to undifferentiated Rate of growthSlow growth over a period of years Rapid growth, sometimes erratic Type of growthExpansileProgressive infiltration, invasion, and destruction of surrounding tissue Separated fromYes, has fibrous capsule composed of stroma of native tissue Poorly separated MetastasisNoYes Effect on hostOften insignificantSignificant, fever, anemia, infections, etc. RecurrenceRareOften Cell shapeMonomorphicPleomorphic Tumor giant cells Nuclear chromatin NormalInreased, hyperchromatic; Peripheral clumping NucleoliNot prominentProminent, irregular shape

28 Precancerous Lesions A premalignant or precancerous lesion is an abnormality in a tissue area which is a just a step away from cancer. a.Not all precancerous lesions change to cancer, but most have potential to become malignant. b.It is important to recognize precancerous lesions because surgical excision is curative. What is precancerous lesions? Table 5-5 page114

29 Dysplasia Dysplasia is an abnormality of both differentiation and maturation. This term should be restricted to abnormalities of cell growth with the characteristics as following: a.Increased size of the nucleus, (absolute and relative to the amount of cytoplasm) b.Hyperchromatism c.Abnormal chromatin distribution (coarse clumping) d.Nuclear membrane is thickneng and wrinkling. e.In squamous epithelium, mitotic figures appear in many layers. What is dysplasia?

30 Carcinoma in situ The term carcinoma in situ refers to an epithelial neoplasm exhibiting all the malignant cellular features. But it has not yet invaded with through the epithelial basement membranes separating it from potential route of metastasis. It is only at this very early stage the excision of the tumor will guarantee a cure. So detection of carcinoma in situ is very important. In clinical practice, detection of carcinoma at the in situ stage, or detection of precancerous lesions is the aim of population screening programs for cervical, breast and some other carcinoma. Through these popular screening, many lives have been saved. What is carcinoma in situ?

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