2. NEOPLASIA DR. AYESHA IMTIAZ PATHOLOGY DR. AYESHA IMTIAZ PATHOLOGY

3. NEOPLASM : An abnormal mass of tissue, the growth of which is uncontrolled (exceeds) and is uncoordinated with that of the normal tissues and persists in the same excessive manner after cessation of the stimuli which evoked the change. DEFINITION

4. Oncology (Greek oncos = tumor) is the study of tumors or neoplasms

5. Adenoma is applied to a benign epithelial neoplasm derived from glands Papillomas :Benign epithelial neoplasms producing microscopically or macroscopically visible finger- like or warty projections from epithelial surfaces are referred to as papilloma TERMINOLOGIES

6. Polyp : Macroscopically visible projection above a mucosal surface or epithelial surface is termed as polyp Cystadenomas : Benign tumors that form large cystic masses, are referred to as cystadenomas. TERMINOLOGIES

7. TERATOMA : Tumors which contain tissues representative of more than one germ cell layer and sometimes all three. Teratomas originate from totipotential cells, such cells have the capacity to differentiate into any of the cell types found in the adult body and so, give rise to neoplasms that reveal bits of bone, epithelium, muscle, fat, nerve, and other tissues. E.g.: ovarian cystic teratoma (dermoid cyst) TERMINOLOGIES

8. BENIGN EPITHELIAL (ADENOMA ; PAPILLOMA) MESENCHYMAL (FIBROMA ; LEIOMYOMA) MALIGNANT EPITHELIAL CARCINOMA MESENCHYMAL SARCOMA CLASSIFICATION

9. Malignant neoplasms of epithelial cell origin, are called carcinomas CARCINOMA

10. Carcinomas may be further qualified. Squamous cell carcinoma : A malignant cancer in which the tumor cells resemble stratified squamous epithelium Adenocarcinoma : A malignant cancer in which the neoplastic epithelial cells grow in glandular patterns. CARCINOMA

11. Malignant tumors arising in mesenchymal tissue are called sarcomas SARCOMA

12. Malignant neoplasms of lymphoid cell origin, are called lymphomas LYMPHOMA

13. HODGKIN’S LYMPHOMA NON-HODGKIN’S LYMPHOMA MULTIPLE MYELOMA CLASSIFICATION

14. HODGKIN’S LYMPHOMA Less common than Non-Hodgkin’s lymphoma. (1 : 7) Highly treatable and curable, even when disseminated. Presence of Reed-Sternberg cell is necessary to make diagnosis. Reed-Sternberg cells are the malignant cells. Less common than Non-Hodgkin’s lymphoma. (1 : 7) Highly treatable and curable, even when disseminated. Presence of Reed-Sternberg cell is necessary to make diagnosis. Reed-Sternberg cells are the malignant cells.

15. HODGKIN’S LYMPHOMA Cell of origin is unknown: T lymphocyte, B lymphocyte ; both. Etiology : EBV infection Male > Female Bimodal age distribution children after age 50 Cell of origin is unknown: T lymphocyte, B lymphocyte ; both. Etiology : EBV infection Male > Female Bimodal age distribution children after age 50

16. Reed-Sternberg cell

17. HODGKIN’S LYMPHOMA Histologic subtypes 1.nodular sclerosis (most common subtype) 2.mixed cellularity 3.lymphocyte-rich 4.lymphocyte depleted 1.nodular sclerosis (most common subtype) 2.mixed cellularity 3.lymphocyte-rich 4.lymphocyte depleted

18. RS cell and variants popcorn celllacunar cellclassic RS cell (mixed cellularity)(nodular sclerosis) (lymphocyte predominance)

19. HODGKIN’S DISEASE Clinical Manifestations Lymphadenopathy Contiguous spread Extranodal sites relatively uncommon except in advanced disease Lymphadenopathy Contiguous spread Extranodal sites relatively uncommon except in advanced disease

20. NON- HODGKIN’S LYMPHOMA 85% B cell origin. Can occur at any age Overall incidence varies with location: – Burkitt’s in tropical Africa 85% B cell origin. Can occur at any age Overall incidence varies with location: – Burkitt’s in tropical Africa

21. NON- HODGKIN’S LYMPHOMA ETIOLOGY Immune suppression – Congenital – AIDS – increasing age DNA repair defects – xeroderma pigmentosum Chronic inflammation – Helicobacter pylori inflammation – Sjögren’s syndrome Viral infections – EBV – HTLV-I & HTLV-V – Hepatitis C ETIOLOGY Immune suppression – Congenital – AIDS – increasing age DNA repair defects – xeroderma pigmentosum Chronic inflammation – Helicobacter pylori inflammation – Sjögren’s syndrome Viral infections – EBV – HTLV-I & HTLV-V – Hepatitis C

22. NON- HODGKIN’S LYMPHOMA CLASSIFICATION Terminology (refers to natural history) – low grade = indolent – intermediate grade = aggressive – high grade = aggressive (indolent: slow growing, incurable) (aggressive: rapidly growing, curable) CLASSIFICATION Terminology (refers to natural history) – low grade = indolent – intermediate grade = aggressive – high grade = aggressive (indolent: slow growing, incurable) (aggressive: rapidly growing, curable)

23. Small lymphocyticImmunoblastic Mantle cellLarge Cell Types of Non-Hodgkin’s Lymphoma

25. The nomenclature of tumors and their biologic behavior are based primarily on the parenchymal component In general, tumors are designated by attaching the suffix -oma to the cell of origin. NOMENCLATURE

30. COMPARISON BETWEEN BENIGN TUMORS & MALIGNANT TUMORS

37. INVASION & METASTASIS ARE BIOLOGICAL HALL MARKS OF MALIGNANCY

42. CYTOPATHOLOGY

43. FINE NEEDLE ASPIRATION WASHINGS (BRONCHIAL ; ABDOMINAL ) CERVICAL SMEARS ( PAP )

45. IMMUNOHISTOCHEMISTRY

46. TUMOR MARKERS

47. Alpha Feto Protein (AFP) Human Chorionic Gonadotrophin (HCG) Calcitonin Prostatic Acid Phosphatase (PAP) Carcinoembryonic antigen (CEA) Ectopic hormones Alpha Feto Protein (AFP) Human Chorionic Gonadotrophin (HCG) Calcitonin Prostatic Acid Phosphatase (PAP) Carcinoembryonic antigen (CEA) Ectopic hormones

48. SUMMARY GOLD STANDARD -HISTOPATHOLOGICAL INVESTIGATIONS INTRA-OPERATIVE CONSULTANCY (FROZEN SECTION) CYTOLOGICAL STUDIES (FNA;SMEARS) BIOPSY INCISIONAL EXCISIONAL IMMUNOHISTOCHEMISTRY TUMOR MARKERS CYTOGENETIC & MOLECULOGENETIC STUDIES FISH ELECTRON MICROSCOPY PCR FLOW CYTOMETRY,etc. GOLD STANDARD -HISTOPATHOLOGICAL INVESTIGATIONS INTRA-OPERATIVE CONSULTANCY (FROZEN SECTION) CYTOLOGICAL STUDIES (FNA;SMEARS) BIOPSY INCISIONAL EXCISIONAL IMMUNOHISTOCHEMISTRY TUMOR MARKERS CYTOGENETIC & MOLECULOGENETIC STUDIES FISH ELECTRON MICROSCOPY PCR FLOW CYTOMETRY,etc.

49. FATE / OUTCOME Both malignant and benign tumors may cause problems because of (1)Location and impingement on adjacent structures (2)Functional activity such as hormone synthesis or the development of paraneoplastic syndromes (3)Bleeding and infections when the tumor ulcerates through adjacent surfaces (4)Symptoms that result from rupture or infarction (5)Cachexia or wasting. Both malignant and benign tumors may cause problems because of (1)Location and impingement on adjacent structures (2)Functional activity such as hormone synthesis or the development of paraneoplastic syndromes (3)Bleeding and infections when the tumor ulcerates through adjacent surfaces (4)Symptoms that result from rupture or infarction (5)Cachexia or wasting.

50. PARANEOPLASTIC SYNDROMES Cushing’s syndrome Hypercalcemia ; etc

51. THANX QUESTIONS & ANSWERS