1. Neoplasia 1: Introduction

2. terminology oncology: the study of tumors neoplasia: new growth (indicates autonomy with a loss of response to growth controls)

3. types of neoplasms benign: localized and amenable to surgical removal; patient usually survives malignant: invasive tumor capable of destroying structures and spread to distant sites (metastasis); may result in early death of the patient

4. examples of benign tumors fibroma: benign tumor of fibrous tissue lipoma: benign tumor of fat adenoma: benign glandular tumor chondroma: benign cartilaginous tumor

5. leiomyomas

6. adenoma

7. examples of malignant tumors sarcoma (mesenchymal derivation: fibrosarcoma, chondrosarcoma) carcinoma (epithelial derivation: adenocarcinoma, squamous cell carcinoma) lymphoma/leukemia

8. adenocarcinoma

9. carcinoma

10. The terms “benign” and “malignant” describe the biologic behavior of a tumor the biologic behavior is characterized by degree of differentiation of the tumor and by the rate of growth (and rate of cell death)

11. differentiation Well-differentiated tumors contain cells that resemble the normal cells of origin poorly-differentiated or undifferentiated tumors contain cells that do not resemble their normal counterparts (ancillary studies may be needed to determine the cell of origin)

12. well-differentiated

13. poorly-differentiated

14. Benign tumors are composed of well- differentiated cells. Malignant tumors are characterized by a wide range of cellular differentiation. Anaplasia (cellular pleomorphism, hyperchromatic nuclei, high N:C ratio, giant cells, bizarre nuclei) is a feature of malignant tumors.

15. anaplasia

16. dysplasia denotes a loss of architectural organization and a loss of cell uniformity in epithelium pleomorphism and mitoses are more prominent than in the normal usually graded: mild, moderate, severe, and carcinoma-in-situ mild to moderate dysplasia is potentially reversible

17. dysplasia

18. normal epithelium

19. dysplasia Dysplasia is a non-neoplastic proliferation. Dysplasia may or may not progress to cancer.

20. rate of growth In general, benign and well-differentiated malignant tumors have a slower rate of growth than moderately-differentiated and poorly-differentiated malignant tumors. There are exceptions. Blood supply, site, and hormonal stimulation are factors that can affect the growth rate of tumors.

21. invasion Benign tumors usually grow by slow expansion. Malignant tumors usually infiltrate and may destroy surrounding tissue (cell surface and the extracellular matrix play an important role).

22. metastasis indicates malignancy a discontinuous spread of the tumor Methods of metastasis include: (1)seeding of body cavities, (2) lymphatic spread, and (3) hematogenous spread.

23. metastatic ovarian carcinoma

24. MRI: metastatic adenocarcinoma

25. metastatic adenocarcinoma

26. grading and staging Grading is based on the microscopic features of the cells which compose a tumor and is specific for the tumor type. Staging is based on clinical, radiological, and surgical criteria, such as, tumor size, involvement of regional lymph nodes, and presence of metastases. Staging usually has prognostic value.

27. morbidity and mortality metastases rupture into major vessels compression of vital organs organ failure infection

28. meningioma

29. basal cell carcinoma

30. melanoma

31. diagnostic procedures FNA (fine needle aspiration) cytological smears biopsy frozen sections

32. cytology smear: adenocarcinoma

33. Pap smear with dysplasia

34. frozen section

35. staining a frozen section

36. ancillary studies immunohistochemistry cytogenetics flow cytometry electron microscopy

37. cytokeratin stain on a carcinoma

38. AFP stain on a yolk sac tumor

39. EM: neurosecretory granules

40. EM: microvilli, tight junction in an adenocarcinoma

41. biochemical assays tumor markers: sometimes diagnostic or prognostic can be helpful in monitoring effectiveness of therapy or in detecting relapses/recurrences

42. some serological markers associated with malignant tumors

43. summary neoplasia- an abnormal mass of tissue which has lost its responsiveness to growth controls benign neoplasms tend to be slow-growing, well-differentiated tumors which lack the ability to metastasize benign neoplasms, in general, remain localized and are amenable to surgery

44. summary malignant neoplasms tend to be fast- growing lesions which invade normal structures malignant neoplasms vary in the degree of differentiation and some show anaplasia malignant neoplasms are capable of metastasis

45. summary The prognosis of a patient with any type of neoplasm depends on a number of factors including: the rate of growth of the tumor, the size of the tumor, the tumor site, the cell type and degree of differentiation, the presence of metastasis, responsiveness to therapy, and the general health of the patient.