1. NEOPLASIA Definitions of terms used in neoplasia
Nomenclature of tumors
Characteristics of benign & malignant tumors
Routes of metastasis
Epidemiology of CANCER
The molecular basis of neoplasia
Carcinogenesis
Tumor immunity
The clinical effects of tumors
Tumor grading and staging
The laboratory diagnosis of neoplasia

2. GENERAL TERMS USED Neoplasm New growth of cells producing a mass
Benign neoplasm= Limited new growth without invasion or spread
Malignant neoplasm= invasive growth that also spreads
Carcinoma : Malignant tumor of epithelial cells
Sarcoma : Malignant tumor of connective tissue cells
Lymphoma

3. Cancer is a general term for all malignant growths of whatever type
Tumor may be used instead of neoplasm but the term is not accurate
Oncology: study of cancer in all its aspects

4. NEOPLASM
Abnormal mass of tissue, the growth of which EXCEEDS and is UNCOORDINATED with that of of the normal tissues, and PERSISTS in the same manner even AFTER CESSATION of the stimulus which produced the change
 A neoplasm develops from a single transformed cell !!!

5. Fundamental to the origin of all neoplasms are heritable (genetic) changes that allow excessive and unregulated proliferation that is independent of physiologic growth-regulatory stimuli.

6. FEATURESOF TRANSFORMED CELL
Persistent & useless
Uncontrolled growth*
Immortal
Transplantable

7. This may arise from Endoderm
Mesoderm
Ectoderm
Epithelial cells may arise from any of the above
Connective tissue is from mesoderm

8. Classification of tumors
Cell of origin
Behavior of tumor: Benign or malignant 
 Appearance of the tumor: Solid/cystic
Degree of differentiation

9. CLASSIFICATION
Benign tumors
Malignant tumors
Mixed tumors
Tetatoma of both benign and malignant

10. Tumors, benign and malignant, have two basic components
(1) the parenchyma, made up of transformed or neoplastic cells, and
The parenchyma of the neoplasm largely determines its biologic behavior, and the component from which the tumor derives its name

11. (2) Stroma the supporting, host-derived, non-neoplastic made up of connective tissue, blood vessels, and host-derived inflammatory cells.
Stroma, it carries the blood supply and provides support for the growth of parenchymal cells.

12. Sebaceous cyst

15. Structure of Neoplasm Parenchymal cell Stromal ( supporting cell )
Degree & type of stromal cells may contribute to the appearance of tumors
If there is stromal proliferation
hardness of the tumor
Scirrhous tumor
Desmoplasia e.g.carcinoma of breast, pancreas..etc

16. If there is lack of many stromal cells, the tumor may be soft or cystic.
This feature may be included in the name of the tumor..e.g Cystadenoma of ovary
Poorly differentiated cyst adenocarcinoma of ovary
Moderately differentiated scirrhous carcinoma of breast 

17. Serous cyst adenoma of ovary

18. Scirrhous carcinoma of breast Desmoplasia

19. Benign tumors
Benign tumors are(microscopic and gross characteristics) are
Innocent
Localized
Cannot spread to other sites
Easy for surgical resection
Survival of the patient is fair.
But in certain tumors it can be serious.

20. Malignant tumors 1.Are cancers, 2 They are not localized
3.They invade, destroy the adjacent
structures.
4.Distant metastasis
5. Can cause death

21. Nomenclature – Benign Tumors
-oma = benign neoplasm
Microscopic and Macroscopic classification.
Mesenchymal tumors
Chrondroma: cartilaginous tumor
Fibroma: fibrous tumor
Osteoma: bone tumor

22. Epithelial tumor
adenoma: tumor forming glands
papilloma: tumor with finger like projections
papillary cystadenoma: papillary and cystic tumor forming glands
polyp: a tumor that projects above a mucosal surface

23. Benign epithelial tumors
Adenoma
glandular epithelium tumor often producing a secretion e.g.(mucin) which may be intraepithelial or intraluminal
Papilloma epithelial tumor forming finger like projections from epithelia surface with a connective tissue core
Polyp a tumor projecting from the mucosal surface of a hollow organ

24. Adenoma of benign arise in solid organs
Liver, Thyroid and kidney typically glandular pattern
Since they are benign they remain
Discrete pushing compressing the surrounding tissue and remain localized also they show tissue of origin

25. Malignant tumors
Malignant neoplasms arising in mesenchymal tissue or its derivatives are called sarcomas
A cancer of fibrous tissue origin is a fibrosarcoma, and a malignant neoplasm composed of chondrocytes is a chondrosarcoma.

26. Nomenclature – Malignant Tumors
Sarcomas: mesenchymal tumor
chrondrosarcoma: cartilaginous tumor
fibrosarcomama: fibrous tumor
osteosarcoma: bone tumor

27. Carcinomas: epithelial tumors
ADENOCARCINOMA: gland forming tumor
SQUAMOUS CELL CARCINOMA: squamous differentiation
undifferentiated carcinoma: no differentiation
note: carcinomas can arise from ectoderm, mesoderm, or endoderm

28. Malignant neoplasms of epithelial cell origin are called carcinomas
Carcinomas that grow in a glandular pattern are called ADENOCARCINOMAS, and those that produce squamous cells are called squamous cell carcinomas.

29. Squamous cell carcinoma
Example-. skin, mouth cervix, bronchus.etc
 Adenocarcinoma from glandular origin
Example-.G.I.T., endometrium ,breast, kidney, thyroid..etc

30. SARCOMA :
Prefix (origin)+ suffix (sarcoma) e.g.Osteosarcoma,liposarcoma,angiosarcomaleiomyosarcoma,rhabdomyosarcoma

31. MIXED TUMOR FIBROADENOMA IT HAS DUCTAL ELEMENT ADENOMA
ALSO EMBEDED IN LOOSE FIBROUS TISSUE FIBROMA
TUMORS OF THE SALIVARY GLAND
PLEOMORPHIC ADENOMA

32. Fibroadenoma
Fibroadenoma is the most common benign (noncancerous) growth in the breast. If it is diagnosed on needle biopsy and the mammographic finding is consistent with a fibroadenoma, it is typically simply followed, with no additional excision. In some instances it may be removed for cosmetic reasons. 

33. A patient's age determines the preferred imaging method
A patient's age determines the preferred imaging method. In general, ultrasonography (US) is preferred if a palpable mass is found, if a patient is younger than 30 years, or if the patient is not pregnant, Mammography and US are both useful if the patient.

34. Fibroadenoma breast mammogram

36. TERETOMA Teratomas originate from totipotential stem cells
which contains recognizable mature or immature cells or tissues representative of more than one germ-cell layer and sometimes all three.

37. BENIGN
Mature teratoma
Dermoid cyst

38. MALIGNANT
Immature teratoma
Terato carcinoma

39. Teratomas originate from totipotential stem cells such as those normally present in the ovary and testis and sometimes abnormally present in sequestered midline embryonic rests

40. Testicular teratoma
Tumor characteristics: Firm, whitish, ovoid mass with discrete yellow and grey areas.

41. Seminoma testis
The firm whitish areas nearby showed extensive intratubular germ cell neoplasia.

42. Figure 7-4 A, Gross appearance of an opened cystic teratoma of the ovary. Note the presence of hair, sebaceous material, and tooth. You do not need a microscope to appreciate this tumor produces both connective tissue as well as epithelial derived elements.
Remember, pure “epithelial” tumors may evoke a fibrous response, such as breast or pancreas or prostate adenocarcinomas, but the connective tissue us regarded as NON-neoplastic.
Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 28 July :41 PM)
© 2005 Elsevier

43. Aberrant differentiation (not true neoplasms)
Hamartoma: disorganized mass of tissue whose cell types are indiginous to the site of the lesion, e.g., lung
Choriostoma: ectopic focus of normal tissue (heterotopia), e.g., pancreas, perhaps endometriosis too
Misnomers are often REDUNDANT, to try to correct the misnomer.

44. BENIGN SOUNDING DESIGNATIONS
Misnomers
Hepatoma: malignant liver tumor
Melanoma: malignant skin tumor
Seminoma: malignant testicular tumor
Lymphoma: malignant tumor of lymphocytes

46. Hamartoma Clinical presentation
Pulmonary hamartomas are usually asymptomatic and found incidentally when imaging the chest for other reasons. It can occasionally present with haemoptysis, bronchial obstruction and cough (especially endobronchial types) .
Pathology
Hamartomas may be chondromatous or leiomyomatous (the former being more common) or a mixture. They are unencapsulated, lobulated tumours with connective tissue septa

47. Dysplasia Literally means abnormal growth
Malignant transformation is a multistep process
In dysplasia some but not all of the features of malignancy are present, microscopically
Dysplasia may develop into malignancy
Uterine cervix
Colon polyps
Graded as low-grade or high-grade, often prompting different clinical decisions
Dysplasia may NOT develop into malignancy
HIGH grade dysplasia often classified with CIS
Do you remember from chapter 1 that DYS- was one of the seven -plasia brothers?

48. Natural History Of Malignant Tumors
Malignant change in the target cell, referred to as transformation
Growth of the transformed cells
Local invasion
Distant metastases.
Another linear process, such as the epics of inflammation or healing.

49. Benign vs Malignant Features
Rate of growth
slow. Mitoses few and normal
Variable. Mitoses more frequent and may be abnormal
Differentiation
Well differentiated
Some degree of anaplasia
LOCAL INVASION
Cohesive growth. Capsule & BM not breached
Poorly cohesive and infiltrative!
Metastasis
Absent
May occur
In some tumors, like smooth muscle tumors, counting mitoses may be the main way to differentiate a benign from a malignant process!
“If you want to think od “anaplasia” as DE-differentiation, you can, but remember, differentiation NEVER occurs backwards!
“LOCAL INVASION” is in HUGE ALL CAPS font because it is the single most important differentiating feature.
ALL malignancies can potentially metastasize, but there is at least one common benign condition which is also said to “metastasize”. Can you name it?

50. Benign vs Malignant Rate of growth
Most benign tumors grow slowly while most cancers grow fast
Many exceptions
Rate of growth for malignant tumors correlates with degree of differentiation
Despite rapid growth, cancers usually take years to become clinically apparent
Rapid growth may lead to necrosis

51. Benign vs Malignant Local invasion
Benign neoplasms do not have the capacity to invade
Invasion is a characteristic of malignancy
Benign neoplasms often develop a fibrous capsule

52. Benign vs Malignant Metastasis
Metastases are secondary, remote implants of tumor
Metastatic spread is the most important hallmark of malignancy
Cancers differ in their ability to metastasize
Methods of metastasis:
Seeding
Lymphatic spread
Hematogenous spread

56. Epidemiology
The study of the relationships of various factors determining the frequency and distribution of diseases in the human community
Contributes to understanding of risk factors and the origin of cancers
Smoking – Lung cancer
Fatty diets – Colon cancer

59. Epidemiology Geographic and environmental factors
Breast cancer – Death rates 4-5x higher in US and Europe than in Japan
Stomach cancer – Death rates 7x higher in Japan than in the US
Hepatocellular carcinoma – Uncommon in US, one of the most common and lethal cancers in some African populations
Most geographic patterns related to environmental exposures

60. Epidemiology Age Heredity Acquired preneoplastic disorders
Frequency of cancer increases with age with peak between ages of 55 and 75
Increased accumulation of somatic mutations
Heredity
5-10% of cancers
Acquired preneoplastic disorders
Dysplasia, colonic adenoma