Post on 05-Apr-2018
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Cancer = Latin for crab
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NOMENCLATURE :
Neoplasia - New Growth
Neoplasm Benign, Malignant
Oncology ( Greek oncos = tumor )
In short Growth dysregulation.
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Neoplasia Outline
Tumor
nomenclature Definitions
Benign tumors
Malignant tumors Mixed tumors
Confusing terms
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Definition:
A neoplasm is an abnormal mass of tissue, the growth
of which exceeds and is uncoordinated with that of
normal tissues and persist in the same manner after
cessation of the stimuli which evoked the change. Persistence genetic alteration passed on ,
parent - progeny.
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Tumors are clonal entire population of neoplastic
cells in an individual tumor arises from a single cell.
Benign Tumors Malignant Tumors
Small large
Slow-growing fast growing
Non-invasive invasive
Well-differentiated poorly differentiated
Stay localized metastasize
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Neoplasm
Benign Malignant
Carcinoma Sarcoma
Classification :
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Benign vs. Malignant
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Benign Tumors Usually designated by adding -oma to cell type
adenomabenign tumor arising from glandular cellsbut may or may not form glandular structures.
leiomyomabenign tumor arising from smoothmuscle cells
chondromabenign tumor arising from chondrocytes Other benign tumor names
papillomahas finger-like projections
cystadenomahas hollow spaces (cysts) inside
polypprojects upward, forming a lump can be benignor malignant.
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11/65Thyroid adenoma
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12/65Thyroid adenoma
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13/65Leiomyoma
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14/65Chondroma
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15/65Oral papilloma
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16/65Oral papilloma
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17/65Ovarian cystadenoma
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Malignant Tumors Carcinomasarise in epithelial tissue ( 3 germ cell layers)
adenocarcinoma tumor cells grow in glandular pattern. squamous cell carcinoma tumor cells resemble stratified
squamous epithelium.
Sarcomasarise in mesenchymal tissue chondrosarcomamalignant tumor of chondrocytes
angiosarcomamalignant tumor of blood vessels
rhabdomyosarcomamalignant tumor of skeletal muscle cells
http://www.microscopyu.com/galleries/pathology/ovarianadenocarcinoma.html7/31/2019 Neoplasia Pp t
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22/65Squamous cell carcinoma
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23/65Rhabdmyosarcoma
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Mixed Tumors
Mixed tumors divergent
differentiation along two lineages.
Examples
pleomorphic adenoma glands + fibromyxoidstroma
fibroadenoma glands + fibrous tissue
Not to be confused with teratomasarises from all three layers.
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Hamartomas : disorganized but benign appearing
masses composed of cells indigenous to a particular
site.eg:- pulmonary chondroid hamartoma
Choristoma: heterotopic rests of well developed and
normally organised tissue.eg:- normal pancreatic tissue in stomach,
duodenum.
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Definitions
Differentiation-extent to which
neoplastic cells resemble normal cells
both morphologically and functionally
Anaplasialack of differentiation
wherein reversal of differentiation to a
more primitive level.
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Pleomorphism variation in size &shape
Abnormal nuclear morphology hyperchromatic
Mitoses especially bizzare atypical mitoses Loss of polarity
Metaplasia
replacement of one type of cell withanother type due to damage, repair or
regeneration. eg: GERD
Dysplasia literally means disordered growth.
Characterized by a constellation of changes thatinclude a loss in the uniformity of the individual cells as
well as a loss in their architectural orientation.
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Cell nuclei become hyperchromatic
Nuclear membranes become irregular
Nuclear to cytoplasmic ratio increased.
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DYSPLASIA
-65yr old tobacco chewer
-oral mucosa shows leukoplakia
(white plaque)-full thickness severe dysplasia
on mucosal biopsy
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GROWTH
Concept:
Benign tumours grow slowly
Cancers grow rapidly
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RATE OF GROWTH
Rate of Growth is determined by three main factors :
(1) The doubling time of tumour cells.
(2) Fraction of tumour cells in replicative pool.
(3) Rate at which cells are shed or die.
Growth Fraction :Proportion of cells with in the tumour population thatare in the proliferative pool (Cancer chemotheraphy).
Aggressive tumours Lymphoma, leukemias melt
with CTCancer of colon and breast Debulk cell cycle Drugtherapy
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BENIGN VERSUS MALIGNANT
TUMOURS
Invasion
Distinguish
malignant
tumours
Metastases
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INVASION
Definition :Growth into the surrounding tissue by directextension / expansion.
Benign tumours
Expansile probing margins
Localized growth
Do not have the capacity to infiltrate
May have a capsule or clear line of separation If resected to not recur
If incompletely removed local recurrence only
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Malignant tumours :
Progressive growth
Infiltration ~ poor line of demarcation
Invasion Destruction of adjacent tissue
Metastatic spread
Death if not treated
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METASTASIS
Spread of tumour to distant sites bylymphatic, hematogenous routes or seeding ofbody cavities.
About 30% of tumours present withmetastases
Poorly differentiated tumours more likely tospread
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1. Detachment of tumour cells
Down regulation of E- cadherin expression
Eg : Adeno Ca of colon
Ca of breast
Reduced expression of protein catenins that
links E cadherin to cells cytoskeleton.
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(b) Down regulation of anti - proteases
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4. Invasion of the circulation :
Matrix metalloproteinase.
Down regulating antiproteases.
5. Homing of tumour cells
Adhesion of tumour cells to endothelium Degradation of vessel wall
Organ tropism.
- Tumour cells express adhesion molecules whose ligands
are expressed on vascular endothelial cells of target organ. - Preference for metastasis to specific organ are explained
by chemokines. ( LN, Lung express CXCR4 and CCR7 )
- Eg : Prostatic Ca Vertebral boneNeuroblastomas Liver, Bone.
M t t ti d
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Metastatic cascade
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PATHWAYS OF SPREAD
Seeding of body
cavities and surfaces
Lymphatic spread
Hematogenous spread
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Types :
1. Direct Spread :Direct infiltration of malignant cells into adjacent
tissue, lymphatic or blood vessels.
(1) Local spread
(2) Lymphatic invasion
(3) Perineural invasion
(4) Venous invasion
(5) Arterial invasion.
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Osteogenic sarcoma
Pagetoid spread
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Tumour infiltrating
into the adjacent
duct and spread
between theepithelial lining and
the myoepithelial
cell lining the BM of
duct
Eg : Breast Ca
Perineural Invasion
Adenoid cystic carcinoma
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Lymphatic spread Sentinel lymphnode :
The first lymphnode in a regional lymphatic drainage that gets involved bytumour metastasis.
Eg : Sentinel lymphnode mapping is important in - breast carcinoma
- Melanoma
- Colonic Ca
Breast Ca spread through lymphatic
and large in sub capsular sinus
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Retrograde embolism :
Embolisation of tumour in the reverse
direction to unusual sites when the flow of
lymph is blocked by tumorous permeation.
E.g. : Gastric cancer cells blocks the lymphatic
drainage thoracic duct into the left
subclavian left cervical nodes. ( Virchow )
Enlarges ( Troisiers sign )
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Blood Vascular spread
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ood ascu a sp ead
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Transcoelomic spread
Malignant cells detached and fall through the natural spaces andspread.
(1) Spread through peritoneal cavity.
Krukenberg tumour : (Ovarian metastasis)
- Ca of stomach, colon, breast infiltrate the peritoneal layer and thenfall through the abdominal space due to gravity and settle on theovaries
- Ovaries are enlarged capsule is smooth and intact.
- Cut section shows diffuse replacement of the ovary by mucinsecreting Ca.
Pseudomyxoma peritonei :
- Mucin secreting adeno Ca of appendix or ovary rupture, dischargethe mucin and tumour cells into the peritoneal cavity.
- The tumour cells grow and secrete large amount of mucinousmaterial filling the abdominal cavity.
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METASTASES
LIVER
METASTASES
FROM A
PRIMARY
BREAST
CARCINOMA
normal
liver
function
tests!
CANCER
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CANCER
one out of every five people who die thisyear will die of tumors