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By fadela

1. NEOPLASIA By: Dr. Sherifa Ali Alammari B.D.S M,Sc . Pathology Assistant Professor

2. LEARNING OBJECTIVES: 1 . Definition 2 . Nomenclature 3 . Classification 4 . Spread of tumours 5 . Pre cancerous conditions

3. Neoplasia “New Growth” An abnormal mass of tissue the growth of which exceeds and is uncoordinated with that of the normal tissue and persists after the cessation of the stimuli which evoked the change Neoplasm ( Greek) Neo = new Plassein = formation Oncology Onos = tumor logos = study of Tumour Abnormal Swelling Autonomous Independent of physiologic growth regulatory stimuli No purpose Irreversible

4. Parenchyma N eoplastic cells Tumour nomenclature Determines differentiation (behavior) Parenchyma Stroma Blood Vessel Tumour Components

5. Supporting Host Stroma Connective tissue Blood vessels and lymphatics Host derived inflammatory cells Consistency (hard or scirrhous ) Crucial to tumour growth (blood) Tumour Components Desmoplasia Some tumours evoke an intense fibrotic reaction with extensive collagen deposition in the stroma e.g. invasive mammary duct carcinoma Hardens the tumour

6. Neoplasms may be: BENIGN TUMOURS‘ Slow-growing. Localised . 'MALIGNANT '. Proliferate rapidly. Spread throughout the body. CLASSIFICATION OF TUMOURS:

7. Benign -Remain localized -Usually capsulated -Expansion -Cannot spread -Local removal -Little effect on survival Malignant “Cancer” - Invade & destroy tissue -Noncapsulated -Infiltration - Can spread (distant) -Some are treated -Can be fatal Locally Malignant - Invades & destroy tissues -Noncapsulated -Infiltration -Cannot spread -Some are treated -Can be fatal 1- Basal cell carcinoma 2- Osteoclastoma (GII) 3- Craniopharyngioma 4- Amyloblastoma Fibroadenoma Advanced cancer

8. Confusingly, some types of malignant tumours also use the- oma suffix e.g : Melanoma Seminoma Lymphoma Hepatoma The benign tumours derive their nomenclature on the basis of the tissue involved ( CELLORIGIN ). They end with suffix - OMA

9. BENIGN TUMOURS MESENCHYYMAL ORIGIN EPITHELIAL ORIGIN Called As

10. CLASSIFICATION OF MALIGNANT TUMOURS: Malignant tumours of epithelial origin are called CARCINOMAS . While Malignant mesenchymal tumours named SARCOMAS . However, some cancers are composed of highly undifferentiated cells and are referred to as undifferentiated malignant tumours .

11. • The word 'cancer' means crab, thus reflecting the true character of cancer since 'it sticks to the part stubbornly like a crab'. The common term used for all malignant tumours is cancer . Carcinoma (Greek) Karakinos = sea crab

12. MALIGNAT TUMOURS MESENCHYYMAL ORIGIN (SARCOMAS) EPITHELIAL ORIGIN (CARCINOMAS) Called As

13. Carcinoma Cell of origin: Epithelial Behavior: Malignant Growth rate: Relatively slower In situ stage Middle and old age (50 or >) Cell arrangement: acini or groups Well developed stroma (  hemorrhage) Early lymphatic spread (blood late) Radiosensitive Sarcoma Mesenchymal (CT) Malignant Rapid No in situ stage All ages (more in young age) Sheets closely related to matrix Poorly formed stroma (  hemorrhage) Early blood spread (rare by lymphatics) Radioresistant

14. DIFFERENCE IN BENIGN AND MALIGNANT TUMOURS

15. Benign -Remain localized Slow growing -Expansion (compression of surroundings) -Usually capsulated Small to moderate size Well differentiated - May regress spontaneously Malignant -Invade & destroy tissue Fast growing -Infiltration -Noncapsulated Large size Less, poorly or anaplastic - Progress relentlessly

16. Benign -Cannot spread -Local removal -Little effect on survival - Death only if: compression of a vital organ (brain) or excessive hormone effect Malignant -Can spread (distant metastases) -Some are treated -Fatal if not treated Cause of death; cachexia destruction ulceration metastases secondary infection

17. Locally Malignant Tumors Basal Cell Carcinoma (skin of face) Osteoclastoma Grade II Craniopharyngioma Amyloblastoma (adamantinoma) Astrocytoma Osteoclastoma (knee) Craniopharyngioma

18. Differentiation Degree of morphologic & functional resemblance of tumor cells to the parent cell(s) of origin Morphologic Benign : Always well-differentiated Malignant : Well-differentiated (better prognosis) Moderately differentiated Poorly differentiated Undifferentiated Functional Cartilaginous matrix by chondroma Keratin by SCC Bile by HCC Hormones of parent cell

19. Anaplasia “De-differentiation” Ana (Greek) = Backward Plassein = Formation Anaplasia = Absolute lack of differentiation (feature of malignancy) Cellular and nuclear pleomorphism , hyperchromasia , abundant and abnormal mitoses, and tumor giant cells, clumped chromatin, large or multiple nucleoli

20. Tumor Grading An assessment of a tumor’s degree of malignancy or aggressiveness Important features used in grading; Nuclear size Nuclear pleomorphism Mitotic activity Degree of differentiation 4 grades; Grade I = 75% of cells well-differentiated Grade II = 50% of cells well-differentiated Grade III = 25% of cells well-differentiated Grade IV = < 25% of cells well-differentiated

21. SPECIAL CATEGORIES OF TUMOURS 1. Mixed Tumours 2. Teratomas 3. Blastomas ( Embryomas ) 4. Hamartoma 5. Choristoma

22. 1- Mixed Tumours More than 1 type of parenchymal cells, that derive from the same germ layer 1- Breast fibroadenoma : duct epithelium (adenoma) and fibrous stroma (fibroma) 2 -Adenosquamous Carcinoma : It is combination of Adenocarcinoma & squamous cell carcinoma in the endometrium . 3- Carcinosarcoma : Rare combination of malignant tumor of epithelium ( carcinoma ) & of mesenchymal tissue ( sarcoma ) such as in thyroid .

23. 2- Teratomas : Teratomas are rare type of neoplasms which contain fully developed tissues/organs like hair, bone, muscle etc. Develops from pluripotent cells i.e., from the three germ layers cells Arise from totipotent stem cells Seen in gonads and midline embryonic rests ( pineal,mediastinum , sacrococcgeal ) Mature (benign), immature (malignant)

24. 95 % are BENIGN OR MATURE - most of the ovarian teratomas - in women . ( more common ) 5 % are MALIGNANT OR IMMATURE - most of the testicular teratomas - in men. 2 molar teeth Yellowish, pasty sebaceous material Hair

25. 3- Blastomas ( Embryomas ) Blastomas or Embryomas are a group of malignant tumours develop from the blastema (precursor cells/ blast cells) of organs. It typically affects children rather than adults .

26. Blastomas ( Embryomas ) Blastema /Blast cells of The organs and t issue d uring embryogenesis

27. Each kind of blastoma is given its own name depending on where it's located in the body For example, Nephroblastoma ( Wilm's tumour ) is found in the kidney . Retinoblastoma is found in the Eye . Medulloblastoma is found in Brain. Hepatoblastoma is found in Liver.

28. Features: All Blastomas are childhood tumours . They usually present before the age of 5 years, and many are present at birth. They are malignant in nature. Exception : ( BENIGN IN NATURE) - Chondroblastomas from chondroblasts - Osteoblastomas from osteoblasts.

29. Retinoblastoma Nephroblastoma

30. 4. Hamartoma It is a benign tumor made of mature but disorganized cells of tissues indigenous to the particular organ . In Greek hamartia, meaning “defect ". It is considered a developmental error and can occur at a number of sites . e.g . Hamartoma of the lung consists of mature cartilage, epithelium,mature Smooth Muscle and Thus, all mature differentiated tissue elements of bronchus are present in lung but are jumbled up as a mass

31. 5. Choristoma . Choristoma is a tumor-like mass consisting of normal cells in an … abnormal location (Foreign to the site) (Ectopic location). The mature tissue elements not normally present at the site of … occurrence . It is a developmental defect. It is not a true tumour . Eg : Presence of Pancreatic tissue in Stomach wall.

32. Hamartoma Malformation Mass Disorganized mature tissue Tissues normal to the site Choristoma Congenital anomaly Mass Normally organized Heterotopic rest of cells

33. Bronchial epithelium Lung Hamartoma Disorganized overgrowth of bronchial epithelium, cartilage, mucus glands Cartilage Pancreatic Choristoma Heterotopic pancreatic tissues Duodenal mucosa Duodenal muscularis propria

34. Eponymously Named Neoplasms Burkitt’s Lymphoma (malignant B cell lymphoma) EBV Ewing sarcoma (malignant tumor of bone marrow) Kaposi Sarcoma (malignant tumor of endothelium) AIDS Wilms tumor ( Nephroblastoma ) Hodgkin’s lymphoma (malignant lymphoma) Eponym = Name of the person who first described the tumor

35. Spread of Malignant Tumors Local spread - Invade and destroy adjacent tissues (muscles, bone) Distant spread “Metastases” - Lymphatic (carcinoma) Permeation Embolism - Hematogenous (sarcoma) - Transcoelomic - Intraluminal - Implantation Local spread of chondrosarcoma

36. Lymphatic Spread Lymphatic spread “breast cancer”

37. Hematogenous Spread Bowel primary Secondary tumor Portal vein Renal and bronchogenic carcinoma Osteosarcoma (femur)

38. Other Methods of Spread Implantation (surgery, needle) rare Intraluminal Transcelomic Pelvic TCC spread to urinary bladder Gastric carcinoma Spread through natural body cavities (pleural or peritoneal cavities) Carcinoma of stomach or colon can send metastases to ovaries ( Krukenberg tumor)

39. Precancerous Conditions Chronic skin fistula (SCC) Liver cirrhosis (HCC) Atypical endometrial hyperplasia (endometrial carcinoma) Dysplastic bronchial mucosa, smokers (bronchogenic carcinoma) Chronic atrophic gastritis (pernicious anemia) gastric carcinoma Persistent regenerative cell replication

40. Thank you