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17/5/2014

Benign and malignant
mesenchymal tumors

Benign and malignant
epithelial tumors
Localization in oral cavity

Localization in oral cavity

Synpsis
Other types tumors (pigment,
nervous system, odontogenic)













Benign tumors of mesenchymal origin.
Malignant tumors of mesenchymal origin.
Benign tumors of epithelial origin – adenoma, papilloma.
Malignant tumors of epithelial origin – carcinoma. Localization in
oral cavity.
Tumors of melanocyte origin.
Tumors of the central nervous system.
Tumors of the peripheral nervous system.
Benign tumors of connective tissue.
Benign and malignant tumors of smooth and striated muscles.
Tumors from vessels’ wall – benign and malignant.
Malignant tumors of connective tissue origin.
Osteogenic sarcoma. Malignant synovioma.
Teratogenic tumors – teratoma

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17/5/2014

Principal characteristics of benign and
malignant tumours

CLASSIFICATION OF
TUMOURS

Behavioural classification

Histogenetic classification -cell of origin




benign or malignant
Epithelial
Mesenchymal
Mixed
Teratomas

Precise classification of individual tumors is
important for planning treatment

Special features of the
epithelial tumors in
different organs

Epithelial tumors

The most often tumors


ectoderm -skin
mesoderm-kidney
endoderm - GIT

Structure

the parenchyma

neoplastic epithelial cells

Benign
malignant

non-neoplastic stroma

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17/5/2014

Tumors of epithelial origin

Epithelial tumors

Benign

Papilloma

Adenoma


from the surface epithelium

Skin
Epithelial lining of glands
and ducts

Malignant


Oral cavity, esophagus,
stomach, intestine,
hepato-biliary system,
pancreas
Nasal cavity, larynx,
trachea, bronchi

Urinary tract epithelium
Male and female genital
systems
Placental epithelium

Endocrine glands

Special features of epithelial
tumors


Benign and malignant epithelial tumors are the most
common in adults.
Epithelial cells grow as cohesive groups
Malignancy can be diagnosed by invasion through tissue
layers -basement membrane, muscularis mucosae

Benign epithelial tumors

2 types according to the epithelium

Papilloma – from the surface epithelium

Adenoma – from the glandular epithelium

Skin, urinary tract epithelium

intact basement membrane in benign tumors

Carcinomas spread generally

Malignant

Respiratory passages

carcinomas

Benign

Gastro-intestinal tract

from the glandular epithelium

Tissue of origin

by lymphatics to lymph nodes,
later -via the blood stream (liver, pulmo, bones)

Treatment is by surgical resection

In carcinomas response to radiation and chemotherapy varies
with type

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4. anus  condyloma acuminatum  condyloma lata   Urothelial papillomas  syphilis Papilloma vesicae urinariae Transitional epithelium of ureter. uretra  Precancerosis   HPV (human papilloma virus -1. 7 type) Urothelial carcinoma with low grade malignancy Histology  Fragile papillae  Urine -cytology 4 . 2.17/5/2014 Papillomas   Tumors with finger-like projections Macroscopic features    Exophytic lesions Rarely endophytic lesions Squamous cell papilloma      esophagus larynx  precancerosis  Papillae      Epithelium lining  skin viruses Squamous cell papilloma  Histology  Verrucae Squamous cell epithelium Transitional epithelium Preserved basement membrane Connective tissue core  children –juvenile papillomatosis trachea Condylomata  genitals. bladder.

Parotis   nodules.oil and sweat glands Salivary gland  Breast Adenoma gl. multiple  Various size   Fibroadenoma       Macroscopy Exocrine glands    Endocrine glands  Adenomas  Exocrine pancreas Gastrointestinal tracts Respiratory tract Ovarium  Liver Kidney  familial polyposis coli < 1 cm > 3 cm Dysplasia Adenomas  Histology  Glands    Various shape and size Preserved basement membrane ± dysplasia   low-grade or high-grade  high grade often classified with carcinoma-in-situ may develop into malignancy  Uterine cervix  Colon polyps Normal gland Moderate dysplasia Mild dysplasia Severe dysplasia 5 .17/5/2014 Adenomas  Glandular epithelium        functional activity – clinical syndromes Pituitary Thyroid gland Suprarenal glands Endocrine pancreas  Skin . capsulated Mucosa surface – pedunculated and sessile polyps Single.

mucinous cut surface Histology   Gland structures Myoepithelial cells  Mucoid substance   Papillary cystadenoma – serous. firm nodules Histology  parenchyma   Gland structures Loose connective tissue    pericanalicular intracanalicular Fibrous stroma 6 . GIT  Nests. GIT  tubulovilous.17/5/2014 Adenoma рleomorphe glаndulae parotis Adenomas  Histological types  acinar  Small glands  lumen. young age Capsulated. endocrine glands  trabecular  tubular   Tarbeculae. bronchi Villous  Mixed  Solid  Cystic      Tumor mixtus Capsulated. suprarenal glands  tubule. ovary Fibroadenoma gl. liver. mammae   Basophilic Resemble cartilagous Ovarian cystadenoma Female. mucous. GIT  Papillae.

cachexia Malignant tumors of surface epithelium Carcinomas  may be due to: invasion through tissue layers -basement membrane. muscularis mucosae differentiation    Rapid growth – necrosis. moderate-. vagina   Face  Adenocarcinoma Hepatocellular carcinoma Renal cell carcinoma Seminoma Choricarcinoma  pressure on and destruction of adjacent tissue metastases blood loss from ulcerated surfaces obstruction of flow (intestinal obstruction) paraneoplastic effects weight loss.high-. hyperplasia.17/5/2014 Malignant epithelial tumors  = Carcinomas  Risk factors       Preneoplastic syndromes –chronic inflammation. regeneration Benign epithelial tumors      Grading . haemorrages Noncapsulated Infiltrative Exophytic and endophytic growth Histology   High morbidity and mortality  Macroscopy   Carcinomas   Squamous cell metaplasia 7 . poor differentiation Metastases    Lymph nodes Distant metastases Seeding   TNM staging From surface epithelium     Squamous cell carcinoma Basal cell carcinoma Transitional (urothelial) carcinoma  Squamous cell carcinoma  skin  Oral cavity   From glandular epithelium    Poorly differentiated carcinoma  leukoplakia Metaplasia of stratified squamous non-ketatinized epithelium into keratinized  Esophagus Larynx Bronchus  Cervix uteri.

17/5/2014 Squamous cell carcinoma Squamous cell carcinoma  Histology     atypical cells at all levels of the epidermis. with nuclear crowding and disorganization invasions of basement membrane variable differentiation   With keratinization  = carcinoma planocellulare keratodes  Moderate differentiation  Low differentiation   Keratinization  High differentiation  perls  keratinization Without keratinization = carcinoma planocellulare non-keratodes Basal cell carcinoma  WELL? =Ulcus rodens  Tumor cells resemble the normal epidermal basal cell layer from which they are derived 2 patterns: superficial type or nodular lesions  Slow growth. local invasion. no metastases   MODERATE? palisading with separation from the stroma. creating a cleft POOR? Grading for Squamous Cell Carcinoma 8 .

17/5/2014 Malignant tumors of glandular epithelium = Adenocarcinoma  Breast Salivary glands Gastro-intestinal tract       esopagus – Barrett esophagus stomach – H.seminoma Adenocarcinomas  Adenocarcinomas Adenocarcinoma ventriculi Histological types  Mucinous –  Mucin production  Intra-.pylori gastritis colon– adenomas Pancreas Endocrine glands Female genital system       Histology  Gland structures    Various shape cellular atypia invasion through tissue layers  basement membranes  muscularis mucosae endometrium ovarium Male denital system   testis . extracellular  "signet-ring" cells Papillary carcinoma Cystadenocarcinoma Adenoacantoma  Adenosquamous carcinoma       + squamous cell metaplasia + squamous cell carcinoma Mucoepidermoid carcinoma  Mucinous adenosquamous carcinoma Intestinal type Diffuse type 9 .

17/5/2014 Adenocarcinoma uteri Seminoma Testis Hepatocellular carcinoma Choriocarcinoma Хепатоцелуларен карцином 10 .

17/5/2014 Poorly differentiated carcinomas Renal cell carcinoma 3 types:  Clear Cell Carcinoma    the most often   Papillary Renal Cell Carcinoma Chromophobe Renal Carcinomas Special features of the mesenchymal tumors in different organs.soft Mesenchymal tumors A broad group of non-epithelial tumors. deriving from different mesenchymal tissue types   Soft tissue tumors       Connective/fibrous tissue Adipose tissue Muscle tissue Vascular tissue Bone tumors Joint tumors 11 . Undifferentiated carcinomas 2 types  Scirousum     stroma – firm breast medullare   stroma .

liver Diagnosis  Difficult differentiation between some benign and malignant variants  Tumors of borderline malignancy  Similar histology – spindle cell type  Need of consultation   mitosis Genetic Abnormality Immunohistochemistry –histogenetic markers 12 .22)(q13.q12) EWS-ATF1 fusion gene Dermatofibrosarcoma protuberans t(17:22)(q22.q12) ERG-EWS fusion gene t(7. radiation.17)(p11.q14) PAX3-FKHR fusion gene t(1.q14) PAX7-FKHR fusion gene Extraskeletal myxoid chondrosarcoma t(9.13)(q35.q12) CHN-EWS fusion gene Desmoplastic small round cell tumor t(11.15)(p13.q25) TFE3-ASPL fusion gene Congenital fibrosarcoma t(12.17/5/2014 Mesenchymal tumors SOFT TISSUE TUMORS      Tumors of Adipose Tissue  Lipomas  Liposarcoma Tumors and Tumor-like Lesions of Fibrous Tissue  Fibroma  Nodular fasciitis  Fibromatoses  Fibrosarcoma Fibrohistiocytic Tumors  Fibrous histiocytoma  Malignant fibrous histiocytoma Tumors of Skeletal Muscle  Rhabdomyoma  Rhabdomyosarcoma Tumors of Smooth Muscle  Leiomyoma  Smooth muscle tumors of uncertain malignant potential  Leiomyosarcoma   Vascular Tumors  Hemangioma  Lymphangioma  Hemangioendothelioma  Hemangiopericytoma  Angiosarcoma Tumors of Uncertain Histogenesis  Synovial sarcoma  Alveolar soft part sarcoma  Epithelioid sarcoma  Granular cell tumor Special features of the mesenchymal tumors  Compared to the epithelial tumors Appear at any age    children adults Risk factors   Physical –trauma.22)(q22.q15) COLA1-PDGFB fusion gene Alveolar soft part sarcoma t(X.2.p11) CHOP/TLS fusion gene Synovial sarcoma t(x. chondroma Malignant  Sarcomas  Fibrosarcoma. liposarcoma.q12) FLI-1-EWS fusion gene t(21:22)(q22.22)(q22.q12) ETV1-EWS fusion gene Liposarcoma—myxoid and round cell type t(12:16)(q13.q12) EWS-WT1 fusion gene Clear cell sarcoma t(12. from which tumor arise   fibroma.q11) SYT-SSX fusion gene Rhabdomyosarcoma—alveolar type t(2.18)(p11.13)(p36.22)(p13. chondrosarcoma Chromosomal and Genetic Abnormalities in Soft Tissue Sarcomas Tumor Cytogenetic Abnormality Extraosseous Ewing sarcoma and primitive neuroectodermal tumor t(11:22)(q24. thermal burn associations Genetic      Chromosome translocations Part of many syndromes No clear distiction between the tumor’s parenchyma and stroma   Benign  by adding “-oma” to cell type. lipoma.q23) ETV6-NTRK3 fusion gene A great diversity of tumors    Mesenchymal origin of the components Diffuse growth Sarcomas spread generally by via the blood stream to the pulmo.

well-encapsulated masses Conventional . epitheliod sarcoma Lipoma  Tumors of Adipose Tissue Numerous capillaries Treatment  complete excision is usually curative 13 . yellow. alveolar soft part sarcoma. thigh Submucosa of GIT soft.17/5/2014 SOFT TISSUE TUMORS         Fat (adipose) tissue Fibrous tissue Fibrohistiocytic Skeletal muscle Smooth muscle Vascular Peripheral nerve Uncertain   Benign tumors of fat The most common soft tissue tumors of adulthood. Solitary lesions  Localization  Macroscopy  Histology         Lipomas Malignant  Liposarcoma Lipoma Back. shoulders.mature adipocytes    Benign Multiple – in rare autosomal dominant syndromes.  Varied in size Clear empty cytoplasm Peripheral nucleus Angiolipoma    synovial sarcoma.

60-70 y . Adults.17/5/2014 Liposarcoma Liposarcoma  Malignant neoplasm of adipocytes Rare tumors. retroperitoneum in visceral sites relatively well-circumscribed lesions . large size polylobulated ± myxoid cut surface Histology  Lipoblasts  myxoid liposarcoma    fetal fat cells with cytoplasmic lipid vacuoles Mucoid stroma Pleomorphic variant   Atypical cells. inc. multinuclated cells mitoses Tumors and Tumor-like Lesions of Fibrous Tissue  Benign   Fibroma Malignant  Fibrosarcoma Fibroma  Benign tumor of fibrous connective tissue A common tumor of the skin Macroscopy  Histology     Capsulated nodule Fibrocytes    Spindle cells with sharp edges nuclei storiform pattern of growth + collagen fibers   hard fibroma -fibroma durum Soft fibroma -fibroma molle 14 .f > m  Localization  Macroscopy          chromosomal translocation .myxoid liposarcomas deep soft tissues.

lungs  Adults Localization  Macroscopy      deep tissues of the thigh. knee.> 10/10 HPF mitoses Leiomyosarcoma 15 .17/5/2014 Fibroma cutis Fibrosarcomas  Malignant neoplasms composed of fibroblasts    tend to grow slowly often recur locally after excision (>50% of cases) can metastasize hematogenously (>25% of cases) . mitoses necrosis Tumors of Smooth Muscle   Leiomyoma Smooth muscle tumors of uncertain malignant potential (atypical leiomyomas)  DD leiomyoma/leiomyosarcoma   Leiomyosarcoma . infiltrative masses ± areas of hemorrhage and necrosis Histology   all degrees of differentiation spindled cells growing in a herring bone fashion    Fbrosarcoma pleomorphism. and retroperitoneal area soft unencapsulated.

Deep tissues of extremities Retroperitoneum. fascicles  ± fibrosis.20% of sarcomas Adult. necrosis. calcifications. up to 20 cm Fascicled cut surface Histology  Spindle cells (smooth muscle). grey-white firm nodules. f> m Localization    skin. subserosal  Age – female  Macroscopy     estrogen-dependent Well circumscribed. metastasis метастази  Macroscopy  Histology    Large.17/5/2014 Leiomyoma  Benign tumor of smooth muscle cells  Localization   Low malignant potential Myometrium – multiple nodules  Submucosa. firm tumor mass spindle cells with cigar-shaped nuclei arranged in interweaving fascicles 16 . cysts  Round edges of the nuclei Leiomyosarcoma   Leiomyosarcoma Malignant tumor of smooth muscle cells   Leiomyoma (HE) 10% . uterus  Local invasion. intramural.

gelatinous. grapelike masses    > 50% of sarcomas in children Localization Frequent and early metastases– lungs Diagnosis  “endothelium” lined blood filled spaces   immunohistochemistry . neck. face extremties genitourinary tract  Macroscopy  Histology  poorly defined.factor VIII mitosis Desmin. actin.round or elongated cells  Embryonal variant  Alveolar variant   Small round cells  Alveoli. fibrous septa Pleomorphic variant Immunohistochemistry     Hemangioma Lymphangioma  Hemangioendothelioma  Angiosarcoma  Locally aggressive. myosin 17 .17/5/2014 Tumors of Skeletal Muscle   Rhabdomyoma Rhabdomyoma Rhabdomyosarcoma   Benign tumor of striated musle cells Very rare  Age   More common   malformation Adult type Fetal type Localization    Skeletal muscles Heart  Sclerosis tuberans Histology   Large round cells with eozinophilic granular cytoplasm Rhabdomyosarcoma Vascular tumors Tumors of blood vessels and lymphatics  Malignant tumor of striated muscle cells      head. rarely metastasize Malignant   hamartomas. not even true neoplasms Intermediate  granular eosinophilic cytoplasm. filaments  Benign  sarcoma botryoides -soft. infiltrating masses  Rhabdomyoblast . myoglobin.

frequent metastases via bloodstream   = a generic term for any benign blood vessel tumor Capillary (small vascular spaces)    Cavernous (large vascular spaces)     Also called “juvenile”. severe atypia Early. rare atypia  No metastases  Malignant     Common mitosis Frequent. often called “birth marks” Usually regress with age Also called “adult” Usually do not regress Smooth-muscle hemangioma Pyogenic hemangioma Hemangioma Hаemangioma cavernosum hepatis 18 .17/5/2014 Hemangioma Vascular tumors  Benign   Rare mitosis Mild.

Generally rare Simple (Capillary) Lymphangioma     Angiosarcoma  ± vessels lumens  atypical endothelial cells  absence of blood cells head. neck. atypical Lymphangiosarcoma   After mastectomy Papillary projections of atypical endothelial cells 19 .neck composed of dilated lymphatic spaces and connective tissue stroma.1 to 2 cm  Cavernous Lymphangioma (Cystic Hygroma)  typically found in the neck or axilla of children   common in Turner syndrome can be enormous (≤15 cm in diameter). not encapsulated   Malignant vascular tumors small lymphatic channels   Producing gross deformities . 1 cm Painful   Factor VIII Cellular pleomorphism Mitoses. axillary subcutaneous tissues flat lesions .17/5/2014 Pyogenic granuloma Glomus tumor Oral cavity most common Regress Histology        like capillary hemangioma Indistinguishable from normal granulation tissue  Lymphangiomas    Benign lymphatic analogue of hemangiomas. Ly aggregates Most commonly under nail Small tumor.

EMA Classification of Primary Tumors Involving Bones Bone tumors Histologic Type Chondrogenic (22%)       Bone Cartilage Fibrous Other  Ewing’s “sarcoma”  Giant cell tumor  Metastases Benign Malignant Benign Hematopoietic (40%) Malignant Myeloma Osteochondroma Malignant lymphoma Chondrosarcoma Chondroma Dedifferentiated chondrosarcoma Chondroblastoma Mesenchymal chondrosarcoma Chondromyxoid fibroma Osteogenic (19%) Osteoid osteoma Osteosarcoma Unknown origin (10%) Osteoblastoma Giant cell tumor Ewing’s sarcoma Histiocytic origin Fibrous histiocytoma Giant cell tumor Adamantinoma Malignant fibrous histiocytoma Fibrogenic Metaphyseal fibrous defect (fibroma) Notochordal Vascular Hemangioma Lipogenic Neurogenic Lipoma Neurilemmoma Desmoplastic fibroma Fibrosarcoma Chordoma Hemangioendothelioma Hemangiopericytoma Liposarcoma 20 .17/5/2014 Tumors of Uncertain Histogenesis    Synovial sarcoma Alveolar soft part sarcoma Epithelioid sarcoma Synovial sarcoma  Uncertain cellular origin.18)   SYT gene (transcription factor) Histology  Biphasic variant  Monophasic variant    Epithelial-like cells. agressive. knee extrajoints Chromosomal translocations t(X. LN Joints .10%. glands Spindle cells Spindle cells – fascicles  DD fibrosarcoma – keratin. bones. malignant  Localization  Young adults      The cells are not synoviocytes metastases –lung.

associated with pre-existing disorders such  Metaphysis of distal femur. skull. and giant cell Different degree of differentiation The most common subtype is osteosarcoma that arises in the metaphysis of long bones. and poorly differentiated. telangiectatic. chondroblastic. skull  Exophytic growth. produces a predominantly bony matrix 21 . Paget disease  Femur. > 40 yrs  Histologic variants   osteoblastic. solitary. 40-50yrs Histology . fibroblastic. 10-20 yrs as benign tumors.similar to normal bone Osteoma metaphysis femur.17/5/2014 Benign osteogenic bone tumors = Bone Forming. 19%   Osteoma      Solitary tumor Mean age Face. humerus. tibia 10-20yrs Histology – similar to woven bone Osteoblastoma      similar to normal bone vertebral column 10-20yrs Histology -similar to osteoid osteoma Frontal sinus Malignant osteogenic bone tumors  Osteosarcoma Osteosarcoma (osteogenic sarcoma)  Primary  secondary . intramedullary. proximal. attached to the bone Histology   Osteoid Osteoma     face. small cell. pelvis.

atypia Osteochondroma (exostosis)      Common Often multiple as a hereditary syndrome m>>>f Pelvis. scapulae. epiphyses. m>>f. 10-30 yrs.much less matrix than a chondroma Chondromyxoid fibroma  Myxoid. Histology .17/5/2014 Benign cartilagenous bone tumors Sarcoma osteogenes   = Cartilage forming. 22% Osteochondroma (exostosis)    Chondroma    Small bones of hands and feet. medullary cavity Histology – hyaline cartilage Chondroblastoma    Metaphysis of long bones.cartilage and bone tissue Knees. Histology . teenagers.if hemangiomas present 22 . ribs  Metaphysis Cartilage and bone present Chondroma   Hyaline cartilage Multiple enchondromas   Ollier’s disease Maffucci syndrome . 30-50 yrs.

pelvis    within medullary cavity 40-60 yrs Histology – atypical chondroblasts – abnormal cartilage     conventional hyaline/myxoid Mesenchymal Clear cell dedifferentiated Chondrosarcoma Other Bone Tumors  Giant cell tumor Ewing sarcoma  Metastases  Variants -conventional hyaline/myxoid. thyroid also seek bone early also 23 .17/5/2014 Malignant cartilagenous bone tumors Chondroma  Chondrosarcoma  Femur. clear  the most common bone tumors  osteoblastic/ lytic    male: prostate female: breast renal. mesenchymal. humerus.

small round cells  Resemble lymphoma  General features of the CNS tumors  85 % .lethal consequences irrespective of histologic classification    A benign meningioma in the medulla cardiorespiratory arrest The ability to resect a lesion may be limited The pattern of spread of primary CNS neoplasms differs from that of other tumors -rarely metastasize outside the CNS  the subarachnoid space .tumors of childhood. cellular uniformity.22)   FLI-EWS gene fusion Histology . and slow growth) may infiltrate large regions of the brain The anatomic site of the neoplasm .  Tumors of the central nervous system primary tumors and metastatic  differ from those in adults both in histologic subtype and location   arise in the posterior fossa ( in adults -mostly supratentorial) Tumors of the nervous system have unique characteristics  Histologic distinction between benign/malignant lesions – not clear   low-grade lesions (low mitotic rate.a seeding along the brain and spinal cord 24 .intracranial.intraspinal tumors  20% of all . 15% .17/5/2014 Ewing sarcoma (tumor) Giant cell tumor of bone  Localization     cortical lesions  Young adults -20-40 yrs Histology   PNET (primitive neuroectodermal tumor) Localization  epiphysis of long bones Diaphysis and metaphysis   Macrophages Giant cells medullary lesions Age -10-20 yrs  Chromosomal translocation -t(11.

oligodendrogliomas ependymomas 25 .17/5/2014 CNS TUMORS  GLIOMAS         Astrocytoma (I. IV) Symptoms? Headache Vomiting  Mental Changes  Motor Problems  Seizures  Increased Intracranial Pressure   Oligodendroglioma Ependymoma MENINGIOMAS NEURONAL POORLY DIFFERENTIATED LYMPHOMAS METASTATIC (medulloblastoma)  any localizing CNS abnormality CNS TUMORS         History Physical Neurologic exam LP (including cytology) CT MRI Brain angiography Biopsy Gliomas  Tumors of the brain parenchyma that histologically resemble different types of glial cells    astrocytomas. II. CNS TUMORS  III.

infiltrative tumor cut surface . gray.firm.17/5/2014 Fibrillary astrocytomas Astrocytomas  Different categories of astrocytic tumors characteristic histologic features  distribution within the brain  age groups    Fibrillary Pilocytic astrocytomas    80% of adult primary brain tumors Age – 40 -60 y Localization     seizures. II gr. headaches. Anaplastic astrocytoma (III gr. or soft or gelatinous ± cystic degeneration and hemorrhage Astrocytoma Microscopy  I –IV grades        cellularity nuclear pleomorphism necrosis mitoses Astrocytoma (I.) Glioblastoma. and focal neurologic deficits Macroscopy    Fibrillary astrocytomas cerebral hemispheres a poorly defined.IV grade  vascular or endothelial cell proliferation and pseudopalisading nuclei 26 .

Oligodendrogliomas cerebral hemispheres infiltrative tumors . and calcifications Microscopy     sheets of regular cells with spherical nuclei containing finely granular chromatin (similar to normal oligodendrocytes) surrounded by a clear halo of cytoplasm a delicate network of anastomosing capillaries. Calcifications Mitoses -rare  Except in anaplastic oligodendroglioma 27 .17/5/2014 Glioblastoma Multiforme Pilocytic Astrocytoma    Relatively benign tumors Age . thin "hairlike" processes. often cystic      Oligodendrogliomas  Frequency -5-15% Age – 40-50 y Localization  Macroscopy       with a mural nodule in the wall of the cyst Microscopy areas with bipolar cells with long. gray ± cysts.children and young adults Localization     Cerebellum. GFAP (+) Rosenthal fibers (eosinophilic granular bodies) Necrosis and mitoses are rare. focal hemorrhage.gelatinous. in the floor and walls of the third ventricle the optic nerves Macroscopy  well circumscribed.

round to oval nuclei with abundant granular chromatin   perivascular pseudo-rosettes Variants  Anaplastic  increased cell density. friable Histology  with sheets of anaplastic ("small blue") cells    with little cytoplasm and hyperchromatic nuclei Rossetes of Homer-Wright mitoses – abundant 28 .children Localization  Макроскопски       Ependymoma Medulloblastoma cerebellum (vermis) well circumscribed.17/5/2014 Ependymoma    Frequency -5-10% Age – 10-20 y Localization  IV –th ventricle  hydrocephalus  Macroscopy  Microscopy   solid or papillary masses cells with regular. necrosis Poorly Differentiated Neoplasms Medulloblastoma  Neuroectodermal cells Age . gray. high mitotic rates.

Discrete.with PAS-positive intracytoplasmic droplets Microcystic . globoid.17/5/2014 Meningiomas  Benign tumors of adults    Microscopy -variants from the meningothelial cell of the arachnoid  Localization    any of the external surfaces of the brain ventricular system   Meningiomas  from the arachnoid cells of the choroid plexus  Macroscopy   well-defined dural-based masses compress underlying brain   Fibroblastic .with elongated cells and abundant collagen deposition Psammomatous . 29 . breast. Most are in cerebrum    in gray-white junctions due to rich capillarity Single or multiple. GI tract.with numerous psammoma bodies Secretory . Common primary sites: melanoma. lung. sharply demarcated tumors  amenable to surgical resection.with a loose. kidney. spongy appearance Atypical meningiomas – mitosis Anaplastic (malignant) meningiomas  Meningeoma resemble a high-grade sarcoma Metastatic brain tumors    Most common brain tumor in adults.

fascicles Verocay bodies     the "nuclear-free zones" of processes that lie between the regions of nuclear palisading Antoni B pattern of growth  well-circumscribed encapsulated masses that are attached to the nerve Morphology – 2 growth patterns Antoni A pattern of growth  Macroscopy  Schwann cells.Antoni B Schwannoma    From Schwann cells Symptoms – due to local compression Localization       in the cerebellopontine angle -attached to the vestibular branch of the 8th nerve (vestibular schwannoma) sensory nerves. large nerve trunks elongated cells with cytoplasmic processes . perineurial cells Fibroblasts less densely cellular areas microcysts and myxoid changes Immuhistochemistry  S-100 protein 30 .17/5/2014 Tumors of the peripheral nervous system Tumors of the peripheral nervous system  Arise from cells of the peripheral nerve     Schwannoma Neurofibroma  Malignant Peripheral Nerve Sheath Tumor  Schwannoma Antoni A .

with varied clinical appearance Macroscopy  Benign – melanocytic nevus Malignant . infiltrative Myxoid stroma De novo plexiform neurofibroma Macroscopy     Highly malignant multiple recurrence metastases Origin  Plexiform  Sarcoma  Form whorls of fibroblasts Two types:   poorly defined tumor masses ±infiltration along the axis of nerve ± invasion of adjacent soft tissues Histology   the tumor cells resemble Schwann cells .17/5/2014 Malignant Peripheral Nerve Sheath Tumor Neurofibroma  Well differentiated. more closely associated with melanoma)‫‏‬  Intradermal  Compound (both)‫‏‬ 31 .melanoma    relatively small. and uniformly pigmented Morphology  Junctional   more pigmented. benign        Classic form  Cutaneous / nerves – solitary collagen matrix. spindle cells. nuclear anaplasia Melanocytic nevus Tumors and Tumor-Like Lesions of Melanocytes    Benign congenital or acquired neoplasm of melanocytes Numerous types. necrosis.elongated nuclei and prominent bipolar processes.     Neurofibromatosis type 1 Multiple. symmetric. fascicle formation Mitoses.

 Morphology  Germ-line mutations in the CDKN2A gene (9p21) MALIGNANT MELANOMA Clinical features  The only primary skin cancer that can quickly metastasizes Sporadic Hereditary -5-10%  MALIGNANT MELANOMA  Related to sun like all other skin cancers  chromatin characteristically clumped at the periphery of the nuclear membrane prominent eosinophilic nucleoli -"cherry red" nests or individual cells at all levels of the epidermis Breslow.17/5/2014 MALIGNANT MELANOMA Melanocytic nevus   Dermal nevus Malignant proliferations of melanocytes. Incidence rising. eye. the meninges.oral and anogenital mucosal surfaces. the esophagus.     Junctional nevus Difficult to differentiate from nevus clinically   often microscopically   Morphology  Skin   a change in the color or size of a pigmented lesion  Vertical growth phase Horizontal growth phase  Related with prognosis  Malignant cells with large nuclei with irregular contours  less common sites . Clark’s staging‫‏‬ 32 .

40%  combination of teratoma. cartilage. bone. adipose tissue.17/5/2014 MALIGNANT MELANOMA Teratomas  =mixed tumors  originate from totipotential stem cells  Ovary. testis   the capacity to differentiate into any of the cell types found in the adult body 3 variants  Mature teratomas  contain fully differentiated tissues from one or more germ cell layers    Cystic teratoma of ovary contain immature somatic elements reminiscent of those in developing fetal tissue   neural tissue. 33 . epithelium in a haphazard array Immature teratomas mediastinum Teratomas with malignancies  malignancy in preexisting teratomatous elements   squamous cell carcinoma or adenocarcinoma Mixed germ cell tumors of testis. embryonal carcinoma. and yolk sac tumors.