Neoplasia

Neoplasia: ("Neo: new", "-plasia: growth") .•

•Tumor: in general word we use the words: "mass or swelling or

Neoplasm" the closest word we’ll use in our next lectures is Neoplasm
and it indicates a type of swelling that is formed by the renewal of
abnormal cells or transformed cells that formed in us.

Transformed cells: Cells that have changed from their normal state
and have undergone several mutations (genetic mutations) leading to
features of :
1-Uncontrolled growth: growth without proper control.
2-Uselessness: that means they are useless 
For example: There are certain cells in the pancreas that produce
insulin to control blood glucose level, a tumor might occur in these cells
and we call it “Insulinoma”, the formation of this tumor leads to
excessive production of insulin in the blood it's useless and sometimes
can be harmful -may cause Hypoglycemia.

3-Persistence: the cells either persist for a while then stop or they may
persist for a long time(keep proliferating) until we intervene and stop
them.
Determined by what? The type of the mutant gene.
According to behavior there are two types of neoplasm:
 Benign neoplasm)‫(األورام الحميدة‬
They have limited new growth
They don't locally invade or spread to different sites of the body.
 Malignant neoplasm: (‫)األورام الخبيثة‬
The growth rate is faster than benign neoplasm
They can invade locally, can spread by direct spread and can even can
jump to distant sites(distant metastasis).

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Both malignant and benign tumours are of many types.
 Other classifications than behaviour are used to determine the type of
tumour (one of great importance is the cell of origin)
Cancer: is a general term for all malignant growths of whatever type
or origin tissue.
Oncology: study of tumours (whether malignant or benign)

Oncologist: is a medical professional(doctor) who studies and treats

tumours.
NEOPLASM: again it's abnormal mass of tissue, the growth of which
EXCEEDS that of normal tissue and is UNCOORDINATED, and PERSISTS in
the same way even AFTER REMOVAL of the stimulus which produced the
initial change.
Unlike Metaplasia which can go back to normal if you remove the
stimulus, {unless it progresses to dysplasia, which we will talk about
later)
Classification of Neoplasm (Tumours):
But before that we have some questions to answer!!
What is the purpose of classification?
1-To provide help in diagnosis
2-To allow correct treatment
How do we classify tumours?
•Cell of origin: (epithelium, fat, connective tissue, etc...)
•Behavior of tumour: as mentioned earlier.
•Degree of differentiation: degree of similarity between the tumor cells
and the normal cells of origin. i.e.: resemblance of tumours to normal
cells.
For example: If we have tumour of fatty nature , if these cells have a
high degree of similarity to normal mature fat this is a good point and
good behavior but if it was low that means we have a problem .

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The structure of Neoplasms:
Parenchymal cells: the main cells in the tumour and we name the
tumour referred to these cells.
Stromal cells: other cells that give support to parenchymal cells by
making a connective tissue surrounding them to provide a framework;
giving them a good environment like heating, nutrition, etc...

Amount & type of stromal cells may contribute to the consistency and
appearance of tumours.
For example: if we have more stromal support (collagen, Fibroblasts,…)
more fibrous tissue support make the consistency in the tumour rough
and even harder (stromal proliferation), the tumour in which this
phenomenon occurs is called Scirrhous tumour(high amount of stromal
tissue, fibrous tissue and collagen Desmoplasia.
And less amount of support makes the consistency soft and cystic (it
appears like a water bag).
Remember that Stromal cells are connective tissue cells, (including
blood vessels that provide nutrition for the area, and all types of
CT that provide support), it is crucial to the growth of the
neoplasm, since it carries the blood supply and provides support
for the growth of parenchymal cells.

The parenchymal cells may arise from:

A- One germ cell layer:
Endoderm (It forms the epithelial lining of multiple systems & viscera).
Mesoderm (CT and other tissue).
Ectoderm (skin & neuroepithelium).
The tumour can come from one of these germ cell layers, but the
expressions of theses tumour cells will appear on an epithelial cell,
connective tissue, endothelial cell, blood, BM, lymph node…etc.…
B- More than one germ cell layer

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Mixed tumours: a tumour that derives from multiple tissue types{ Have
component parenchymal cells from two or more germ cell }
There are two types:
1) Derived from a single germ cell layer that differentiates into more
than one cell type.
2) Derived from more than one germ cell layer.
e.g. Tumour that has parenchymal cells arising from epithelium and
parenchymal cells arising from connective tissue.

A lot of support cells and fibers in Soft and filled of fluids what we
the center and we can't call cystic

Differentiate between normal

cells and tumor cells

Serous cystadenoma of ovary

Scirrhous Carcinoma of breast

Epithelial Cell Origin (most common)

1) Benign Epithelial tumors:
Divided according to origin whether from columnar cells or
squamous cells:
Adenoma ( oma: "benign neoplasm" Aden: "arising from glandular
epithelium or columnar") : Glandular epithelial tumours often producing
a secretion.
We find it in most of the GIT except esophagus, and we also find it in RS,
epithelial, in uterus and thyroid gland.
e.g. (mucin) which may be intraepithelial or intraluminal, {good point for
differentiation}
Cystadenoma which was mentioned in the previous picture is an
example of Adenoma.

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Papilloma (oma: "benign neoplasm" Papill: "arising from squamous
epithelium”): Epithelial tumor forming finger-like fronds/projections
from any epithelial surface, with a connective tissue core/ center

Squamous Papilloma

Polyp-: (could be neoplastic or non-neoplastic)

It is a general term of any mass projecting from the mucosal surface of a
hollow organ.
“Polyp” is not necessarily neoplastic, it could be an inflammatory lesion.
If it is neoplastic we call it adenomatous polyp.
Polyp

Structure of Adenoma (Adenomatous Polyp)

In this picture we see that this isn't a malignant case because the cells
are not invading the underlining tissues so it's a (Benign Neoplasm).

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 2) Malignant epithelial tumours (Carcinomas):
Squamous cell carcinoma: if they come from squamous epithelium
e.g.: skin, mouth, cervix, bronchus...etc.
Adenocarcinoma: from glandular origin e.g. G.I.T., endometrium, breast,
kidney, thyroid, lung…etc.

Connective tissue cell origin:

1) Benign: prefix + oma
Indicates the type of the tissue of origin

e.g. Fibroma: fibrous tissue tumor

Lipoma: fat tumor
 Chondroma: cartilaginous tumor
Osteoma: bone tumor ,
Adenoma: epithelial tissue with glandular origin tumor
Angioma : *vascular blood vesseles(hemangioma) or lymphatic
vesseles (lymphangioma)
Leiomyoma: smooth muscle tumor
Rhabdomyoma: skeletal muscle tumor …etc
2) Malignant connective tissue tumors:
Replace omasarcoma
Prefix (origin) + suffix (sarcoma)
e.g. Osteosarcoma, liposarcoma, angiosarcoma, leiomyosarcoma,
rhabdomyosarcoma
Exceptions: Leukaemia(many types) , Lymphoma(from lymphocytes),
seminoma (germ cells of testis), and finally Melanoma, they are always
malignant.

*Nevus (plural nevi) is a benign tumor ‫الشامة‬

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Glioma (glial cells of brain or spinal cord) is also an exception, it has
different levels of behaviour, there are the weak ones that are near
benign but not called benign and other ones that are very bad.

Mixed tumors
Single germ cell tumors:
Derived from one germ cell layer that differentiates into more than one
cell type.
Example: Mixed tumor of Salivary Gland composed of epithelial and
stromal cells (or CT) and both are considered parenchymal cells
“Pleomorphic adenoma of salivary gland” it is a benign mixed tumor and
it is common in Parotid gland.
Other example is Fibroadenoma of breast which is a small discrete mass
in young ladies freely mobile that can move in the breast “breast
mouse”, not fixed to surrounding tissue which is good point.
It is a benign tumor composed of epithelial cells + stromal cells (or CT).
More than one germ layer:

Teratomas: tumour made of a variety of parenchymal cell types that

are derived from more than one germ cell layer formed by totipotential
germ cells that are able to form ectoderm, endoderm& mesoderm
This teratoma can contain any mature or immature component, i.e. may
contain: teeth, skin, respiratory epithelium, bone cartilage, sebaceous &
mucus glands, hair, glial tissue and neuroepithelium (even mature or
immature) in teratoma.

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*Might be benign or malignant depending on structure, site, age, sex…
Usual location is ovary or testis.

Respiratory epithelium tissue

Stratified squamous epithelium

Sebaceous Glands
Bone + bone marrow

Tumors of primitive (immature) fetal origin:

*Blastoma: from immature tissue
May arise in kidney, liver, retina…etc
e.g. * Nephroblastoma* Retinoblastoma *hepatoblastoma
The great majority of these tumors are malignant & occur in infants &
children
Some tumors have names that do not conform to general rules:
Melanomas arise from nevus cells
Seminomas arise from testicular germ cells
Lymphomas arise from lymph nodes
Some tumors are named eponymously
e.g. Hodgkin lymphoma, Wilms’ tumor….etc.
Note: See table on page 164

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Some ‘tumors’ are NOT true neoplasms:
Hamartoma: (Tumor-like) develop malformation in which there is
abnormal mixing of normal components of the tissue in the organ, either
in the form of change in quantity or arrangement of tissue elements.
e.g. Lung Hamartoma: mass in which the dominant part is cartilage,

Choristoma:
Congenital anomaly where different types of tissue grow ectopic to the
region.
For example: gastric tissue in small intestines (Meckle’s Diverticulum)
Or pancreatic tissue in the stomach called pancreatic heterotopia (or
ectopic pancreatic tissue)
These 2 types can cause some problems like ulceration but both
hamartoma & choristoma Do Not become malignant.

‫في الختام أتمنى ان ينال هذا المجهود على إعجابكم وأعتذر أشد اإلعتذار‬
‫عن أي تقصير أو خطأ قد بدر مني‬
‫اي مالحظة على التفريغ ال تتردد بالتواصل معي‬
‫ معاذ عبيدات‬:‫زميلكم‬

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