Neoplasia I

Prof Alfred Lam

Pathology
Summary
•Nomenclature
•Classification
•Concepts
•Spread of tumour
•Clinical effects of
tumour
Neoplasm - definition

 "An abnormal mass of tissue, the growth of

which exceeds and is uncoordinated with that
of the normal tissues and persists in the same
excessive manner after cessation of the stimuli
which evoked the change."
Dysplasia
 Dysplasia is a morphological term used to
describe disorderly proliferation.
 It signifies the early steps of progression in
carcinogenesis.
 Dysplasia is encountered principally in the
epithelia.
 It is a loss in the uniformity of the individual
cells as well as a loss in their architectural
orientation.
Dysplasia
 There are varying degrees of severity from
mild to severe dysplasia, the end of the
spectrum is considered a pre-invasive
neoplasm and is referred to as carcinoma-in-
situ.
 Mild to moderate dysplasia may be reversible
with the removal of the putative inciting
causes.
 Dysplasia may precede the development of
carcinoma for many years, and may not
necessarily progress to carcinoma.
Dysplasia

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Dysplasia
Classification
 1. histogenetic differentiation
Epithelia
Connective tissue
Lymphoid
melanocyte
Others
 2. clinical behaviour
Benign vs
Malignant vs
Borderline (undetermined malignant potential)
Biological behaviour
 The only criteria that differentiate malignant
from benign tumour is the presence of
metastastic disease
 However, there are certain criteria to
differentiate benign from malignant tumours
 In some cases, the differentiation is not easy
or not possible and borderline category exists
Benign tumour - fibroma
Benign tumour – schwannoma (nerve sheath
tumour)

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Malignant tumour – basal cell carcinoma

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Basal cell carcinoma in parotid gland

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Note the infiltrative pattern

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Note the mitosis

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Malignant tumour – atypical mitosis in carcinoma
Examples of tumour classification
differentiation benign malignant

Epithelium Adenoma carcinoma

Lymphoid - Lymphoma
Smooth muscle Leiomyoma Leiomyosarcoma

Blood vessel Haemangioma Angiosarcoma

Nerve Neuroma Malignant peripheral

nerve sheath tumour
Fat Lipoma Liposarcoma
Melanocytes naevus melanoma
Tumour subtypes
 Different types of cancer of similar
histogenesis have different biological
behaviour
 Squamous cell carcinoma
 Adenocarcinoma
 Small cell carcinoma
 Neuroendocrine carcinoma
 Others
Oral squamous cell carcinoma

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Oral squamous cell carcinoma

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Adenocarcinoma -subtype – adenoid cystic
carcinoma in oral cavity

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Small cell carcinoma
Merkel cell carcinoma of cheek

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Melanoma
Oral melanoma

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Metastatic melanoma in salivary gland

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Spread of tumour
 Local invasion
 Metastasis
a) By lymphatics
b) By blood
 Transcoelomic spread
 Implantation
Direct spread
 Angiogenesis
 Loss of adhesion of tumour cells to each other
 Adhesion of malignant cells to basement
membranes and extracellular matrix
 Lysis of basement and interstitial stroma
matrix
 Active movement of malignant cells
 Changes in extracellular matrix
 Survival of host immune attack
Metastasis
 Definition: a growing colony established at a
point distant from the primary tumour with no
continuity between primary and new deposit
 Mechanism of enter the blood or lymphatic:
liberation of cells from primary tumour
invasion of blood or lymphatics
transfer of tumour cells as emboli to a distant
site
Lymphatic spread
 Invasion of lymphatic channels at early stage
of the infiltrative process is a characteristic of
carcinomas (sarcoma invade small vessels)
 Invasion of lymphatic may be easier because
of a lack of type IV collagen and lamin in their
basement membrane.
metastatic lymph node
Blood spread
 Invading new vessels or by invading host
vessels near the growing edge of the tumour
 The new vessels have a defective basement
membrane and may lack normal perivascular
connective tissue
 Sarcoma often have large irregular blood-filled
channels, the linings of which are entirely or
partly composed of malignant cells which can
be shed into the lumen
 Vascular endothelial growth factor (VEGF)

key mediator of tumour-associated neo-angiogenesis and progression

Metastatic nodules in liver
Transcoelomic spread
 Invasion of serosal lining of an organ by
malignant cells
 The tumour cells become detached, float in
the fluid portion of the exudate and settle in
the walls of the cavity at a distant site
 Common seen in peritoneal cavity associated
with cancer of the stomach, colon or ovary
Clinical parameters for cancer
 Diagnosis – histological subtypes
 Grading
well / moderate / poor – differentiated
carcinoma
low grade or high grade sarcoma
 Staging (TNM)
 Others: resection margins
clinical status of patients
Staging
 T (tumour) extent of the primary tumour) –
size of tumour or depth of the tumour invasion
 N (lymph node) lymph nodes metastases)
 M (metastases) distant metastases)

Most important clinicopathological parameter

affecting the prognosis of patient
Effect of neoplasms on the host

 Local effect
 Local and distant spread
 Systemic manifestations
Local effect

 Mechanical pressure or obstruction

 Destruction of tissue
 Haemorrhage and anaemia
 Infection
Systemic manifestations
(paraneoplastic manifestations)
 Fever
 Cachexia
 Depression of immune system
 Hematological
 Endocrine effects
 Osseous and soft tissue changes
 Cutaneous manifestations
Take home massage
How to classify tumour
How to differentiate benign from
malignant tumour
What are the common types of cancer
How the cancer spread
What are the stages of cancer

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