MORPHOLOGY OF BENIGN AND

MALIGNANT EPITHELIAL TUMORS

Lab 7- 8
Epithelial Tumors
BENIGN EPITHELIAL TUMORS
Macroscopy:
•Papilloma - skin
•Condyloma acuminatum
•Adenomatous polyposis coli
•Adenoma (breast fibroadenoma, adenoma of
thyroid gland, cystadenoma of ovary)
Microscopy:
•Squamous papilloma - skin
•Tubulo-villous adenomatous polyp - colon
•Fibroadenoma – breast
•Adenoma of thyroid gland
MALIGNANT EPITHELIAL TUMORS
• Microscopy: microscopic features of cancer cell.
• MORPHOLOGY OF CARCINOMAS
• SQUAMOUS CELL CARCINOMA
• Macroscopy:
• Ulcerated basal cell carcinoma - ulcus rodens
• Vegetative and ulcerated squamous cell carcinoma of the lip
• Microscopy:
• Keratinized squamous cell carcinoma (differentiated)
• Basal cell carcinoma
• ADENOCARCINOMAS
• Macroscopy:
• Vegetative carcinoma - stomach, cecum
• Ulcerated carcinoma - stomach
• Ulcerative and vegetative carcinoma - cecum
• Infiltrative carcinoma - stomach, colon
• Primary nodular carcinoma - lung, liver
• Visceral metastases (secondary cancer) - lung, liver
• Breast cancer
• Microscopy:
• Moderately differentiated adenocarcinoma - colon
• Metastatic adenocarcinoma - lymph node
• Metastatic squamous cell carcinoma - lymph node
 Morfology of neoplasms
• Abnormal tissue proliferation
• non concordant with nearby tissue
• persistent and continuous proliferation after the ceasing of
the stimulus inducing it
• Tumor classification
• histogenesis criterion
• epithelial
• mesenchymal
• clinical - biological criterion
• benign
• malignant
Tumor structure

- 2 components:
(a) parenchyma-is the mass of neoplastic cells
(b) stroma consists of:
• connective tissue with role of support
• vessels with nutrient role - ensures the
development of cancer cells
 Features of the tumors
Criterion Benign tumor Malignant tumor

Cytological Well differentiated Undifferentiated (anaplastic)-

features lack of cell differentiation

Rate of growth Slow growth-Well Rapid growth-Bad demarcated

demarcated
Local invasion No invasion Local invasive

Metastasis Absent Present

EPITHELIAL TUMORS
• Origin - epithelial tissues
Nomenclature
• Benign Epithelial tumor (BET) - suffix – oma added to cell
of origin
• adenoma: tumor forming glands
• papilloma: tumor with papillary structure or finger like
projections
• Malignant Epithelial tumors (MET) = carcinomas
• Squamous cell carcinomas- squamous cell origin
• Adenocarcinomas: MET forming glands
Benign epithelial tumors
Lab 7- 8
 Benign epithelial tumors
• Origin
• in epithelial tissues
• Types
• Papilloma
• benign epithelial tumor formed by papillary
structures composed of proliferated epithelium
disposed on a connective-vascular axes.
• Adenoma
• benign epithelial tumors originating in the glandular
epithelium of cavity organs and exocrine or
endocrine parenchyma.
Squamocellular papilloma– skin

Gross: vegetative tumor

projecting on the skin
surface
• large basis and short
pedicle of attachment
• irregular surface
• skin color
Condylloma accuminatum

• Origin in epidermoid mucosa

• Location - frequently in the perianal
region
• Causative agent-human papilloma
virus (HPV).

Gross
• the vegetative tumor consists of
bouquets, looking like a cauliflower
lesion
 Squamocellular papilloma – skin
• origin – epidermis
• vegetative tumor
• structure
• proliferated squamocellular
epithelium with normal
structure and preserved
stratification (basal,
squamous, granular,
keratin layers);
• connective-vascular axis
with role of support and
nutrient roll
• intact basement membrane
Squamocellular papilloma – skin

HE
- prominent vegetated tumors of the skin
- tumor proliferations of epidermis are disposed on connective-
vascular axes with role of support and nutrition
- intact basement membrane
Squamous cell papiloma - skin
• The proliferated epidermis
keeps the normal
stratification:
• many basal layers
 many squamous layers
(acanthosis)
 many granular layers -
hypergranulosis
• many keratin layers
(hyperkeratosis)
UROTHELIAL PAPILLOMA

• Vegetative tumor
• Short and large basis
• Irregular surface
• Location: renal pelvis
 Adenoma
• Adenoma is a BET with origin in glandular epithelium:
• proliferation of glandular epithelium from cavity or parenchymal
exocrine and endocrine organs
• Classification: 3 types of adenomas (after macroscopic appearance
and place of origin):
• adenomas developed from glandular parenchyma
• macroscopic appearance of nodule enclosed in parenchymal
tissue solid adenomas
• adenomas developed in cavity organs
• macroscopic appearance of polyp (pedunculated nodule) or
adenomatous polyp
• ovary adenomas have cyst appearances
• ovarian cystadenomas
Colonic adenomatous polyp

Gross – vegetative tumor

• short base of implantation
• long and thin pedicle
• nodular or globular
extremity (bell
appearance).
Adenomatous polyps - FAMILY
ADENOMATOUS POLYPOSIS

• BET originating in the

colonic epithelium

Gross:
• Multiple pedunculated
polyps (> 100)
• Variable dimensions <1cm

! Malignant transformation
 Tubulo-villous adenomatous polyp
• Vegetative tumor (BET)
resulting from the
proliferation of the colonic
epithelium
• The tumor is composed from
villi sustained by a
branching connective-
vascular axis
 With role of support and
nutrition
 Contains numerous
glands limited by a
dysplastic epithelium
• The muscularis mucosae is
intact
 Fibro-adenoma of mammary glands
• Mixed tumor, hormono-dependent
(hyperestrogenism).

• Only the connective component is

monoclonal, so neoplastic.
• Epithelial proliferation is reactive, no-
neoplastic.
Gross:
• nodular solid
• encapsulated
• small (1-2 cm) tumor.
Fibro-adenoma of mammary glands
Microscopy
- nodular, encapsulated tumor
included in breast glandular
parenchyma.
- FA is composed of 2 elements:
(a) epithelial component - tubular
elements lined by a similar
epithelium with ductal
epithelium;
(b) mesenchymal component -
proliferate fibroblasts.

HE
Breast fibroadenoma
• There are two histologic
variants:
 pericanalicular – the
fibroblasts proliferate around
the duct lumens keeping the
lumen opened
 intracanalicular – fibroblasts
proliferate and compress the
duct lumens which have a
slit-like appearance
• The two histologic types can
coexist in the same tumor
 Thyroid glandular adenoma

• Origin: follicular epithelial cells

• Gross: solitary, round, reddish-
brown nodule with calcifications
delimited by a fibrous capsule
• Mostly dysfunctional; rarely
produces thyroid hormones (toxic
adenoma) - clinical presentation:
thyrotoxicosis
 Thyroid glandular adenoma

HE HE

Origin: follicular epithelium • Nodular tumor delimited by the adjacent parenchyma

Encapsulated nodule through a fibrous capsule
• Similar histological thyroid structure
• Tumor cells form follicles of various sizes containing
colloid
 SEROUS OVARY
CYSTADENOMA
• Benign tumor originating in the
coelom epithelium of the ovarian
surface
• Gross
• Large, multicyst tumor, with
thin smooth walls
• The tumor cavity contains a
serous fluid; the secretion is
produced by the epithelial cells
lining the cyst wall.
 MUCINOUS OVARY
CYSTADENOMA
• Benign tumor originating in the coelom
epithelium of the ovarian surface
Gross:
• mainly, large, solitary cyst;
• thin-walled tumor
• tumor cavity contains a mucous, gelatinous
fluid; the secretion is produced by epithelial
cells lining the cyst wall
Malignant epithelial tumors
Lab 8
 Carcinomas
• They are malignant tumors derived from epithelial tissues.
• Histogenetic classification: two major categories:
 Epidermoid carcinoma / Squamocelullar Carcinoma with origin in:
 Epidermis
 Epidermoid mucosa
 Epidermoid metaplasia
 Adenocarcinoma with origin in the glandular epithelia of cavity organs and endocrine
and exocrine parenchyma
• After degree of differentiation of the tumor cells are of four main types:
 Differentiated
 Moderate differentiated
 Poor differentiated
 Undifferentiated / anaplastic
 Anaplasia = total loss of differentiation
Morphology of malignant cells
• Cellular and nuclear
abnormalities:
• Cellular and nuclear
pleomorphism
• Various cellular and nuclear size
• The change of
nucleo/cytoplasmic ratio
(1/41/1)
• Nuclear hypercromasia
• Single or multiple nucleoli
• Atypical mitoses
 Keratinized epidermoid
carcinoma – skin /
cutaneous squamous cell
carcinoma
• Is an ulcero-vegative
malignant tumor with
origin in epidermis
• The tumor cells destroy the
basal membrane and
infiltrate the connective
tissue of the dermis

HE
 Keratinized epidermoid carcinoma – skin /
Cutaneous squamous cell carcinoma
• Islands of polygonal
atypical cells, that resemble
the stratum spinosum of the
epidermis, are separated by
a reduced connective
stroma
• By differentiation, the
tumoral cells fill with
keratin disposed as
concentric lamellae (keratin
pearls or globes) HE

HE
WD squamous cell carcinoma

Microscopy:
•Destroyed basal membrane
•Invasive tumor, forming nests or
islands of polygonal atypical cells,
which synthesis keratin, as central,
concentric globes, called keratin
pearls
•Stroma contains a reduced
inflammatory infiltrate

HE
Basal cell carcinoma

HE HE
 Basocellular
carcinoma

•Is a particular form of

cutaneous carcinoma
• Origin: basal layer of
epidermis and appendix
glands
• The tumor destroys the
basal membrane and
infiltrate the connective
tissue of the dermis
Basal cell carcinoma

• The invasive tumor is

composed of tumor islands
separated by a reduced
stroma
•The tumor islands are
composed of tumor cells
resembling with basal layer
cells having a characteristic
disposition:
 in palisade at periphery
 disordered appearance
in the center of the tumor
islands
 Adenocarcinomas
• Gross: macroscopic appearance varies
according to the tumor site:
• tumor located in cavity organs
(stomach, colon) presents 3
appearances:
• vegetative carcinoma
• ulcerative carcinoma
• infiltrative carcinoma
• tumor located in parenchymal
organs (liver, lung) presents 2
appearances :
• nodular carcinoma
• Infiltrative / diffuse carcinoma

MET-origin in glandular epithelium of cavity organs (stomach, etc) or parenchymal organs (lung, liver).
Colonic / cecum
vegetative carcinoma

Gross: vegetative carcinoma

•cauliflower tumor mass, with
large basis and irregular
surface;
Colonic / cecum
ulcerative carcinoma

Gross: ulcerative carcinoma

•Crater like ulcer, with broad,
deep basis and raised edges
consisting of tumor tissue;
Colonic / cecum
infiltrative carcinoma

Gross - infiltrative carcinoma

• The tumor infiltrates
circumferentially entire
wall, causing wall thickening
and narrowing of the lumen
(stenosis);
Infiltrative carcinoma of the rectum
and anal channel

• The tumor infiltrates the wall of

the rectum and anal channel
• The wall thickening and lumen
reduction
Adenocarcinoma of the colon

HE HE
Well differentiated adenocarcinoma of the colon
• The tumor has origin
in glandular
epithelium of the
colon.
• The tumor
penetrates the
muscularis mucosae
and infiltrates the
submucosa and
muscular layer.
 Well differentiated
adenocarcinoma of colon

• The tumor is composed

from:
 Tubular elements
separated by a reduced
stroma (back to back
tumor glands).
 The tumor glands are
lined by an atypical
epithelium disposed on
one or multiple layers
with an irregular lumen.
GASTRIC CARCINOMA
MET originating in gastric mucosal epithelium

Gross - vegetative carcinoma:

•cauliflower tumor mass, with
large basis and irregular surface
+/- areas of necrosis and
hemorrhage
GASTRIC CARCINOMA
MET originating in gastric mucosal epithelium

Gross
•ulcerative carcinoma: crater like
ulcer, with broad and deep basis, and
raised edges consisting of tumor
tissue
•tumor basis is covered by necrotic
detritus

•DD: chronic peptic ulcer

GASTRIC CARCINOMA
MET originating in gastric mucosal epithelium

Gross - infiltrative carcinoma

•the tumor infiltrates entire gastric
wall, causing the wall thickening and
the narrowing of the lumen
(stenosis);
•the gastric mucosa has flattened
folds
•partial or total involvement of the
gastric wall
PRIMARY HEPATIC CARCINOMA –
Solitary nodul
MET arising from hepatocytes

Gross - nodular carcinoma:

•nodular, large tumor
•imprecise edges due to invasive
feature;
•central necrotic area
PRIMARY HEPATIC CARCINOMA
MET arising from hepatocytes

Gross infiltrative carcinoma

•diffuse tumor replacing
gradually the liver tissue
•irregular in shape tumor
•destroyed liver has no
vascular spaces within the
tumor area
PRIMARY HEPATIC CARCINOMA
multinodular tumor
MET arising of
hepatocytes

Gross
Multinodular
tumor arising on
cirrhotic liver
PRIMARY LUNG CARCINOMA –
Nodular tumor
MET- Origin: bronchiolar-alveolar epithelium

Gross - nodular carcinoma

•peripheral tumor

•nodular, large tumor, with imprecise edges

due to invasive feature
•central necrotic area
PRIMARY LUNG CARCINOMA –
Infiltrative tumor
MET-Origin: bronchi epithelium od 2nd or 3rd degree

Gross - Infiltrative carcinoma:

•central / hilar tumor

•diffuse tumor infiltrating and

replacing gradually the bronchial
wall (thick) and adjacent lung
tissue (irregular edges) reaching
the pleural surface.
BREAST INVASIVE CARCINOMA
Gross: Infiltrative carcinoma:
•solid, whitish-gray tumor
•imprecisely delimited tumor
•infiltrates the parenchyma of the
mammary gland
•can reach the pectoralis muscle
•can give nipple retraction
•skin has the appearance of
"orange peel" (lymphedema,
secondary to infiltration of the
lymphatic vessels)
Liver metastases
 Liver metastases
• Secondary tumor

• Origin: any primary

malignancy

Macroscopy
• Liver has an increased
volume;
• many nodular, well
defined, no encapsulated
tumors
Lung metastases
• Secondary tumor
• Origin: any primary
malignancy
Macroscopy
• many nodular, well
defined tumors of
various sizes involving
one or both lungs
Lymph node metastasis of adenocarcinoma

HE HE
 Lymph node metastasis of adenocarcinoma
Microscopy
Tumor cells
•reached the lymph
node by lymphatic
way
•colonized the
subcapsular sinus
•invaded the entire
lymph node, where
they form tumor
glands limited by an
atypical epithelium
Lymph node metastasis of squamous cell carcinoma

HE HE
 Lymph node metastasis of squamous cell carcinoma
Microscopy:
•The tumor cells enter within the
subcapsular sinus
•Inside of LN, tumor cells invade the
entire LN mass and form islands of
atypical polygonal cells with epithelial
appearance
•In well-differentiated tumor, tumor
cells are centered by “keratin globes" /
" keratin pearls"
•LN= Lymph node
HE