Neoplasia

 Cancer is one of the leading cause of death

worldwide.
 Emotional and physical suffering by the
patient.
 Different mortality rate …..
Some are curable
Others are fatal
 Neoplasia: Facts and Figures

 Recently there has been a decline in cancer

mortality but the problem is still mammoth
 With many forms of malignancy, most notably the
leukemias and lymphomas, there are now
dramatic improvements in the 5 year survival
rates
 Today a greater proportion of cancers are being
cured or arrested than ever before
 Neoplasia
 Neoplasia = new growth
 Neoplasm = tumor = swelling
 Definition:
 A mass of tissue formed as a result of abnormal,
excessive, uncoordinated, autonomous and purposeless
proliferation of cells which continues even after cessation
of stimulus which caused it’. The branch
of science dealing with the study of neoplasms or tumours
is called oncology (oncos=tumour, logos=study).
 Different from hyperplasia, metaplasia and dysplasia.
Neoplasia
 In neoplasia proliferation, differentiation
and organisation are all disturbed

Proliferation: a neoplasm is
characterized by partial or complete loss of
regulation of mitosis and cell maturation
Differentiation reduction or deletion of
the specialized function of the cells
Organization loss of the morphologic
tissue and organ characteristics.
 Neoplasia
 All tumors have two basic components:
Parechyma: made up of neoplastic cells
Stroma: made up of non-neoplastic, host-
derived connective tissue and blood vessels

:The parenchyma :The stroma

Determines the Carries the blood
biological behavior of supply Provides
the tumor from which support for the growth
the tumor derives its of the parenchyma
name
 Classification of neoplasms
According to their clinical behaviour into:
 Benign tumours, which usually grow slowly and
do not interfere with the person's well being or
shorten his life, unless the tumour encroaches on
a vital organ e.g. the brain or produces harmful
substances e.g. excess hormones.
 Malignant tumours generally are more rapidly
growing, destroy and infiltrate the normal
structures and unless effectively treated interfere
with health and eventually cause death.
Classification of tumours

1. Benign:
 Epithelial
 Mesenchymal
 Germ cell tumours

2. Malignant:
 Epithelial
 Mesenchymal
 Germ cell tumours
 Neoplasia
 Epithelial benign tumors are classified on the basis of :
The cell of origin & Microscopic pattern
Adenoma : benign epithelial neoplasms producing
gland pattern….OR … derived from glands but not
necessarily exhibiting gland pattern
Papilloma : benign epithelial neoplasms growing on
any surface that produce microscopic or macroscopic
finger-like pattern
Polyp : a mass that projects above a mucosal surface
to form a macroscopically visible structure.
e.g. - colonic polyp - nasal polyp


Adenoma Papilloma
Polyp
 Neoplasia
 Malignant tumors
Malignant tumor arising in mesenchymal tissue :
SARCOMA
○ From fibrous tissue: Fibrosarcoma
○ From bone : Osteosarcoma
○ From cartilage : chondrosarcoma

Malignant tumors arising from epithelial origin :

CARCINOMA
Squamous cell carcinoma
Renal cell adenocarcinoma
cholangiocarcinoma
Osteosarcoma
 Neoplasia
 Melanoma ( skin )
 Mesothelioma (mesothelium )
 Seminoma ( testis )
 Lymphoma ( lymphoid tissue )
 Hodgkin’s disease
 Burkitt tumor
 Ewing tumor
 Kaposi sarcoma
 Wilm’ tumor
 Grawit’z tumor
 Neoplasia nomenclature
”…historic eponyms – “first described by -
Hodgkin’s Malignant lymphoma (HL) of B Ly cell origin
disease
Burkitt tumor NHL – B Ly cell in children (jaw and GIT)

Ewing tumor Bone tumor (PNET)

Grawitz tumor Kidney tumor - clear cell adenocarcinoma

Kaposi sarcoma Malignant tumor derived from vascular epithelium

(AIDS)
Brenner tumor Ovarian tumor derived from Brenner cells

Askin tumor Malignant chest wall tumor of PNET

Merkel tumor Skin tumor derived from Merkel cell

C- Tumours derived from more than one germ layer
(from totipotential cells)

Teratoma (mature)
Immature teratoma
 Characterization of benign
and malignant tumours

1- Capsulation

 Benign tumours grow by expansion leading to

pressure atrophy of the surrounding tissue with
formation of a fibrous capsule. Though not all
benign tumours are encapsulated, but there is
always a plane of cleavage around the tumours.
 Malignant tumours grow by an infiltrative
manner that destroys and penetrates the
surrounding tissue; they do not develop a
capsule. The infiltration tends to occur in
anatomic planes of cleavage
Comparison between a benign tumor of the myometrium
(leiomyoma) and a malignant tumor of similar origin
(leiomyosarcoma).
Benign tumor

Capsule
Uterine leiomyoma
Malignant tumor
Malignant tumor
 2- Differentiation and anaplasia

 Differentiation refers to the extent to which the

tumour cells resemble their normal counterpart,
both morphologically and functionally

 Benign neoplasms are composed of well-

differentiated cells that resemble very closely
their normal counterpart e.g. lipoma. Mitoses
are extremely scant in number and are normal
in configuration.
Follicular adenoma thyroid
 Malignant tumours are characterized by a
wide range of parenchymal differentiation
from surprisingly well-differentiated to those
completely undifferentiated.
Well differentiated adenocarcinoma colon
Poorly differentiated carcinoma
Lipoma
Fibroadenoma
Teratoma
 Anaplasia:
Definition
It implies dedifferentiation or loss of
structural and functional differentiation of
normal cells. e.g. Malignant tumours,
formed of undifferentiated cells are called
anaplastic tumours. Anaplasia is a marker of
cancer.
 Well-differentiated tumours, whether benign or
malignant, tend to retain the functional
characteristics of their counterparts such as the
production of hormones in tumours of endocrine
origin or keratin in squamous epithelial tumours.
Anaplastic tumours have no specialized
functional activity.
 Behavior of tumors
Benign tumors: Malignant umors:
 are expansive,  are invasive,
compressing replacing adjacent
adjacent tissue tissue
 do not recur when  often recur even if
completely excised completely excised
 do not metastasize  may metastasize
 usually grow slowly  often grow quickly
 do not cause  may cause
cachexia cachexia
 Histologic and cytologic features
Benign: Malignant:
 Well-differentiated cells
 Poorly-differentiated (anaplasia)
 Uniform cell size and shape
 Variable size, shape (pleomorphism)
 Well-demarcated
 Poorly demarcated
 Encapsulated
 Unencapsulated
 Few mitotic figures
 Many mitotic figures
 Mitotic figures have bizarre shapes
 Mitotic figures normal morphology
 Variably sized nuclei, aneuploid
 Uniform nuclei, euploid
 Occasional multiple nuclei
 One nucleus per cell
 Numerous or large nucleoli
 Nucleolus single or not visible
 Invasion of lymphatics and veins
 Tumor not within vessels
 Areas of necrosis and hemorrhage
 Uniform appearance
 Epithelium invades past basement
 Epithelium arranged on basement membranes
membranes  Dense, abundant, fibrous supporting
 Orderly supporting stroma stroma (desmoplasia)
WHAT ARE HAMARTOMAS AND
CHORISTOMA?
They are distinguished from neoplasms by the fact
that they do not exhibit continued growth. they are
group of tumor-like tissue masses which may be
confused with neoplasms
 Hamartoma: are disorganized but benign masses
composed of cells indigenous to the involved
site. e.g. pulmonary hamartoma.
 Choristoma: is the term applied to a heterotopic
 rest of cells
e.g. pancreatic choristoma in liver or stomach.
Malformation and not neoplasm.
Pulmonary Hamartoma
Pancreatic choristoma in gall bladder