Departemen Patologi Anatomi Fakultas Kedokteran Usu MEDAN - 2020

Block Oncology (ON-K7)
(November 2020)
DEPARTEMEN PATOLOGI ANATOMI

FAKULTAS KEDOKTERAN USU
MEDAN - 2020
Understand the concepts of
cellular growth adaptations
2
Departemen Patologi Anatomi FK-USU-2015

HYPERTROPHY
 KEY FACTS
 Hypertrophy of
myocardium due to
hypertension
 Skeletal muscular
hypertrophy due to
exercise
3 Departemen Patologi Anatomi FK-USU-2015

HYPERPLASIA
 KEY FACTS
 Red-cell hyperplasia in
bone marrow
secondary to low
atmospheric oxygen
(living at high attitude)
 Hyperplasia of
epidermis & connective
tissue due to release of
GF to aid wound healing
 Uterine
hyperplasia/hypertroph
y secondary to hormonal
changes of pregnancy

METAPLASIA
WHY ?
7
SQUAMOUS METAPLASIA OF
8
ENDOCERVICAL GLANDS

10 NEOPLASIA
Define neoplasia
Departemen Patologi Anatomi FK-USU-

2015
Neoplasia
Neoplasia means ”new growth”
 Sir Rupert Willis (British)
An abnormal mass of tissue, the growth

exceeds, uncoordinated with the normal tissues
& persists excessive manner after cessation of
the stimuli which evoke the change

The growth of neoplastic cells
(contrast to normal cells) is :

Define other key words in study neoplasia

Oncology
From : oncos = "tumor" & logos = "study of"
Oncos (Greek term) = tumor (Latin)

Neoplasm's potential clinical behavior

If cells LOOK BAD, they are probably going to BEHAVE
17 BAD
If cells LOOK GOOD, they are probably going to BEHAVE GOOD
All tumors, benign & malignant,
have 2 basic components:

NOMENCLATURE

Benign Tumors
Colonic polyp
stalk
 Projecting into colonic
lumen

Malignant tumors
Nomenclature follows benign tumors, with certain additions

& exceptions
For example the terms :
Used for
malignant neoplasms

The other confusing terminology

Parenchymal cells neoplasm
(whether benign /malignant ?)
As though all derived from

a ‘single progenitor’
Tumor cells may divergent differentiation,

called mixed tumors
Example : mixed tumor of salivary gland

Mixed tumor of parotid gland
Contains epithelial cells forming ducts & myxoid stroma resembles cartilage

Dysplasia

Dysplasia
 Literally means abnormal growth
 Malignant transformation is a multistep process
 In dysplasia some but not all of the features of malignancy
are present, microscopically
 Dysplasia :
 May develop into malignancy
 Uterine cervix
 Colon polyps
 May NOT develop into malignancy
 Graded dysplasia as:
 Low-grade or high-grade
 HIGH grade often classified with carcinoma-in-situ
Spectrum of CIN: normal squamous epithelium for comparison; CIN I with koilocytotic atypia;
CIN II with progressive atypia in all layers of the epithelium; CIN III (carcinoma in situ) with
diffuse32
atypia and loss of maturation.
Anaplasia

“ANAPLASIA”
 Pleomorphism
 Size
 shape
 Abnormal nuclear morphology
 Hyperchromasia
 High nuclear cytoplasmic ratio
 Chromatin clumping
 Prominent nucleoli
 Mitoses
 Mitotic rate
 Location of mitoses
 Loss of polarity
ANAPLASTIC LARGE CELL
CARCINOMA OF LUNG

Anaplasia
Adult somatic cells are

Normal : differentiated, express genes tissue-
specific
Defined as lack of differentiation
Differ from
normal cells
Called
Atypical

Common features of anaplasia

39
Nothing is more important to the patient with

a tumor
than being told
"It is benign"

2015
Refer only to
Parenchymal cells transformed elements of

neoplasms
Differentiation Refers to : Extent to resemble their

parenchymal cells normal morphologically
& functionally

Stroma

Well-differentiated tumor
Leiomyoma of the uterus Adenoma thyroid
(Courtesy of Dr. Trace Worrell, University of Texas

Southwestern Medical School, Dallas, TX.)
Identical to normal smooth muscle Colloid-filled thyroid follicles

cells in myometrium

Malignant tumor (adenocarcinoma colon)
43
 Cancerous glands :
 Irregular (shape, size)
 Not resemble normal colonic glands
 Differentiated (gland formation +)
 Glands invaded muscular layer of

colon


2015
Anaplastic
44
Rhabdomyosarcoma Anaplastic Tumor
(Courtesy of Dr. Trace Worrell, University of Texas Southwestern Medical School, Dallas, TX.)
 Cellular & nuclear pleomorphism,  Cellular nuclear variation (size & shape),
hyperchromatic nuclei prominent cell
 Tumor giant cells  Center field : abnormal tripolar

Well-differentiated squamous cell carcinoma of skin
45
(Courtesy of Dr. Trace Worrell,

University of Texas Southwestern
Medical School, Dallas, TX.)
 Tumor cells similar to normal squamous epithelial cells

 With intercellular bridges & nests of keratin pearls (arrow)

Carcinoma in situ
46
A. Entire thickness of the epithelium is replaced by atypical dysplastic cells. There is no orderly differentiation of squamous cells.
The basement membrane is intact & no tumor in the subepithelial stroma
B. Failure of normal differentiation, marked nuclear and cellular pleomorphism, and numerous mitotic figures extending toward the
surface. The basement membrane (below) is not seen in this section.

Departemen Patologi Anatomi FK-USU-2015 47
Rate of growth of malignant tumors
Correlates in general with their level of differentiation
Rapidly growing tumors tend to be poorly differentiated
48
Wide variation in the rate of growth
49
2015
Rapidly growing malignant tumors often contain
central areas of ischemic necrosis
Because
Tumor blood supply (derived from host)

fails to keep pace with oxygen needs of the expanding mass of cells
Departemen Patologi Anatomi FK-

50 USU-2015
Schematic representation of tumor growth
51
 Cell population expands, progressively higher % tage of tumor cells leaves

‘replicative pool’ by reversion to G0, differentiation & death

Local Invasion
Benign neoplasm remains localized at its site of origin
Cancers grow by progressive :
The
surrounding
tissue

Invade the host tissues
53
Tumor cells secrete lytic enzymes
That :
Digest membranes & various components of

extracelluler matrix
”Matrix Metallo-
Proteinases”
The most important enzymes

Metastasis
54
Development of secondary implants (metastases)

discontinuous with the primary tumor
Multistep process

Not all cancers have equivalent ability to
metastasis

56
2015
57

Invasion of epithelial
basement membranes by
tumor cells
Invasion of the ECM is an active
process that requires 4 steps :
1.Detachment of tumor cells from

each other
2.Degradation of ECM
3.Attachment to novel ECM
components
4.Migration of tumor cells

Metastatic cascade
 Schematic illustration of
the sequential steps
involved in the
hematogenous spread of a
tumor

GRADING/STAGING
 GRADING:HOW
“DIFFERENTIATED” ARE THE
CELLS?
 STAGING:
HOW MUCH ANATOMIC
EXTENSION? TNM
 Whichone of the above do you think is
more important?

Features of Malignant Tumors
 Cellular features

Local invasion
 Capsule
 Basement membrane
 Metastasis
 Unequivocal sign of malignancy
 Seeding of body cavities
 Lymphatic
 Hematogenous

66 Selamat Belajar
Thank You

2015

Departemen Patologi Anatomi Fakultas Kedokteran Usu MEDAN - 2020

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Block Oncology (ON-K7)

DEPARTEMEN PATOLOGI ANATOMI

Departemen Patologi Anatomi FK-USU-2015

3 Departemen Patologi Anatomi FK-USU-2015

4 Departemen Patologi Anatomi FK-USU-2015

Departemen Patologi Anatomi FK-USU-2015

Departemen Patologi Anatomi FK-USU-

 Sir Rupert Willis (British)

An abnormal mass of tissue, the growth

11 Departemen Patologi Anatomi FK-USU-2015

12 Departemen Patologi Anatomi FK-USU-2015

13 Departemen Patologi Anatomi FK-USU-2015

Oncos (Greek term) = tumor (Latin)

14 Departemen Patologi Anatomi FK-USU-2015

15 Departemen Patologi Anatomi FK-USU-2015

19 Departemen Patologi Anatomi FK-USU-2015

20 Departemen Patologi Anatomi FK-USU-2015

22 Departemen Patologi Anatomi FK-USU-2015

Nomenclature follows benign tumors, with certain additions

For example the terms :

23 Departemen Patologi Anatomi FK-USU-2015

24 Departemen Patologi Anatomi FK-USU-2015

As though all derived from

Tumor cells may divergent differentiation,

Example : mixed tumor of salivary gland

25 Departemen Patologi Anatomi FK-USU-2015

26 Departemen Patologi Anatomi FK-USU-2015

27 Departemen Patologi Anatomi FK-USU-2015

34 Departemen Patologi Anatomi FK-USU-2015

36 Departemen Patologi Anatomi FK-USU-2015

Adult somatic cells are

Defined as lack of differentiation

37 Departemen Patologi Anatomi FK-USU-2015

38 Departemen Patologi Anatomi FK-USU-2015

Nothing is more important to the patient with

Departemen Patologi Anatomi FK-USU-

Parenchymal cells transformed elements of

Differentiation Refers to : Extent to resemble their

40 Departemen Patologi Anatomi FK-USU-2015

41 Departemen Patologi Anatomi FK-USU-2015

Leiomyoma of the uterus Adenoma thyroid

(Courtesy of Dr. Trace Worrell, University of Texas

Identical to normal smooth muscle Colloid-filled thyroid follicles

42 Departemen Patologi Anatomi FK-USU-2015

 Differentiated (gland formation +)

 Glands invaded muscular layer of

(Courtesy of Dr. Trace Worrell, University of Texas

Departemen Patologi Anatomi FK-USU-

Departemen Patologi Anatomi FK-USU-2015

(Courtesy of Dr. Trace Worrell,

 Tumor cells similar to normal squamous epithelial cells

Departemen Patologi Anatomi FK-USU-2015

Departemen Patologi Anatomi FK-USU-2015

Correlates in general with their level of differentiation

Rapidly growing tumors tend to be poorly differentiated

Tumor blood supply (derived from host)

Departemen Patologi Anatomi FK-

 Cell population expands, progressively higher % tage of tumor cells leaves

Departemen Patologi Anatomi FK-USU-2015

Benign neoplasm remains localized at its site of origin

Cancers grow by progressive :

52 Departemen Patologi Anatomi FK-USU-2015