INTRODUCTION TO

NEOPLASIA

Salvador J. Diaz-Cano
s.j.diaz-cano@qmul.ac.uk
Nomenclature of various growth
processes (“Plasias”)

• Hyperplasia
• Metaplasia
• Dysplasia
• Neoplasia
• Desmoplasia
 Metaplasia
an adaptive substitution of one type of adult tissue to
another type of adult tissue
under stress a more vulnerable type of tissue will be
replaced by another more capable of withstanding
stress
 Dysplasia
An abnormality in cell size, appearance,
with or without a disorganized growth
pattern
 Neoplasia
A disease of cells characterized by alteration of normal growth
regulatory mechanisms
 Desmoplasia
The formation and proliferation of connective
tissue in response to neoplastic growth
 Neoplastic progression
• Benign or malignant neoplasms can
acquire increasingly aggressive features
• Most malignant neoplasms arise de novo
• Some malignant neoplasms are thought
to be preceded by preneoplastic
conditions
 Definitions
Neoplasm - (new growth) abnormal mass of
tissue, the growth of which exceeds and is
uncoordinated with the normal tissues
Tumor - a non-specific term meaning lump or
swelling. Often syn. for neoplasm
Cancer - any malignant neoplasm or tumor
Metastasis - discontinuous spread of a
malignant neoplasm to distant sites
 Cancer (L. Crab)
• Any malignant growth of cells (clonal)
• Second most common cause of death in US
• One in 3 Americans will die of cancer

Gross features Microscopic features

 Classification - Approach

Terminology which is used to describe a mass is

based on the clinical, gross and microscopic
features-which in combination are a reflection
of the predicted/expected biologic behavior

Benign
? Malignant
 Classification Criteria

• Growth Characteristics
• Rate of Proliferation and Cell Death
• Differentiation
• Metastasis
 Classification Criteria and
Associated Biologic Behavior
Characteristics Benign Malignant

Growth pattern expansive infiltrative

rate of slow fast

growth

differentiation nl, good atypical, poor

metastasis absent typical

 Growth pattern
Benign Malignant
Rate of Growth

Rapid
 Classification - Differentiation

• According to biologic behavior and

histogenesis or cellular features
– Benign
• Adenoma - benign epithelial neoplasm
• Lipoma -benign mesenchymal neoplasm
– Malignant
• CARCINOMA - malignant epithelial neoplasm
• SARCOMA - malignant mesenchymal neoplasm
• LYMPHOMA/LEUKEMIA - malignant neoplasm of
lymphoid cells
 Classification According to
behavior
Fibroadenoma Adenocarcinoma
 Classification According to
Cellular Features
Squamous-
Eosinophillic (pink)
abundant cytoplasm
Normal epithelium
Keratin, keratin pearl
Hyperchromatic
(dark) nucleus

Lack of differentiation

Intercellular clear spaces

Squamous cell carcinoma

Lung Cancer

x-ray Squamous carcinoma

 Classification According to
Cellular Features
Adenocarcinoma Normal

Gland-like spaces
Mucin production,
secretory activity
 Colon Cancer

X-ray Gross Microscopic

Classification According to
Cellular Features
Lymphoma
 Classification According to
Cellular Features

Recapitulation of
normal features
Differentiation
along
mesenchymal
pathways

Osteogenic sarcoma
 Invasion and Metastasis
• Characteristics that are unique to
malignant neoplasms (cancer)
• The major cause of morbidity and
mortality
 Invasion
• Associated with activated motility and
local tissue independence in vitro
• Balance between tissue destruction and
synthesis
• Cell surface and extracellular matrix
play important roles
 Metastasis
• Require acquisition of additional tumor
characteristics beyond those necessary
for invasion
• Multiple lesions
• Organ specificity
 Metastasis

Mechanisms of Spread:
•Hematogenous
•Lymphatics
 Other mechanisms of spread
• Direct extension
• Seeding
• Surgical or procedural transplantation
(iatrogenic)
 Prognosis
• Prediction of Outcome
– Criteria are different for each cancer type
– Grade, stage, histology routine criteria
– Patient characteristics are important
– Treatment considerations critical
 Prognostic Factors
• Grade
• Stage
• Tumor type
• Biomarkers (slide based and molecular
techniques)
 Cancer Grade
• Alternate term “tumor grade”
• Based on microscopic features
(cytology or histology)

low grade moderate high

 Cancer Stage
• Reflects degree of spread, for an individual
cancer patient
• Assigned at the time of diagnosis, may be
updated as patient progresses
T Tumor characteristics
N Nodal involvement
M Metastasis
 Morbidity and Mortality
• Metastases
• Rupture into major vessels, structure
• Starvation
• Infection
• Compression of vital organs
• Organ failure
 Summary
• Cancer is synonymous with malignant
neoplasia
• Precursor/precancerous lesions exist
• Invasion and metastasis are the hallmark of
malignancy
• Cancer typing and subtyping is pre-requisite
for patient treatment