Neoplasia

Background
The tumor is a common disease all over the world.
In many countries especially developed countries, malig-
nant tumor has become the first or second leading cause
of death.
The underlying causes include air pollution, pressure, ex-
cess weight, unhealthy lifestyle, ageing population and so
on.
Contents
Definition
Structure Characteristics of Tumors
Nomenclature
Differentiation and Anaplasia
Growth, Local Invasion and Metastasis
Difference Between Benign and Malignant tumors
Effects of Tumors on the Hosts
Precancerous Lesions, Dysplasia, and Carcinoma in
situ
Brief Introduction of Common Neoplasms
Definition of Neoplasm
A neoplasm is an abnormal mass of tissue, it’s growth
exceeds and is uncoordinated with that of the normal
tissue and persist in the same excessive manner after
cessation of the stimuli which evoke the change. (Dr.
RA Willis)
Definition of Neoplasm
At molecular level, neoplasm is disorder of growth
regulatory genes ( the activation of proto- oncogenes
and the inactivation of tumor suppressor genes ). It de-
velops in a multistep fashion, such that different neo-
plasms, even of the same histological type, may show
different genetic changes.
Features of Neoplasm
1. Excessive cellular proliferation;
2. Lack of responsiveness to control mechanisms;
3. Lack of dependence on the continued presence of the
stimulus.
Structure Characteristics of Tumors

The gross appearance of tumor is varied. It is

usually related to histogenesis, site and biologic
behavior.
Structure Characteristics of Tumors

Gross appearance of tumor-shape:

a. polypoid
b. papillary
c. nodular
d. lobulated
e. cystic
f. fungating
g. ulcerated
Structure Characteristics of Tumors
Color of tumor:
Hepatocellular carcinoma

lipoma
Structure Characteristics of Tumors
Two basic components of all the tumors:
1. Parenchyma – the parenchyma is made up of prolif-
erating neoplastic cells and largely determines the bi-
ologic behavior of the tumor. In addition, the classifi-
cation, nomenclature and histological diagnosis are
also made according to the parenchymal cells.
2. Supporting stroma – the supporting stroma is made
up of connective tissue, blood vessels, and possibly
lymphatics.
parenchyma

supporting stroma
Nomenclature
Basic principle:
Neoplasms are named according to binomial system de-
noting their histogenic origin of the parenchymal com-
ponent and the biologic behavior.
Nomenclature
Benign tumors: “ ~ oma”, e.g., fibroma; lipoma

Malignant tumors: “ ~ carcinoma, ~ sarcoma”

 thyroid adenoma colonic adenoma

leiomyoma of uterus fibroadenoma of breast

adenocarcinoma of colon Squamous cell carcinoma

heptocellular carcinoma osteosarcoma of bone

Differentiation and Anaplasia
What is neoplasm differentiation?
Neoplasm differentiation denotes the degree to which a
neoplasm cell resembles the normal mature cells of the
tissue both morphologically and functionally.
Differentiation and Anaplasia

Benign tumors are usually well differentiated. They

resemble closely their normal counterpart. Malignant
tumors, on the other hand, show variable degree of
differentiation. Malignant tumors that are composed of
undifferentiated cells are said to be “anaplastic”,that
means no morphological resemblance to normal tissue.
Differentiation and Anaplasia
What is anaplasia?
lack of differentiation; literally means
‘to form backward,’ implying a ‘reverse differentiation’
of mature normal cells. For cancers, it does not represent
reverse differentiation. It means lack of differentiation .
Growth, Local Invasion and Metastasis

Rate of growth and malignancy:

The growth rate of neoplastic cells varies greatly
and is one of its chief factors that serves to
distinguish benign from malignant.
In a general rule, the degree of malignancy of a
neoplasm is correlated with its growth rate: the
more rapid the growth, the more malignant the
neoplasm.
Growth, Local Invasion and Metastasis
Invasion ( Infiltration)
Nearly all benign tumors grow as cohesive expansile
masses that remain localized to their site of origin.
a. Benign tumors grow slowly and usually develop a fi-
brous capsule keeping the tumor as a discrete, readily
palpable and easily movable mass that can be excised.
b. When a benign tumor arises in a epithelial or mucosal
surface, the tumor grow away from the surface, often
forming a polypoid.
 Lipoma
Here is a benign lipoma on the serosal [si'rəusəl] surface of
the small intestine. It has the characteristics of a benign
neoplasm: it is well circumscribed, slow growing, and re-
sembles the tissue of origin (fat).
Growth, Local Invasion and Metastasis
Invasion ( Infiltration)
The growth of cancers, in contrast, is accompanied by in-
filtration, invasion, and destruction of the surrounding
tissue.
a. In general, malignant tumors are lack of a well defined
cleavage plane and usually exhibit local invasiveness or
infiltration that make it difficult to be excised.
b. Malignant tumors on epithelial or mucosa surface may
form a protrusion in the early stages, but eventually in-
vade the underlying normal tissue.
Squamous cell carcinoma of lung
Malignant neoplasms are also char-
acterized by the tendency to invade
surrounding tissues. Here, a lung
cancer is seen to be spreading
along the bronchi into the surround-
ing lung.
 hepatic adenoma hepatocellular carcinoma
Here is a small hepatic adenoma that shows how well-demar-
cated an benign neoplasm is.
In contrast, this hepatocellular carcinoma is not as well cir-
cumscribed (note the infiltration of tumor off to the lower
right) nor as uniform in consistency. It is also arising in a cir-
rhotic (nodular) liver.
Metastasis
What is metastasis of neoplasms?
Metastasis is to form a second neoplastic mass
through transfer of the neoplastic cells from the
first neoplasm to a distant site on separate from
the original tumor.
Metastasis
Routes of metastasis
1. Lymphatogenous metastasis- The most common
pathway for initial dissemination of carcinomas, but
sarcomas may also use this route.
2. Hematogenous metastasis- This route is typical of
sarcomas but is also seen with carcinoma..
3. Metastasis in body cavities ( seeding )- Direct
seeding of body cavities or surface (exfoliation and
implantation on peritoneum, pleura, subarachnoid)
Characteristics Benign Malignant
Differentiation Well differentiated Range from well differentiate to
undifferentiated
Rate of growth Slow growth over a period of Rapid growth, sometimes erratic
years
Type of growth Expansile Progressive infiltration, invasion,
and destruction of surrounding
tissue
Separated from Yes, has fibrous capsule com- Poorly separated
posed of stroma of native tis-
sue
Metastasis No Yes
Effect on host Often insignificant Significant, fever, anemia, infec-
tions, etc.
Recurrence Rare Often
Cell shape Monomorphic Pleomorphic Tumor giant cells
Nuclear chro- Normal Inreased, hyperchromatic; Pe-
matin ripheral clumping
Nucleoli Not prominent Prominent, irregular shape
Precancerous Lesions
What is precancerous lesions?
A premalignant or precancerous lesion is an
abnormality in a tissue area which is a just a step
away from cancer.
a. Not all precancerous lesions change to cancer, but
most have potential to become malignant.
b. It is important to recognize precancerous lesions
because surgical excision is curative.
Dysplasia
What is dysplasia?
Dysplasia is an abnormality of both differentiation and
maturation.
This term should be restricted to abnormalities of cell
growth with the characteristics as following:
a. Increased size of the nucleus, (absolute and relative to
the amount of cytoplasm)
b. Hyperchromatism
c. Abnormal chromatin distribution (coarse clumping)
d. Nuclear membrane is thickneng and wrinkling.
e. In squamous epithelium, mitotic figures appear in many
layers.
 Carcinoma in situ
What is carcinoma in situ?
The term carcinoma in situ refers to an epithelial
neoplasm exhibiting all the malignant cellular
features. But it has not yet invaded with
through the epithelial basement membranes
separating it from potential route of metastasis.

It is only at this very early stage the excision of the tumor will guarantee a cure.
So detection of carcinoma in situ is very important. In clinical practice, detec-
tion of carcinoma at the in situ stage, or detection of precancerous lesions is the
aim of population screening programs for cervical, breast and some other carci-
noma. Through these popular screening, many lives have been saved.
Thankyou