Cancer histopathology Flashcards
a) Common sites of cancer
b) Key feature of adenocarcinoma
c) Key feature of Squamous carcinoma
d) Key features of leukaemias/lymphomas
a) Lymph node, liver, colon, lung, cervix
b) Look for glands
c) Keratinising vs non-keratinising (keratin pearls/whorls)
d) High myelocytes vs lymphocytes. BCR-ABL. Bone marrow failure → immunosuppression → infection
Identify specimen and what’s happening
GLANDS (adenocarcinoma)
Commonly foind in breast, colon, lung, protstate (also oesophagus, pancreas, cervix)
Identify specimen and whats going on
KERATINISED SQUAMOUS CELL CARCINOMA
Keratin = skin
Metastasise to local lymph nodes and other organs (breast, cervix, oesophagus)
Identify specimen and what’s going on
Right - normal intestine
Left - Adenoma (benign precursor to cancer). VAriation in nuclei size, shape and chromatin staining (pleomorphism). NO INVASION
Identify specimen and what’s going on
Transition of benign polyp (adenoma) to malignancy
Disordered glandular structures - closely crowded columnar cells, many inflammatory cells
Shape - pleomorphic cells, many different forms and shapes
Nuclei - larger and hyperchromatic
Beginnign to invade into muscularis mucosae
Identify specimen and features A-E
Malignant adenocarcinoma
A - Normal mucosa, normal structure with crypts lined by normal epithelium
B - Adenocarcinoma, irregular malignant glandular epithelium invades underlying submucosa
C - Noramal muscularis propria, smooth muscle layer of GI wall
D - Malignant adenocarcinoma invading muscularis propria (pale areas are forming glandular structures)
E - Normal smooth muscle of intestine wall
Adenocarcinoma stage 3 vs stage 4
Stage 3 - very irregular glands with induced fibrotic stromal response around them, remnants of invaded parts of muscularis propria
Stage 4 - Deep edge of tumour is poorly differentiated and cells barely form glands, individual cells invade muscularis propria
Uterine leiomyoma vs leiomyosarcoma
Leiomyoma - benign, encapsulated, tumour has connective tissue capsule, little nuclear polymorphism, no mitotic figures
Leiomyosarcoma - malignant (although uncommon), invasion of smooth muscle of myometrial wall, nuclear enlargement, tumour giant cells, mitotic figures
Identify specimen and whats going on
Breast adenocarcinoma
Fatty areas at edge of specimen (top). Irregular, dense fibrous collagen at centre. Infrequent mitotic figures. Coarse chromatic. Mild nuclear pleomorphism
Identify specimen and what’s going on
Cervical Intraepithelial Neoplasia (CIN)
Pre-malignant neoplasia
Much nuclear pleomorphism. Neoplastic cells HAVEN’T broken through underlying basement membrane, so no invasion of adjacent stroma
Identify specimen and features A-D
Uterine cervix: squamous cell carcinoma of cervix
A - Lympahtic vessel that has been invaded (very likely to metastasise to local lymph nodes)
B - Invasive zone of squamous carcinoma
C - Large area of squamous carcinoma forming solid sheets and trabeculae of cancer cells
Identify images and what they show
Cervical smear tests
Left - normal smear. Superficial squamous cells have pink cytoplasm, intermediate cells have green/blue cytoplasm, both have small nuclei
Right - smear showing cervical intraepithelial neoplasia. Nuclei are hyperchromatic (dark staining), high nuclear to cytoplasmic ratio
Identify specimen and features A-F
Squamous cell carcinoma (SCC) of skin (invasive)
A - Normal skin of outer ear
B - Invasive squamous carcinoma, not islands and tongues of malignant squamous cells that are invading underlying dermis
C - Normal cartilage
D - Normal skin of inner ear (keratinising epithelial layer)
E - Keratin pearl. Pink-staining material is keratin (normally produced on surface of epithelial layer, but as malignant keratin is laid down in whorls
F - Squamous cell carcinoma
Talk through images A-D
Lynch Syndrome
B - Testing for MLH1 (positive = stain brown)
C - Testing for MSH2 (positive = stain brown)
Therefore, MLH1 is missing (mutated), but MSH2 preserved
D - Liver biopsy showing Lynch syndrome (metastasis from colon as glands formed). Liver tissue infiltrated with irregular glands, nuclei pleomorphic and hyperchromatic. Desmoplastic response (densely fibrolytic)
