Epithelial tumors – classification, typing and grading. Flashcards
covering eipthelia carcinomas
squamos cell carcinomas
epidermoid carcinoma
basaloma-semimalignant
covering epithelial-transitional carcinomas
transitional cell carcinoma
papillocarcinoma
glandular epithelia: glandualr and ductal epithelia
adenocarcinoma
glandular epithelia: hepatocytes
hepatocellular adenocarcinoma
glandular epithelia: renal ductal epithelia
renal cell carcinoma
carcinoma clarocellulare
where can squamos cell carcinoma develop from and how can tehy look
metaplastic resp failure,
The presence of keratin pearls and intercellular bridges
can be keratinizing/non kera: 80% is keratinzing and well differentiated
outcomes/prognosis of squamos cell carcinoma
- Acantholytic(pseudoglandular or adenoid)
- spindle cell (sarcomatoid)
- pseudoangiosarcomatous(pseudovascular)
-small cell or basaloid - post traumatoc (marjolins ulcer)
- adeno-squamos (mixed differentation
other, abit better outcomes of suqmoas cell caricnomas
- verrucous
- clear cell (elderly, scalp) (renal cell carcinoma)
- papillary
- lymphoepithelial (nasopharyngeal localization)
- keratoacanthoma
verrucous
- sole of foot and anal margin
- outward-growing (exophytic) lesion featuring “church spire” shaped hyperkeratosis and a deep margin that pushes into surrounding tissue, characterized by a cytologically bland, bubble-like (bullous) process.
keratoacanthoma
rapid growth and craterifrom(central depression) with central keratin plug and lipped rim of hyperplastic squamos epithalim
Basal cell carcinoma
msot common non-melanocytic cutaneous carcinoma
- semimalignant
different types/growth patterns of basal cell carcinoma
nodular
superficial multifocal
infiltrative and mrphoiex
micronodular
metypical /basosquamos carcinoma
nodular -substyoe of BCC
charcateristics
- can vary in size
- can be wiht or without tumor necrosis and cystic spaces: may form cyst like structure
hsitological patterns:
- peripheral palisading-outer layer of cell in tumor forms a fence like pattern
- mitoses and dermal retraction artifact ar common (mellomrom mellom tumor or resten av tissue)
other features:
- can contian tarbecular(cords of cells), keratotic area(area with keratin cyst or squamos differentitation), squamos meyaplasia
- may exhinit fibroepithelial (pinkus tumor like) features and adnexal(like hair follicles or sweat glands) differentitation
superficial multifocal- subtype of BCC
-multiple tumor cell nests that are budding off form epidermal basal layer (laterally)
- superficial, flt lesions, welldefined and thin borders
infiltrative and morphoeic
small. irregulaar groups of tumor cells that infiltarte into fibrous or hyaline (glassy) scirrhous storme. –<porly circumscribed lesion that can be challenging to identy and remove
micronodular- sub of BCC
nest less than 25 cell in dia
- asymmetrical infiltrative growth pattern
metatypical/basosquamos carcinoma
- more nuclar atypia, fibroblastic responsive and may have areas of malignant squmaos differense
- more aggressive-characteristic of SCC AND BCC
usual types of transitional cell carcinoam
papillary and sessile
variant with bening features-TCC
- microcystic tyoe:intra-urothelial microcysts. like cystitis cystica
-nested type: uniform cell in lamina propria like von Brunns neste
- irr margin, muscle invasion, maybe agrresive
-micropapillary type: like ovarian serous papilalry carcinoma
- stromal retraction artifact like
lymphovascular inavasia
- high grade tumor
- inverted: like inverted papilloma but with WHOO II/III cytology
- muscle invasion
clear cell, plasmacytoid, lipid cell, psuedosacamatous stroma, trophobalstic cells, lymphoepithelouma
what are adenocarcinomas classified on
on the tumor cell-stroma relationship
- carcinoma solidum/simplex: Storma and Parenenchyme =1:1
- medulalry carcinoma: S:P=1:2
- scirrhous: S:P=2:1
ehat is peculiar form of adenocarcinoma
singnet cell carcinoma: cell are round and enclose in their cytoplasm a large PAS+, vacoule of mucin that pushes the nucleus to periphery
what are most majority of adenocarcinoma
colorectal adenocarcinoma because colon has so many glands in the tissue
how does normal ciolonic glands look liek
simole and tubular with a mixture of mucus secreting goblet cells and water absorbing cells(absorb water and feces into blood)
groeth pattern of galndular and ductal adneocarcinoma
exophytic: grworing into lumen-best
endophytic: into wall
grading of malignant neoplasm:
how well differentiated
- well diff, >95%
- moderatly, 50-95%
- poorly diff, <50%
- nearly anaplastic
stagining of malignant neopplasm: T-umor staging
Tis: in situ, non invasive, attached to epi
T1: small, minimall invasive within primary organ site, into lamina propria
T2: large, more invasinve within, inti muscularis prorpia/subserosa/lesser or greater omenta
T3: large, more , penetrate serosa(visceral peritoneum)
T4: very large and inavsive, spread to adjacent organs
staginin og malignant neoplasm: N(LN)
No: no lymphnode involved
N1: nearby ln involved
N2: regional
N3: Distant
staging of malignant neoplams: M(metastasis)
M0: no distant metastasis
M1: distant metastasis involved
how do we differentiate carcinomaform lymphoma or sarcoma
by positice cytokeratin
signet cell
grade 3
small cell carcinoma
grade 4
carcinoembryonic antigen (CEA): immunohistochemical staining to detect systems for carcinomas
adenocardinomas
cytokeratin:immunohistochemical staining to detect systems for carcinomas
carcinomas, but can also be in sarcomas
alpha fetoprotein:immunohistochemical staining to detect systems for carcinomas
yolk sac tumors and hepatocellular carcinoma
CD 117(c-KIT):immunohistochemical staining to detect systems for carcinomas
gastrointestinal stromal tumours-GIST
CD 10(CALLA):immunohistochemical staining to detect systems for carcinomas
renal cell carcinomas and acute lymphoblastic leukemia
prostate specific antigen-PSA:immunohistochemical staining to detect systems for carcinomas
Prostate cancer
Estrogens and progestrone:immunohistochemical staining to detect systems for carcinomas
tumor identificaition
most common cancer in women
skin, breast, lung, colon, uterus
most common cancer in men
skin, prostate, lung, colon
virchow node
left supraclavicular lymph node metastaiss from abdominal malignancy
trosseaus signq
migratory venous thrombosis most often associated with pancreativ and brochogenic carcinomas
what the guardian genome and how does mutation affect it
P53, tumor suppressor gene, located on chromosome 17
severe to arrest cell cycle and induce apoptosis under condition of DNA damage. when mutated: dna damage will continue to divide and proliferate
papilloma
-squamos cell
- squamos or transitional epit
- skin, oral cavity, UB, oesophagus, vagina
condylomata accuminata
- other papilloma
- on penios, around female ext genitalia, urethra,
-HPV virus-16&18
adenoma
-bening, exophytic neoplasm of galndular pei
solid adenoma
hepatoma
cystic adenoma
ovarian mucinous
what do we uaslally se in squamos papilloma
hyperkeatosis, acanthosis with elogngation of rete ridges ans parakeratosis
seborrheic keratosis
- squamos papilloma
- also called verruca seborrhoica, vercua senilis
- idiopathic epidermal prolif composed principally of monomorphous basaloid keratinocytes
- middle ages adults, exophittc
- trunk, shoulder, face, neck
- macro: soft/hard, yellow/black/grey, sharply demarked, warty surface
- histo: basaloid cells (spehircal, pale, large nucleus), sharply demarkated, hyperkeratosis, acanthisis, papillomatosis, HORN CYST/PERALS IN EPIDERMIS
renal papillary adenoma
- well circumasisted, yellow-gray -white nodules in renal cortex
- solitary-but may renal adenomatosis
micro: papirllay/tubulopapillary, around thin fibrous capsule, psammoma bodies, foamy macrophages,
renal onocytoma
-neoplams of renal cortex
- may be palpalbe mass or with hematuria
- mahagony brown color
-central zones of withish storma and foci of hemorrhae
mciro: cells in diffuse sheets or cellular island in loose edematous CT
bening epithelial(urothelial tumors)
- form transinotal epi of bladder in continuity wiht epi of renal pelvis, ureter and urethra
TRansitional cell papilloma
- branchin patters
- cells resebel normal: no size of shape diff
- exo or endophytic growth
-^micro or macro hematouria
serous cystadenoma of ovary
-bening glandular epit tumor
- unilocular or multilocular, >5cm in dia, spehrical masses
-20-50y
- coelomic epi–>tubal type of epi
- thin walls with clear fluid
micro:
- lined by cilated or non ciliated low columnar cells with bland ovoid nucleo
- epi becomes falttend if cyst under tension
- small foci of mild to moderate nuclear atypia or nuclear stratificaiton
mucinous cystadenoma of ovary
- larger, ca 10 cm in dia, unilat/uniocular/multiocular
- 20-50y
- coelomic epi–>endocervical type or intestinal type of mucos
-smooth surfaced - non ciliated columnar cells
-focal low grade atyoua
adenoma of GI tract
- not before 40y
- asymptomatic, larger adenoma–>bleeding, rare villous adenoma may produce abundant mucus–>diarrhea
- rare in stomach or SI
- ^colon and rectum
micro: tubular or villous structure lined by dysplastic epi
- ^proportion of immature cells-hyerpchromatic stratified nuceli
- mitotic act-upper crypt and surface eoi
3types:
1. tubular adenoma
2. villous adenoma
3. tubulovillous adenoma
tubular adenoma (adenomatous polyp)
- most common neoplastic polyps
-^DISTAL COLON AND RECTUM - asymptomatic or rectal bleeding
macro: single/multiple, sessile(pedunculated, varibale size
micro: tumor overlying muscuaris mucosa, branchin tubules in propria , linign eoi with decreased mucus secreting capacity, large nuclei and ^mitotic act
5% mal
villous adenoma(villous papilloma)
- ^distal colon and rectum
- invaribly symptomatic, rectal bleeding, diarrhea
macro: round and oval exophytic masses, sessile, 1-10cm in dia, surface can be hemorrhagic or ulcertated
micro: finger like villi, sometimes excess mucus secretion
30% mal
tubulovillous adenoma (papillary adenoma)
- distal colon and rectum
- macro: sessile or pedunculated, 0,5-5cm in dia
- micro: intermediate or mixed pattern
-tubular pattern
familial polyposis syndromes
group of disoders with multiple polyposis of the colon with autsomal dominant inheritence pattern
- familai polyposis coli(adenomatosis
- over 100 neoplastic polyps of mucosal surface of colon
-autosomal dominant
-germline mutation in APC gnee
-20-30y
-hig malignancy
-micro:^tubular structure
-colectomy
garderns syndroem
FAP and extra colonic lesions(mutliple osteomas, sebaceous cysts, CT tumors)
tucots syndorme
-combinaiton of FAP and malignant neoplasm of central nevorus system
juvenile polyposis syndorme
multiple juvenile polyps in colon, stomach, SI
-lower nr than in FAP
-no malignant potnetial
follicilar adenoma of TG
- most common bening
- adult woman
macro:
-solitary nodule
- cold noduel, small and spheical
-celarly distinct architercture inside and outside capsule
- compression of thyroid parnchyma outside capsuel
micro:
-tumors cells–>being follicular epi cells
type sof follicualr adneoma of TG
- microfollicualr-fetal: no/little collid
- normofollicular-simple: closed packed follicles
- macrofollicualr-colloid
- trabecular-embryonal
- hrutle cells-oxyphilix- solid trabecula or larger cells haveing abundant granular oxyphilic cytoplasm and vesicular nuclei, cells do not form follicles
- atypical-follicula adenoma, more cellualr prolif, pleomorphism, ^mitosis, nucelar atypia, no capsular or vascualr invasion
cortical adenoma-adrenal gland
- most common
-small and nonfucntional - large adenoma-ecess corticsol, aldosteron, androgens–>cushing/cohn/adrenogenital syndome
- MEN 1
macro:
- solitary, spehrical, encapsulated tumor, well delineated form surordny
mciro: cells arranged intrabeculae and resemble clles of zona fasciculata
breast -fibroadenoma
- during reproductive life, 15-30y
- single, mutiple, uni or bilateral, discrete, freely mobile noduel
macro:
- small, spherical or ovoid nucleus
, sharply circumsied and clearly separated
micro:
-prolif of loose cellualr stromal CT which surrond varibale number of ductal structure
- intracellualr patter-stroma compresses ductus–>slit like cleft with ductal epi, or pericanalicular-encircling masses of fibrous stroma around patent or dilated ducts
pleomorphic adenoma(mixed salivaru tumor
- parotid ecsepsially
- women, 30-50y
-soliatry, smooth surfaced, painless, slow growing,
macro:
-circumscribed
-pseudo encapsulated
micro:
-pleomorphic or mixed apperance
monomorphic adenoma
- no evidence of mesenchumal liek tissues
-warthins tumor(papillary cystadenoma)-parotid gland
-oxyphil adenoma(oncocytoma)-major salivary glands
-myoepithelioma
-basal cell adenoma - clear cell adenoma
