L1: Cancer pathology part 2

Question 1

tumour cell pleomorphism?

Answer 1

Pleomorphism- variety in colour, size, shape etc. variation amongst the cells. Image- cells of tumour. Cannot tell tumour type as it is not forming anything, no mucin, not layered, not forming keratin, not glandular (cant see glands), just collection of cells. Angles?? This is poorly differentiated, cells are diff from eachother.

Question 2

tumour cell mitotic figures?

Answer 2

abnormal mitoses: pleomorpic?, hyperchromatic, multinucleated, giant, ‘bizzare’

Question 3

neoplasia

Answer 3

Neoplasia- once cells continue to grow once stimulus has ceased, these cells are very mitotically active. In normal skin, mitosis is in basal layer. If start seeing mitosis high up where cells are beginning to die close to the keratin layer, abnormal. In this tumour (1st image) not only mitosis. arrow= cannot tell what phase, x shape, abnormal mitosis. Can also have multinucleated cell. Very polymorphic, second image- 1 cell has decided to take 8 nuclei, one with 1, one cone shape etc.

Question 4

rate of growth + differentiating benign from malignant

Answer 4

Rate of growth
Most benign tumours grow slowly over a period of years, whereas most malignant tumours grow rapidly, often at an erratic pace.

The growth rate of tumours correlates with the level of differentiation, and thus most malignant tumours grow more rapidly than benign tumours.
Malignant growth reflected in mitotic activity.

Differentiation of benign from malignant tumours
Rests on their morphology - more specifically, parenchymal differentiation.

Anaplasia and evidence of invasion of surrounding structures constitute the two major criteria for diagnosis of cancer in its primary site of origin.

Question 5

the spread of tumours?

Answer 5

The spread of tumours
Encapsulation – invasion.
Nearly all benign tumours grow as localised expansile masses enclosed within a fibrous capsule.
Cancers are never encapsulated and are characterised by infiltrative, erosive growth that extend crab-like feet into adjacent tissues.
Next to the development of metastases, invasiveness is the most reliable feature that distinguishes malignant from benign tumours.

By removing tumour try to stop the spread. Spread of tumour in cancer pathology,
Staging- what stage is tumour. Has it stayed in epithelim, in situ? If has invaded tissue how deeply invasive is it? Deep invasive- beyond layers of lamina propria and stroma, begins to access bood vessels and lymphatics.

Question 6

metastasis?

Answer 6

Metastases are tumour implants discontinuous with the primary tumour. The metastases may themselves give rise to metastases.

Metastasis unequivocally marks a tumour as malignant because benign tumours never metastasise.

From metastasis? deposits other metastases can occur.
Say someone has breast cancer e.g: ductal or lobular. Breast cancer metastasises by preference goes first to liver. Mechanism not understood
Lung cancer- goes to the adrenals.
Ductal carcinoma of breast gets access to blood vessels, moves around in circulation and stops in liver. Marginates and then begins to multiply and grow. Now tumour in liver. That does not change into a liver tumour. Continues to be breast cancer. This breast cancer with duct from breast (cells are breast duct cells) will grow inside liver and will aquire new mutations, start invading through blood vessels of the liver and from there metastasise to other areas. E.g: brain.
Lung cancer goes to the adrenals

Question 7

dissemination of cancer

Answer 7

Dissemination of cancer

Direct seeding of body cavities or surfaces

Transplantation

Lymphatic permeation

Embolization through blood vessels

Question 8

essential steps for metastasis?

Answer 8

• primary neoplasm —>
• progressive growth

vascularisation —> invasion —> detachment —> embolisation—> survival in circulation—> arrest—> extravasation—> evasion of host defences–> progressive growth–> metastasis

Lecture capture did not include loads of images at the end…