U3 LEC: NEOPLASIA Flashcards
Process of new growth
Neoplasia
A new growth is called a?
neoplasm
Neoplasm is commonly known as?
tumor
Study of tumors or neoplasms
Oncology
common term for all malignant tumors
Cancer
This refers to abnormal or uncoordinated growths due to lack of stimulus
Neoplasia
In the cell cycle, it would have a problem with?
proapoptotic factors > production of aberrant DNA
Tumors remain dependent on host for?
nutrition and blood supply
Two basic components of tumors
- Parenchyma
- Stroma or non-neoplastic stroma
made up of transformed or neoplastic cells
Parenchyma
determines the biologic behavior of the neoplasm, and it is the component from which tumor derives its name
Parenchyma
made up of connective tissue and blood vessels
Stroma
carries the blood supply and provides support for the growth of parenchymal cells
Stroma
Nomenclature of benign tumors
-oma to cell type from which the tumor arises
Benign tumors are sometimes based on their?
microscopic and macroscopic pattern, cells of origin
This is applied to benign epithelial neoplasms which produce gland patterns, but do not exhibit gland patterns
Adenoma
Benign epithelial neoplasms growing any surface, producing finger-like fronds
Papilloma
Papillomas are mostly induced by?
viruses
Papillomas are characterized by?
finger-like projections
Mass that projects above a mucosal surface
Polyp
These are polypoid masses called as skin tags.
Fibroepithelial polyp
Polyp can also be used to term non-neoplastic growths in the?
colon
Hollow cystic masses with fluids inside
Cystadenomas
Cystadenomas are typically seen in the?
ovary
filled with mucoid cystadenoma
Mucinous cystadenoma
filled with watery fluids na cystadenoma
Serous cystadenoma
Malignant neoplasms arising in mesenchymal tissues
Sarcomas
Sarcomas are designed by their?
histogenesis
Malignant cancer of fibrous tissue origin
Fibrosarcoma
Malignant neoplasm composed of chondrocytes
Chondrosarcoma
Malignant neoplasms of epithelial cell origin derived from three germ layers
Carcinomas
Three germ layers
- mesoderm
- ectoderm
- endoderm
Examples of mesoderm
renal tubular epithelium
Examples of ectoderm
skin epidermis
Examples of endoderm
lining epithelium of the gut
T/F: Mesoderm may give rise both to carcinomas and sarcomas.
True
but rare
Denotes a cancer in which tumor cells resemble stratified squamous epithelium
Squamous Cell Carcinoma
Malignant neoplastic epithelial cells grow in glandular patterns
Adenocarcinoma
Tumors that grow in a very undifferentiated pattern
Poorly Differentiated Carcinoma
Tumors that may arise from stem cells that undergo divergent differentiation
Mixed Tumors
Best example of mixed tumor
salivary gland origin
Mixed tumors should not be confused with a?
teratoma
Originated from totipotential cells
Teratoma
Totipotential cells are normally present in the?
ovary and testis
Have the capacity to differentiate into any of the cell types found in the adult body
Totipotential cells
Teratoma
all components are well differentiated
Benign (mature) teratoma
Teratoma
less differentiated
Malignant (immature) teratoma
Tumors of mesenchymal origin (CT derivatives)
Benign
- Fibrinoma
- Lipoma
- Chondroma
- Osteoma
Malignant
- Fibrosarcoma
- Liposarcoma
- Chondrosarcoma
- Osteogenic sarcoma
Blood vessels
Benign
- Hemangioma
Malignant
- Angiosarcoma
Lymph vessels
Benign
- Lymphangioma
Malignant
- Lymphangiosarcoma
Synovium
Synovial sarcoma
Mesothelium
Mesothelioma
Brain coverings
Benign
- Meningioma
Malignant
- Invasive meningioma
Hematopoietic cell
Leukemias
Lymphoid tissue
Malignant lymphomas
Smooth Muscle
Benign
- Leiomyoma
Malignant
- Leiomyosarcoma
Striated muscles
Benign
- Rhabdomyoma
Malignant
- Rhabdomyosarcoma
Stratified squamous
Benign
- Squamous cell papilloma
Malignant
- Squamous cell or epidermoid carcinoma
- Basal cell carcinoma
Epithelial linings
Benign
- Adenoma
Malignant
- Adenocarcinoma
Glands or ducts
Benign
- Papilloma
- Cystadenoma
Malignant
- Papillary carcinomas
- Cystadenocarcinoma
Respiratory passages
- Bronchogenic carcinoma
- Bronchial “adenoma”
Neuroectoderm
Benign
- Nevus
Malignant
- Malignant melanoma
Renal epithelium
Benign
- Renal tubular adenoma
Malignant
- Renal cell carcinoma
Liver cells
Benign
- Liver cell adenoma
Malignant
- Hepatocellular carcinoma
Urinary tract epithelium
Benign
- Transitional C. papilloma
Malignant
- Transitional cell carcinoma
Placental epithelium
Benign
- Hyatidiform mole
Malignant
- Choriocarcinoma
Testicular epithelium
Seminoma
Salivary glands
Benign
- Pleomorphic adenoma
Malignant
- Malignant mixed/phyllodes tumor
Breast
Fibroadenoma
Renal anlage
Wilm’s tumor
Characteristics of Benign and Malignant Neoplasms
- differentiation and anaplasia
- rate of growth
- local invasion
- metastasis
Differentiation
Benign: well differentiated
Malignant: anaplasia, atypical structure
Local Invasion
Benign: cohesive and expansile, well demarcated, do not invade tissues
Malignant: locally invasive, infiltrating surrounding tissue
Metastasis
Benign: absent
Malignant: frequently present
Extent to which neoplastic cells resemble comparable normal cells
Differentiation
Lack of differentiation
Anaplasia
Morphologic changes in Anaplasia
- Pleomorphism
- Abnormal nuclear morphology
- Mitoses
- Loss of polarity
Variation in size and shape of cells and nuclei
Pleomorphism
abundance of DNA, dark staining, increase in N:C ratio, coarsely clumped chromatin, large nucleoli
Abnormal nuclear morphology
Hallmark of malignancy
Anaplasia
Reflects high proliferative activity of parenchymal cells
Mitoses
Disturbed orientation of cells
Loss of polarity
Lesion marked by dysplastic changes involving the entire thickness of the epithelium
Carcinoma in situ
Local invasion of benign tumors
remain localized, have fibrous capsule
Local invasion of malignant tumors
progressive infiltration, invasion, destruction of surrounding tissue
Malignant neoplasms disseminate through the following pathways:
- seeding within body cavities
- lymphatic spread
- hematogenous spread
- local spread
Local spread is also known as?
locoregional metastasis
Seeding within body cavities is also known as?
Transcoelomic spread
Occur when neoplasms invade a natural body cavity
Seeding
Carcinoma of the _____ may penetrate the wall of the gut and reimplant at distant sites in peritoneal cavity
colon
Typical in carcinomas
Lymphatic spread
This depends on the site of primary neoplasm and natural lymphatic pathways of drainage of the site
pattern of lymph node involvement
These are the lymph nodes closest to the tumor
Sentinel Lymph Nodes
Typical of sarcomas
Hematogenous spread
Common sites of metastasis and hematogenous spread
Liver and lungs
Chemical carcinogens
- Benzene
- Nitrosamine
- Aflatoxin
These induce tumors in initated cells (reversible)
Promoters
Benzene causes?
aplastic anemia
Nitrosamine can be seen on?
food colorings, fried hotdogs
Aflatoxin can be seen in?
expired peanuts
Aflatoxin induces?
hepatic adenomas
Carcinogenic UV rays
UVA, UVB
Cancers under UV rays
- Squamous cell carcinoma
- Basal cell carcinoma
- Malignant melanoma
Ionizing electromagnetic and particulate radiation
- Xrays
- gamma rays
- a particles
- B particles
- protons
- neutrons
Oncogenic viruses
- HPV
- Epstein barr
- Hepa B
- H. pylori
This causes squamous papillomas (warts), carcinoma of the cervix
Human Papilloma Virus (HPV)
This causes Burkitt’s lymphoma, nasopharyngeal carcinoma
Epstein-Barr virus
This causes hepatocellular carcinoma
Hepatitis B
This causes gastric carcinoma, and gastric lymphoma
Helicobacter pylori
Most common cause of peptic ulcer disease
Helicobacter pylori
HPV can also cause?
adenocarcinomas
Expansile growth, endocrine gland neoplasm
Local and hormonal effects
This is the tumor of adrenal medulla, causes hypertension
Pheochromocytoma
Progressive loss of body fat and lean body mass accompanied by weakness, anorexia, and anemia
Cancer cachexia
Symptom complexes that cannot be readily explained
Paraneoplastic syndromes
Acanthosis Nigricans Maligna
Abdominal adenocarcinomas (gastric neoplasia)
Acquired Pachydermatoglyphia
gastric and pulmonary carcinoma
Erythema gyratum repens
Pulmonary, esophageal, breast
Bazex paraneoplastic acrocheratosis
Aerodigestive tract (oral cavity, larynx, pharynx, trachea, esophagus and lungs)
Acquired hypertrichosis lanuginosa
Colorectal, pulmonary and breast
Necrolytic migratory erythema
Glucagonoma
Leser-Trelat sign
Gastric and colorectal
Paraneoplastic pemphigus
- Non-hodgkin lymphoma
- Chronic lymphocytic leukemia
- Castleman’s disease
- Thymoma
Pityriasis rotunda
- Hepatocellular carcinoma
- gastric and esophageal carcinoma
- prostate cancer
- chronic lymphocytic leukemia
- multiple myeloma
Dermatomyositis
Ovarian carcinoma, bronchogenic adenocarcinoma
Palmoplantar keratoderma
Esophageal carcinoma
Pyoderma gangrenosum
Myelodysplastic syndrome, myeloma, leukemia
Sweet syndrome
Acute myelogenous leukemia, myelodysplastic syndrome
Based on the degree of differentiation of tumor cells and number of mitoses
Grading
Based on size of primary lesion, extent of spread to regional lymph nodes, presence or absence of metastases
Staging
Most common systems for staging
TMN classification
Based on size and extent of invasion
T score (tumor)
Indicates extent of lymph node involvement
N score (node)
Indicates whether distant metastases are present
M score (Metastasis)
In breast cancer, what is being checked?
size of tumor
In colon cancer, what is being checked?
area/extent of invasion
Tis
In situ, non-invasive
T1
Small, minimally invasive within primary organ site
T2
Larger, more invasive within primary organ site
T3
Larger, invasive beyond margins of organ site
T4
Very large/invasive, spread to adjacent organs
N0
No lymph node involvement
N1
Regional lymph node involvement
N2
Extensive regional lymph node involvement
N3
More distant lymph node involvement
M0
No distant metastases
M1
Distant metastases present
Resembling normal cells
Differentiated cells
Younger or immature cells
Undifferentiated cells
Grade 1
DC: 100-75
UC: 0-25
Grade 2
DC: 75-50
UC: 25-50
Grade 3
DC: 50-25
UC: 50-75
Grade 4
DC: 25-0
UC: 75-100
Value of Grading
- guide for treatment
- prognostic guide
lower grades
Surgery
higher grades
Radiation
higher grades, _____ prognosis
poorer
Laboratory diagnosis of neoplasia
- Histologic and cytologic
- Immunohistochemistry
- Molecular diagnosis
- Flow cytometry
- Tumor markers
Used to determine treatment modality
Immunohistochemistry
Used for hematologic neoplasms (leukemia)
Molecular diagnosis
Tumor markers include:
- CA125
- CA19-9
- AFP
- Prostatic specific antigen