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Morphopathology > Workshop 9 - malignant epithelial tumors > Flashcards

Workshop 9 - malignant epithelial tumors Flashcards

1
Q

What differences can we have between BT and MT?

( morphological caracteristics )

A
  1. differentiation and anaplasia
  2. rate of growth
  3. local invasion
  4. metastasis
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2
Q

Differentiation
of MTs and BTs

A

Refers to morphological and functional similarity of neoplastic cells with cell origin

MTs : showing various degrees of differentiantion

  • WD - well differentiated forms
  • ND - non differenciated forms
  • anaplastic forms

BTs : well - differentiated tumors

***anaplasia or lack of differentiation is a characteristic feature of malignancy

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3
Q

characteristic feature of malignancy

( differentiation )

A

anaplasia

and

lack of differentiation

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4
Q

what rate of growth have the MTs and the BTs?

A

MTs : rapid rate

  • WD MTs : grow more slowly
  • ND Mts : grow rapidly

BTs : slow rate

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5
Q

Invasion of BTs

A
  • grow as masses at the site of the origin of the tumor
  • grow locally - causing compression of adjacent tissues
  • usually have capsules that separate them from the tissue
  • they are not all encapsuled but they are clearly defined
  • not all are wel defined , except hemangioma
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6
Q

Invasion of MTs

A
  • the growth is not limited at the site of the origin
  • grow rapidly , invading adjacent tissues, cause damage
  • not well defined
    ( exc renal nuclear cell carcinoma - has capsule )
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7
Q

MTs are not well defined
Name an exception

A

renal clear cell carcinoma

  • grows slowly
  • has capsule
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8
Q

Metastasis

definition

A

Metastasis are tumoral implants located at distance from primary tumor site

characteristic of MTs

4 ways of spreading

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9
Q

Metastasis

4 ways of spreading

A
  1. Local
  2. Lymphatic dissemination
  3. vascular dissemination
  4. Transcelomic
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10
Q

Local metastasis

A

tumor spreads by direct way

in adjacent tissues

along cleavage plans and nervous fibers

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11
Q

Lymphatic spread

Macro and micro

A

tumor cells disseminate along lympthatic vessels

causing secondary lymphatic metastasis

  1. Macro
    lymph nodes : increase volume, loss of structure
  2. Micro
    tumor cells replace the normal lymph node
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12
Q

Vascular dissemination

Macro , Micro

A

tumor cells disseminate by hematogenous way
( tumor emboli)
in this way a primary tumor cause secondary visceral metastases in :
liver, lung, adrenal, brain etc

  1. Macro
    Affected organ is increased in volume and presents many tumor nodules, well defined, uncapsuled
  2. Micro
    can be similar to primary tumor or not
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13
Q

transcelomic dissemination

A

primary abdominal and thoracic tumor disseminate alog the mesothelial surfaces

ex. pleural cavities

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14
Q

Histological features of BT and MT

A

Benign

  • Differentiation : Well - diff.
    resembling with cell origin
  • Mitosis : few
  • Nucleus / Cytoplasm Ratio : normal 1/4
  • homogenous cell shape and size

Malignant

  • Differentiation : Failure of cell diff.
  • **Mitosis : **many
  • **Nucleus / Cytoplasm Ratio : **high 1/1
  • cell and nuclear pleomorphism
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15
Q

histological feature of BT

A

Benign

  • **Differentiation **: Well - diff.

resembling with cell origin

  • **Mitosis **: few
  • Nucleus / Cytoplasm Ratio : normal 1/4
  • homogenous cell shape and size
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16
Q

Histological features of MTs

A

Malignant

  • Differentiation : Failure of cell diff.
  • Mitosis : many
  • Nucleus / Cytoplasm Ratio : high 1/1
  • cell and nuclear pleomorphism
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17
Q

Characteristic features of Mts

A
  1. aplasia of lack of differentiation
  2. rapid rythm of growth
  3. invasion
  4. metastasis
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18
Q

Stages of development of neoplasia
and
progression of dysplasia to neoplasia

A
  1. normal epithelium
  2. dysplastic epithelium
  3. CIS - carcinoma in situ
  4. micro invasive carcinoma
  5. invasive carcinoma
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19
Q

Stages of development of neoplasia
and
​progression of dysplasia to neoplasia

Dysplastic epithelium

A

mild , moderate and severe

  • cytologically : defines morphological neoplastic features of cells characterized by incomplete maturation and increasing of mitosis number
  • causes : ex. chronic inflammation
  • may develop into neoplasia
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20
Q

Stages of development of neoplasia
and
​progression of dysplasia to neoplasia

CIS- carcinoma in situ

A
  • represents an early stage of neoplasia
    previous to invasion
  • Cytologically : characterized by cell and nuclear pleomorphysm and increased mitotic activity
  • Histologically : disruption of normal architecture , but BM remains intact
  • may progress to neoplasia
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21
Q

Stages of development of neoplasia
and
​progression of dysplasia to neoplasia

Micro invasive carcinoma

A

results by invasion of cancer cells
into subjacent stroma ( 5 mm in diameter )

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22
Q

Stages of development of neoplasia
and
​progression of dysplasia to neoplasia

Invasive Carcinoma

A

corresponds to an advanced cancer
presenting clinical manifestation

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23
Q

Features of malignant epithelial tumors

A
  • common in adults and elderly
  • diagnosis established in stahe 0 (CIS) :
    100% healing
  • usually present lymphatic metastasis
24
Q

Histogenic classification of carcinomas

A
  1. Epidermoid / squamocellular carcinoma
  2. adenocarcinoma
25
Q 
Squamocelullar carcinoma ( epidermoid ) 
( SCC )

origin

A
  • epidermis
    ( skin )
  • mucous epidermoid membrane
    ( lip , tongue, pharynx, larynx, exocol, vagina )
  • **epidermoid areas of squamous metaplasia **
    ( pluristratified gut epithelium )
    ( bronchial epithelium-smoking, billiary duct-stone )
26
Q

Squamocelullar carcinoma ( epidermoid )

Macroscopically 2 types of growth

( SCC )

A
  • vegetative tumor
  • ulcerative tumor
27
Q

Squamocelullar carcinoma ( epidermoid )

macro. Vegetative

( SCC )

A

tumor has a large basis of implantation and
**irregular surface **

areas of necrosis and bleeding

and may ulcerate

28
Q

Squamocelullar carcinoma ( epidermoid )

Macro. Ulcerative tumor

( SCC )

A

Tumor has a broad -base of implantation and
prominent margins

consisting of tumoral infiltration

29
Q

Squamocelullar carcinoma ( epidermoid )

Micro. 3 degress of differentiation

WD

( SCC )

A

invasive tumor

forming nests or islands of polygonal atypical cells
which syntheses keratin
forming concentric globes
called keratosic pearls

30
Q

Squamocelullar carcinoma ( epidermoid )

Micro. 3 degress of differentiation

MD

( SCC )

A

aggregates of polygonal tumor cells
with nuclear atypia and reduced keratonization

31
Q

Squamocelullar carcinoma ( epidermoid )

Micro. 3 degress of differentiation

PD

( SCC )

A

invasive tumor

composed of **individual polygonal **cells
with marked nuclear atypia
and no keratinization

32
Q

Squamocelullar carcinoma ( epidermoid )

Keratizined , differentiated epidermoid carcinoma

( SCC )

A

The tumor,
with origin in cutaneous squamocellular epithelium
invades dermal connective support,
forming tumoral islands
separated by reducted connective stroma
infiltrated by lympocytes

The tumoral islans are compoused of atypical polygonal cells ,resembling with epidermal squamous :
through defferentiation the tumoral cells synthetise keratin forming central concentric lamellae
( keratin pearl is a mark dignostic element for differentiated epidermoid carcinoma )

33
Q

Squamocelullar carcinoma ( epidermoid )

general

( SCC )

A

Cutaneous SCC has metastatic potential
Lymphatic dissemination and metastases in regional lymph nodes occur lately

SCC us not radiosensitive cancer

34
Q

Basal cell carcinoma
BSC

A

Is a particular form of skin carcinoma , located at face

Originates on basal cell layer of
epidermis and hair

35
Q

Basal cell carcinoma
​BSC

macro

A 
there is an ulcerative carcinoma with prominent
pearled edges ( ulcus rodens )
36
Q

Basal cell carcinoma
​BSC

Microscopically

A

presents two main histological subtypes :

  1. superficial
  2. nodular

The nodular tumor originates from the basal layer of epidermis, infiltrates the subjacent dermis, where it forms islands of tumor cells separated by a connective - vascular stroma that is infiltrated by mononuclear inflammatory cells , tumoral islands are composed of tumor cells resembling with basal cells with peripheral parallel disposition and central disordely disposition.

37
Q

Basal cell carcinoma
​BSC

general

A

BCC is a local invasive tumor
without metastatic features

is a radiosensitive tumor

38
Q

Basal cell carcinoma
​BSC

basocellular carcinoma of skin

A

The tumor has origin in skin basocellular layer , invades derman connective tissue support ,
forming tumoral islands separetaed by reduced connective stroma,
infiltrated by lymphocytes

The tumoral islands are composed by atypical cells, resembling with epidermal basal cells , arranged in parallel manner to the periphery of the tumoral sheets and chaotically in the center of this tumoral island.

39
Q

Adenocarcinoma

what is it?origin?

A

Ia s tumor with origin in glandular epithelium from cavitary organs ( stomach , colon ) or parenchymal organs ( lungs, liver )

40
Q

Adenocarcinoma
Macro

In cavitary organs

A

present 3 appearances

  1. **vegetative carcinoma **
    cauliflower tumor mass
    with large base of attachement
    and irregular surface
  2. ulcerative carcinoma
    crater ulcer , with broad , deep basis and raised edges
  3. Infiltrative carcinoma
    tumor infiltrates entire wall , causing thickness of the wall and narrowing of the lumen ( stenosis )
41
Q

Adenocarcinoma
​Macro

in parenchymal organs

A

present 2 macro. appearances

  1. Nodular carcinoma
    nodular, large tumor with irregular edges , due to local invasive feature
  2. Inflitrative carcinoma
    Diffuse tumor replacing gradually adjacent tissues and finally, entire organ
42
Q

Adenocarcinoma
​Micro. degrees

A

WD

MD

PD

ND

43
Q

Adenocarcinoma
​Micro. degrees

WD adenocarcinoma

A
  • Tubular
    Colonic ADC is composed of tumor glands , lined by atypical epithelial cells arranged on one or multiple layers and forming a lumen
  • Papillary
    Of the thyroid.
    composed of connective-vascular axis covered by atypical cells
  • Vesicular or Follicular
    of thyroid
  • Trabecular
    Hepatic carcinoma is composed of tumor hepatocytes forming cords or trabecules
44
Q

Adenocarcinoma
​Micro. degrees

MD ADC

A

composed of differentiated tumor elements ( tubes ) and athypical tumor cells with chaotic disposition,
forming masses, cords, etc

45
Q

Adenocarcinoma
​Micro. degrees

PD ADC

A

composed of athypical tumor cells forming irregular masses that are no-cohesive one to each others, and with no specific epithelial differentiation ( or specific architecture )

46
Q

Adenocarcinoma
​Micro. degrees

ND carcinoma

A

No-cohesive masses of anaplastic cells

47
Q

Adenocarcinoma

colonic moderate differentiated tubular carcinoma

A
  • The tumor originates in the glandular epithelium of the colon and penetrates the muscularis mucosa and infiltrates the submucosa and muscular layer
  • Is composed from tubular elements separated by a reduced stroma
    The tumoral glands are lined by atypical epithelium disposed on one or multiple layer with an irregular lumen
48
Q

Particular Forms of ADC

(2)

A
  • Cordonal carcinoma
  • Mucinous Carcinoma
49
Q

Cordonal carcinoma : the two parts

A
  • Schirrous
  • Medullary
50
Q

Schirrous carcinoma

Micro and macro

A

Micro :
Think cords of tumor cells in an abundant connective stroma

Macro:
tumor of firm , hard consistency ( schir )

51
Q

Medullary carcinoma

Micro and Macro

A

Micro :

Large cords of tumor cells produced in reduced connective stroma

Macro :

Tumor of soft consistency ( encephaloid appearance )

52
Q

Mucinous carcinoma :
2 parts

A
  • colloid carcinoma
  • signet ring cell carcinoma
53
Q

Colloid carcinoma

Micro , Macro

A

Micro :

Large mucous sheets , containing tumor cells arranged individually or in groups ( tubes , cords ) which dissect the wall layers and inflitrate the affected organ

Macro :

tumor of gelatinous appearance

54
Q

Signet ring cell carcinoma
Micro

A

tumor cell produce, retain and excrete mucus,
resulting cells loaded with mucus

55
Q

Carcinoma metastasis :

Lymph nodes
Macro, Micro

A

Macro
Lymph nodes are increased in volume

Micro :

tumor cells invade and replace the lymph node structure

56
Q

Visceral metastasis : lung, liver

Macro , Micro

A

Macro :

the organ has increased volume
presence of multiple , well defined uncpasuled nodular tumor

Micro :

Metastatic tumors resemble or not with the primary tumor

Morphopathology (7 decks)

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