內(nèi)容教程成果neoplasiaii

1、nTumor，NeoplasmMa liqin (馬麗琴馬麗琴)M.D.Department of Pathology and Patho-physiology Institute of Pathology and Forensic MedicineService Center of Forensic Science & Technology lWhat is a neoplasialMorphology of neoplasialAtypia,classification,stage of NeoplasialCommon neoplasia-1: Epitheliar neoplasial

2、 Common neoplasia-2: Mesenchymal neoplasia lPrecancerous lesions, dysplasia, intraepithelial neoplasia(IN ) and carcinoma in situlDistinguish between carcinoma and aThe points in this chapterCommon NeoplasiaBenign and malignantEpithelial TumorsMesenchymal TumorsBenign tumorMalignant tumorAdenocarcin

3、omasSquamous Cell CarcinomasTransitional Cell Carcinomas asOthers （Malignant Lymphomas）Epithelial tissueMesenchymalBenign Epithelial TumorsAdenoma: Colon, many other tissues (examples: liver, adrenal cortex, salivary glands (pleomorphic adenoma)Cystadenoma (ovary)Papilloma: squamous epithelium (skin

4、, mouth, vagina) or transitional cell papilloma (urothelium, nose)Benign Mesenchymal TumorsfibromalipomaleiomyomachondromaosteomaangiomaBenignCommon AdenocarcinomasBreast: invasive ductal, invasive lobular, medullaryLung: GI-tract: stomach, pancreas, large bowelUterusOvaryProstateCommon Squamous Cel

5、l CarcinomasSkinMouth Pharynx Larynx EsophagusLung- after metaplasia Anus VulvaCervixTransitional Cell CarcinomasUrinary Bladder, Ureter, renal pelvis CarcinomasMalignant tumorCommon asFibro aLipo aLeiomyo aRhabdomyo aMFH malignant fibrous histiocytomaMalignant peripheral nerve sheath tumor (maligna

6、nt Schwannoma)Angio aunkown origin: Ewing a, . . .Common Malignant LymphomasB-cellB-CLLfollicular lymphomamantle cell lymphomamarginal cell lymphomaimmunocytomaplasmacytomaT-cell lymphomasHodgkin DiseaseGerm Cell TumorsSeminomaEmbryonal CarcinomaYolk Sac TumorChoriocarcinomaTeratomaMalignant tumorPa

7、pilloma nsite：skin,esophagus,larynx,penisnG：exophytic growth, finger-like frondsM：well-differentiated epithelium nconnective tissue axis nPrognosis: good! n exceptions: out-tract of ear, penis, bladder, colon-potential malignant!Skin papillomaAdenoma nsite：thyroid gland, ovary, breast, salivary glan

8、d and colon, et,aln G：node-like, polyp-like, often circumscribed and encapsulatedn M：(1) crowded glands，uneven distributed (2) disorder, absence of lobule and duct n (3) well differentiated cells (secretion)Classified into:(1) cystadenoma (2) fibroadenoma (3) pleomorphic adenoma (4) polypous adenoma

9、 (1) cystadenoma ：means benign tumor of glandular epithelium that is largely cystic grosslycystadenom（ovary）serousmucousMucous cystadenom（ovary）(2) fibroadenoma （3） pleomorphic adenoma Neoplasia located in Parotid gland(3) pleomorphic adenoma Squamous celladnoma cellMucin () polypous adenoma Maligna

10、nt epithelial tumorsCarcinomaClassification ： Squamous cell carcinoma Basal cell carcinoma Transitional cell carcinoma Adenocarcinoma Undifferentiated carcinoma Common features：1. Often Age40；2. incidence90% of malignant tumors3. often form Cancerous ulcer 4. usually dry, grey-white in color and har

11、d, rough in consistency5. cancer nest, circumscribed between parenchyma and stroma, have reticular fibers surrounding cancer nests.6. Favor lymphatic metastasis at early stage.1. Squamous cell carcinomaArised normal squamous cellscervixfrom metaplasiabronchi, gall bladder, renal pelvissites：cervix,

12、esophagus, skin, oral cavity G：invasive growth, fungating, ulcerated, papillary M：well-differentiated-intercellular bridge and keratin pearls Keratinpearlcancer nestKeratinpearlsquamous cell carcinomasquamous cell carcinomaintercellular bridge2. Basal cell carcinoma (BCC)nsites：face of aged man or w

13、omannG：rodent ulcer pigmented BCCresembles malignant melanoman nSlow growth, local invasive, metastases are exquisitely rare, low-grade malignancy,nSensitive to radio-therapybasal cell carcinoma (rodent ulcer)basal cell carcinoma (rodent ulcer)basal cell carcinomabasal cell carcinoma 3. Transitional

14、 cell carcinomansites：bladder, renal pelvisnG：papillory nM：atypia of transitional cellsn thick papillan invasive growthn prone to relapse!Transitional cell carcinoma in bladdertransitional cell carcinomathick papilla4. Adenocarcinoma Sites : stomach, intestine, breast, thyroid gland, gall bladderTyp

15、es ： tubular adenocarcinoma mucoid carcinoma solid carcinoma(1) Tubular adenocarcinomasites：stomach, intestine, thyroid gland, gall bladderGlands with atypia Papillary adenocarcinoma cystadenocarcinoma papillary cystadenocarcinoma anusrectum adenocarcinomaadenomanomalTubular adenocarcinomacystadenoc

16、arcinoma cystadenocarcinoma(2) Mucoid carcinoma or Colloid carcinomasignet-ring cell: Mucus secretion is usually takes the form of intra-cytoplasmic vacuoles which may compress the nucleus to form so-called signet ring cells.mucoid carcinoma (colloid carcinoma) signet ring cell carcinoma(3) Solid ca

17、rcinoma (carcinoma simplex) poorly differentiated adenocarcinoma scirrhous carcinoma（parenchymastroma） scirrhous carcinoma scirrhous carcinomamedullary carcinomamedullary carcinomaPrecancerous lesions, dysplasia, intraepithelial neoplasia(IN ) and carcinoma in situ1. Precancerous lesions (preneoplas

18、tic disorders)： certain clinical conditions well-recognized predispositions to the development of malignant neoplasia. It implies a certain inevitability, but in fact,although such conditions may increase the likelihood,in most instances cancer does not develop. nLeukoplakia (leukoplasia )-Hyperkera

19、tosis of mucous membrane nChronic cervicitis and cervical erosionnProliferative fibrocystic change of the breastnVillous adenomas of the colonnChronic atrophic gastritis and gastric ulcernChronic ulcerative colitisnChronic skin ulcernCirrhosis of liver Possible es of Precanceroses may persist lifelo

20、ng may progress to cancer- after few months (weeks)- after 20 years may spontaneously regress may regress and come back againPossible es of Precanceroses progression from CIN I to CIN III is rare ! carcinoma may develop without preexisting dysplasia ! invasive carcinoma may develop as the first step

21、, having secondarily an in situ componentChronic atrophic gastritisnGlandular atrophy , decrease or loss of specialized secretory cell (parietal cell, chief cells )nChronic inflammatory cell infiltration and H.pylori-induced proliferation of lymphoid tissue within the gastric mucosa. Chronic gastric

22、 ulcerChronic cervicitisVillous adenomas of the colon2. Dysplasia-atypical hyperplasia and INIt is a loss in the uniformity of individual cells,as well as a loss in their architectural orientation. Dysplastic cell: pleomorphism (variation in size and shape) deeply stained (hyperchromatic) and large

23、nuclei more mitotic figures architectural anarchy nDysplasia -It is used to describe disorderly but non-neoplastic proliferation, which is encountered principally in the epithelia. Frequently the mitoses appear in abnormal locations with in the epithelium. The epithelium may revert to normal with re

24、moval of the putative inciting causes.n nThree types:n -Mild dysplasian -Moderate dysplasian -Severe dysplasianThe term intraepithelial neoplasia(IN), as in cervical intraepithelial neoplasia(CIN), is used to embrace both carcinoma in situ and dysplasia. slight(Mild) moderate severe CISintraepitheli

25、al neoplasia I IIIIIdysplasianormal cervical epithelium1 glycogen rich superficial cells2 intermediate cells3 basal cells123koilocytes enlarged nuclei of superficial cellsirregular nuclear contourmultinucleated cellscytoplasmic vacuolationatypical mitosiscarcinoma in situ (CIN III)dysplasia in basal

26、 cellsloss of stratificationloss of differentiationhyperchromasialoss of polarity of cellsatypical mitosesintact basement membraneusually flat growth = not seen by macroscopyexophytic growth (rare)extension of CIS into cervical glandsatypical mitosisnormal CIS3. Carcinoma in situ Refers to an epithe

27、lial neoplasm exhibiting all the cellular features associated with malignancy, but which has not yet invaded through the epithelial basement membrane separating it from potential routes of metastasisblood vessels and lymphatics.nIt is only at this very early stage that excision of a carcinoma will g

28、uarantee a cure. nThe phase of in situ growth may last for several years before invasion commences.Cervical carcinoma in situFigure 1 CIN Figure 2 CINFigure 3 CIN123atypical mitosisMesenchymal neoplasia benign mesenchymal tumors 1. Fibroma-arising in fibrous tissue Affected sites：cutaneous and subcu

29、taneous, connective tissue of limbs and trunkG：grey-white, expansive growth, encapsulation, M: interlacing bundlesPrognosis: good! grow slowly 2. posed of mature adipose tissue. nAffected sites： subcutaneous tissue of limbs and trunknG：encapsulation, n lobulatednprognosis：good! n LipomaM： well diffe

30、rentiated fat3. Angioma(hemangioma) Angioma are abnormally dense collections of dilated small blood vessels (capillaries) that may occur in the skin or internal organs.Affected Sites: on the infants face or headred to reddish purple raised vascular lesion on the skin,possibly massive, markedly eleva

31、ted vascular tumor .types : cavernous hemangioma capillary hemangioma mixed angioma.nSmall superficial hemangiomas should involute completely. Large cavernous hemangioma should be evaluated by a physician and treated appropriatelyHemangiomacapillary hemangiomacavernous hemangiomaHepatic cavernous he

32、mangioma LymphangiomaAn mon benign neoplasm arising from lymphatic vessels manifesting as a raised, soft, shaggy, bubbly, pinkish-white lesion.most common sites: tongue, cheekM: many lymphatic vessels filled with lymphPrognosis: GoodLymphangioma4. leiomyomabenign neoplasm of smooth muscle Affected s

33、ites：esophagus,(uterus, gastrointestinal tract) G: well encapsulated , hard, white, nodular,M: comprised of interlacing bundles of spindle-shaped or stellate smooth muscle cells with elongated, blunt-ended, pale-staining nuclei, little cellular pleomorphism or mitotic activityVery few recurrences no malignant transfo