Pathology of neoplasia by sammyc2007

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									Neoplasia

“Never let the competition define you. Instead, you have to define yourself based on a point of view you care deeply about.”
– Tom Chappel

Shashi-Aug-08

Pathology of Neoplasia
Dr. Venkatesh M. Shashidhar.
Senior Lecturer in Pathology Fiji School of Medicine

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Introduction:
 Inflammatory,

Neoplastic  Growth – Increase in size due to synthesis of tissue components.  Proliferatation- Cell division.  Differentiation: functional and structural maturity of cells.  Tumor – Swelling / new growth / mass
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Degenerative &

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Controls of Growth:
 Cytokines:

Cyclins, Cyclin dependent kinases (CDK).  Growth factors – PDGF, FGF  Growth Inhibitors.  Cancer suppressor genes – p53  Oncogenes – c-onc, p-onc, v-onc etc.

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Non-Neoplastic Proliferation:
*Controlled & Reversible
Hypertrophy – Size  Hyperplasia – Number  Metaplasia – Change  Dysplasia – Disordered


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Neoplastic Proliferation:
Uncontrolled & Irreversible*  Benign
– Localized, non-invasive.
 Malignant

(Cancer)

–Spreading, Invasive.

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Neoplasia:
Purposeless, Pathologic, Proliferation of cells characterized by loss of control over cell division.  DNA damage at growth control genes is central to development of neoplasm.  Carcinogens – Chemical, physical & genetic  DNA damage  Neoplasm.
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 Progressive,

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Willis Definition:
 Neoplasm

is an abnormal mass of tissue the growth of which exceeds and is uncoordinated with that of normal tissue and persists in the same excessive manner after cessation of the stimuli which evoked the change

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Pathogenesis of Neoplasia:
Normal  Hyperplasia  Metaplasia (DNA damage)  Dysplasia  (DNA damage)  (DNA damage) Anaplasia (DNA damage) Infiltration  (DNA damage)  Metastasis….  Progressive DNA Damage – features of neoplasia.


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Pathogenesis of Neoplasia:


Non lethal DNA Damage leading to uncontrolled cell division.

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Mechanism of Neoplams
Normal Adaptation Benign Malignant

Non-Neoplastic
(Polyclonal)
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Neoplastic
(Monoclonal)

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Structure of Neoplasm:
cells parenchyma. Non-neoplastic - stroma (Connective tissue & BV) growth  less stroma Less stroma  more necrosis,
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Neoplastic

Fast

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Biology of Neoplasm:
of origin  Rate of growth  Differentiation  Local Invasion  Metastasis
 Cell

cancer  Grade - low, high  Well, Mod, P, Un.  Staging  Staging

 Lung

Lung cancer: Squamus cell carcinoma. Poorly differentiated, high grade, stage 4, Liver+
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Benign
growing,  capsulated,  Non-invasive  do not metastasize,  well differentiated,  suffix “oma” eg. Fibroma.
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Malignant:
 Fast

 Slow

growing,  non capsulated,  Invasive & Infiltrate  Metastasize.  poorly differentiated,  Suffix “Carcinoma” or “Sarcoma”

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Nomenclature: Cell of origin +
Suffix - oma  Fibroma  Osteoma  Adenoma  Papilloma  Chondroma

Suffix

Carcinoma / Sarcoma  Fibrosarcoma  Osteosarcoma  Adencarcinoma  Squamous cell carcinoma  Chondrosarcoma

Exceptions: Leukemia, Lymphoma, Glioma,
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Grading & Staging of Tumor
 Grading

– Cellular Differentiation (Microscopic)  Staging – Progression or Spread (clinical)

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TNM: Staging of tumor:

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Pathways of Spread:
 Direct

Spread  Body cavities  Blood vessels  Lymphatic vessels
 Lungs

– Systemic Venous blood  Liver – GIT venous return, nutrition.  Brain – End arteries.
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Tumor Diagnosis:
 History

and Clinical examination  Imaging - X-Ray, US, CT, MRI  Tumor markers Laboratory analysis  Cytology –Pap smear, FNAB  Biopsy - Histopathology, markers.  Molecular Tech – Gene detection.

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Bilateral Cystadenoma Ovary:

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Lipoma Intestine:

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meningioma

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Lung carcinoma

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Hepatic Adenoma:

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Carcinoma Breast:

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Carcinoma Lung:

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Osteo - sarcoma:

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CT: metastatic adenocarcinoma

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Biopsy – Slide preparation

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staining

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Colon Polyp:

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Hepatic Adenoma:

Normal

Adenoma

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Anaplasia in Sarcoma:

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Anaplasia:

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Hepatic Adenocarcinoma:

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Hepatic Adenocarcinoma:

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Liver Metastasis:

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Clinical Features.
 Tumor

Impingement on nearby structures
– Pancreatic ca on bile duct  Obst. Jaund.

 Ulceration/bleeding

– Colon, Gastric, and Renal cell carcinomas
 Infection  Rupture

(often due to obstruction)

– Pneumonia, Urinary inf.

or Infarction

– Ovarian, Bladder, colon,
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Cancer Cachexia
 Progressive

weakness, loss of appetite, anemia and profound weight loss (>20%)  Often correlates with tumor mass & spread  Etiology includes a generalized increase in metabolism and central effects of tumor on hypothalamus  Probably related to macrophage production of TNF-a
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Paraneoplastic Syndromes
Due to Products released by tumor  Cushing’s Syndrome  Adrenal, Lung Ca – ACTH  Inappropriate ADH syndrome (Hyponatremia) – lung ca  Hypothalamic tumors (vasopressin)  Hypercalcemia – Ca is the common cause. – lung.  Hypoglycemia - insulin or insulin like activities Fibrosarcoma, Cerebellar hemangioma.

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Skull in Myeloma:

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summary
 neoplasia-

uncontrolled cell division non responsive to growth controls.  Benign and Malignant  Naming – Cell of origin + Suffix  Oma, Carcinoma, Sarcoma  benign  slow-growing, welldifferentiated, localized, do not metastasize, amenable to surgery.
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summary
 malignant

neoplasms tend to be fastgrowing lesions which invade normal structures  malignant neoplasms vary in the degree of differentiation and some show anaplasia.  malignant neoplasms are capable of infiltration, invasion & metastasis.
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summary
 The

prognosis of a patient with any type of neoplasm depends on a number of factors including: the rate of growth of the tumor, the size of the tumor, the tumor site, the cell type and degree of differentiation, the presence of metastasis, responsiveness to therapy, and the general health of the patient.

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NEOPLASM

Uncontrolled cell Division

(DNA abnormality)

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Self Assessment Questions:
What is a neoplasm? Write two special characters?  What is a papilloma, adenoma  What is dysplasia, Metaplasia, Anaplasia Hyperplasia? Mention examples?  Mention major classes of neoplasms with five differentiating features?  Mention three features of malignant tumor?

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Self Assessment Questions:
 What

is carcinoma-in-situ?  What is grading? And staging?  How are neoplasms named?  What is CIN? Classify  What are the common routes of cancer spread?  How do we diagnose cancer?  Brief note of tumor markers?
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“Don’t fight a battle if you don’t gain anything by winning.”
–George S. Patton

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To be a great champion you must believe you are the best. If you’re not, pretend you are….!
– Muhammad Ali

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•Learning is the beginning of wealth. •Learning is the beginning of health. •Learning is the beginning of spirituality. •Learning is where miracles begin.
– Jim Rohn

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