TUMOR,NEOPLASM. Pathology Department, Zhejiang University School of Medicine,
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1 TUMOR,NEOPLASM Pathology Department, Zhejiang University School of Medicine,
2 The points in this chapter What is a neoplasm (conception) Morphology of neoplasm Macroscopy of Neoplasm Histology of Neoplasm Atypia of Neoplasm Growth and Spread of Neoplasm
3 epithelial:adenoma, papilloma benign Mesenchymal: lipoma, leiomyoma neoplasm malignant epithelial(carcinoma) mesenchymal(sarcoma) Hematopoietic and lymphoid system(lymphoma, leukemia) others:immature teratoma, malignant melanoma, carcinosarcoma
4 Neoplasm was an ancient disease and rare in remote Ages Neoplasm could be suffered in human, animal and botany
5 The most common cancer in our country: gastric carcinoma, hepatic carcinoma, pulmonary carcinoma, esophageal carcinoma colorectal carcinoma leukemia & lymphoma cervical carcinoma breast carcinoma
6 Morphology of Neoplasia Gross appearances Please pay attention to following key words: Shape Size Number Color Consistency
7 Shape :varied Local thickness Polyp-like Papillary Nodular Tree-root Ulcer-like Cyst-like Volcano-mouth Crab-like
8 Nodular
9 Cyst-like
10 Ulcer-like
11 Polyp-like
12 Papillary
13 Size Could a neoplasm in small size trend more to be benign? Could a neoplasm in large size trend more to be malignant? Squamous cell carcinoma Femur Osteosarcoma
14 Ovarian mucinous cystadenoma
15 multiple primary tumor Uterus leiomyoma multiple Cylindroma in sweat gland
16 Color Generally speaking, the color of a neoplasia comes from its originated tissue. Benign tumor: similar to its original normal tissues Malignant tumor: fish-flesh, gray-white, gray-yellow,brown and so on
17 Benign or malignant? Lipoma with yellowish color from fat tissue
18 Benign or malignant? Pulmonary carcinoma
19 renal carcinoma
20 Color melanoma Black color
21 Consistency It quite depends on neoplasia s originated tissue. (1). its type:osteoma hard lipoma --soft (2). proportion of parenchyma to stroma: (3). consequent lesions: cystoid,necrosis softening calcification hard
22 Histology of Neoplasm Microscopy: Parenchyma = tumor cells (decide its biological behavior) Stroma = connective tissue + blood vessels to provide mechanical support and nutrition to the neoplastic cells.
23 Parenchyma Stroma Stroma squamous carcinoma
24 stroma parenchyma Adenocarcinoma
25 Atypia of Neoplasm Please attention to four words usually encountered: Atypia( 异型性 ), Differentiation( 分化 ), Dysplasia( 异常增生 ), Anaplasia( 退行性 ) 1. Atypia The noun refers to their difference between neoplasia and their normal forebears, both morphologically and functionally. a. pleomorphism ( 多形性 ) b. disorderliness ( 紊乱 )
26 Atypia of Neoplasm Cell Features of cells: nuclear-cytoplasmic ratio=1:4-6 polarity size and shape chromatin Pathological mitosis Features of tissue Structure of tissue Polarity of tissue
27 Ratio of Nucleus / Cytoplasm Normal cell Tumor cell
28 pleomorphism
29 Cellular pleomorphism with abnormal mitosis
30 Pathological mitosis
31
32 Atypia of Neoplasm tissue abnormal structure and arrangement loss of polarity variation in size and shape invasive growth
33 Normal Well-differentiated Mild differentiated Poorly-differentiated
34 Differentiation The noun refers to the extent to which they (neoplasia cells) resemble their normal forbears, both morphologically and functionally.
35 Benign tumor Normal tissue malignant tumor
36 Growth and Spread of Neoplasm
37 Biology of growth Growth pattern and spread of tumor Mechanisms of local and distant spread in malignant tumors
38 Growth pattern and spread of tumor Growth rate benign tumor slow malignant tumor fast
39 Growth pattern 1. Expansive growth (often benign) 2. Infiltrating growth (often malignant) 3. Exophytic growth (both)
40 Expansive growth
41
42 Expansive growth
43 Invasive growth
44 Invasive growth
45 Invasive growth
46 Exophytic growth
47 Exophytic growth
48 Spread of Neoplasia Including direct spread and metastasis 1. direct spread Malignant tumor cells spreading basement membrane interstitial space lymphatic vessels blood vessels Direct and local spread in cervical carcinoma
49 Three Pathways of Metastasis Lymphatic metastasis Hematogenous metastasis Planting of the transfer
50 Merging of Lymph nodes
51 Metastatic adenocarcinoma in lymph node
52 Hematogeneous metastasis Tumor cells systemic veins lung portal veins liver pulmonary veins all over the body( brain, bone, kidney, adrenal gland, et, al.)
53
54 Multiple and scattering, marginal location, round,
55 Liver metastatic carcinoma
56 spleen metastatic carcinoma
57 Brain metastatic carcinoma
58 osseous metastatic carcinoma pathological fracture
59 Implantation metastasis Seeding in body cavity and surface. common sites: pericardial, pleural and peritoneal cavities results in an effusion of fluid into the cavity,to accompany adherence / fluidify The fluid: rich in protein and may contain the neoplastic cells cytological examination : important in diagnosing the cause of effusions into body cavities.
60 Implantation metastasis
61 Implantation metastasis
62 Krukenberg tumors
63 Implantation metastasis, Ascites
64 Grading and staging of neoplasia
65 Grading and staging of neoplasia Grading cytologic differentiation the number of mitoses grade Ⅰ: well-differentiated ( low potential malignancy) grade Ⅱ : moderately differrentiated (medium potential malignancy ) grade Ⅲ : poorly-differentiated (height potential malignancy ) Undifferrentiated
66 well-differentiated adenocarcinoma
67 well-differentiated SqCa
68
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