TUMOR,NEOPLASM. Pathology Department, Zhejiang University School of Medicine,

Transcription

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

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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

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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.)

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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

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