Neoplasia

Dr.K.Vijaya
Professor
Department of Pathology
MIMS,VKB
 NEOPLASIA (TUMORS)

• Definitions
• Nomenclature
• Biology of Tumor Growth
• Epidemiology
• Molecular Basis of Cancer
• Molecular Basis of Carcinogenesis
• Agents (The Usual Suspects)
• Host Defense (Tumor Immunity)
• Clinical Features of Tumors
 Definitions
• Neoplasia - New growth
• Excessive proliferation of cells
• Oncology –study of tumor or
neoplasm
• Cancer –Malignat tumors (derived
from Latin word cancrum meaning
crab)
 Defnition of Neoplasia

• A neoplasm is an abnormal mass of tissue,

• The growth of which exceeds and is
uncoordinated with that of the normal
tissues
• Persists in the same excessive manner
after cessation of the stimuli which evoked
the change” - Willis
 Components of tumor
• Parenchyma –Neoplastic cells
Classification of tumors is based on
parenchyma
• Stroma – connective tissue ,blood vessels,
variable number of cells of immue system
• Growth and spread are dependent on –Stroma
scanty stroma- soft and fleshy Prostatic CA
Abundant stroma- scirrhous CA breast
 Nomenclature of tumors
• Benign –
• Expansile mass of tissue ,composed of well
differentiated cells resembling their tissue of
origin.Amenable to surgery .eg-Lipoma
• Malignant- They are called Cancers
They invade adjacent structures and spread to
distant organs-metastasis,
 Nomenclature – Benign Tumors
• -oma = benign neoplasm
• Mesenchymal tumors
1. Chrondroma: cartilaginous tumor
2. Fibroma: fibrous tumor
3. Osteoma: bone tumor
4.leiomyoma-smooth muscle tumor
5.Rhabdomyoma-skeletal muscle
• Epithelial tumor
1. Adenoma: tumor forming glands
2. Papilloma: tumor with finger like projections
3. Papillary cystadenoma: papillary and cystic tumor
forming glands
• 4. Polyp: a tumor that projects above a mucosal surface
Leiomyoma
Papilloma- tumor with finger like projections
Adenoma- tumor forming glands
Polyp- a tumor that projects above a mucosal
surface
 Nomenclature of malignant tumors

Mesenchymal origin –sarcoma-

• Fibrosarcoma,
• Chondrosarcoma,
• leiomyosarcoma,
• Rhabdomyosarcoma
• Osteosarcoma
 Nomenclature of malignant tumors

• Epithelial origin –derived from any of the

three germ cell layers ecto , endo and
mesoderm are called Carcinomas
• Adenocarcinoma –colon ,kidney
• Squamous cell carcinoma-arising from
squamous epithelium
 Mixed tumors

• Cells derived from

more than one germ
layer. Contain both
epithelial and
connective tissue
• Example is Mixed
tumor of salivary
gland, these neoplasm
are called Pleomorphic
Adenoma
Teratoma
• Originate from totipotent
germ cells that are normally
present in ovaries and
testis.
• They differentiate along
different germ lines
producing ,fat, muscle,
epithelium, Skin ,hair ,tooth
any body tissue. E.g.
Ovarian Cystic teratoma
(Dermoid cyst)
 Special nomenclature
• Malignant tumors that sound benign-Misnomers
Lymphoma
Hepatoma
Mesothelioma
Seminoma
Melanoma
Astrocytoma
Blastoma-tumors arising from immature tissue or
nervous tissue – medulloblastoma, retinoblastoma
 Nonneoplastic growths
Hemartoma
Developmental abnormality
Present at birth
Focal ,circumscribed , tumor like
Improper proportion of tissues normally present in that
part of body –lung chondroma,liver adenoma
Choristoma
Heterotopic rest of cells
Small nodule of normal pancreas found in the
submucosa of stomach,duodenum or small intestine.
 Environmental factors
• Infectious agents
• Smoking
• Alcohol consumption
• Diet
• Obesity
• Reproductive history
• Environmental carcinogens
• Genetic factors
Epidemiology of cancer
 Chatacteristic features of Benign and Malignant
Neoplasms

1.Differentiation and Anaplasia

A.Pleomorphism
B. Abnormal nuclear morphology
C.Mitoses
D.Loss of polarity
E.Other changes
2.Rate of growth
3.Local invasion
4.Metastasis
 Benign Malignant

Surface Smooth Irregular

Capsule Well capsulated Invasive

Size Small to large

Course Rarely fatal Usually fatal

Necrosis Unusual Common

 Characteristics of Benign and Malignant
Neoplasms
• 1.Differentiation and Anaplasia
• The extent to which the neoplastic parenchymal
cells resemble the normal parenchymal cells both
morphologically and functionally .
• Lack of differentiation is called Anaplasia.
• Benign tumors are well differentiated
• Example- lipoma a benign tumor of adipocytes
closely resembles normal adipocytes
• Growth of these cells into a discrete mass
discloses their neoplastic nature.
• Malignant neoplasms exhibit a wide range of
parenchymal cell differentiation
• Well differentiated
• Moderately
• Poorly – malignant neoplasms that are
composed of poorly differentiated cells are
said to be anaplastic
 Anaplasia
• Lack of differentiation ,or anaplasia
• Hallmark of malignancy
• It is associated with many morphological
changes
• A.Pleomorphism
• B. Abnormal nuclear morphology
• C.Mitoses
• D.Loss of polarity
• E.Other changes
1.Pleomorphism –Variation in size and shape
 B.Abnormal nuclear morphology

• Large nuclei
• Abnormal nucleo cytoplasmic ratio
• Instead of 1:4 or 1:6 it may approach 1:1.
• Irregular nucleus, variable in size.
• Coarse clumped chromatin
• Dark staining of nucleus-hyperchromatic
• Abnormal large nucleoli
 C. Mitoses

• Many cells are in

mitoses –rapid cell
growth
• Indicating high
proliferative activity
• Atypical ,bizarre mitotic
figures
 D. Loss of polarity

• The orientation of the anaplastic cells is

markedly disturbed
• Sheets of large masses of tumor cells grow in
anarchic ,disorganized fashion.
• E. Other changes
• As the vascular stroma is insufficient for the
growing tumor cells
• Many of them develop central areas of
ischemic necrosis.
 Metaplasia and Dysplasia
• Metaplsia -Replacement of one type of cell with
another type .It is associated with tissue damage,
repair and regeneration.
• Dysplasia-disordered growth.Loss of uniformity of
the individual cell and loss in their architectural
orientation.
• Carcinoma in situ-when dysplastic changes are
marked and involve the full thickness of the
epithelium ,but the lesion does not penetrate the
basement membrane. Barrett”s esophagus.
• Invasive carcinoma-once there is breach of
basement membrane it is invasive
 2.Rate of growth

• Benign tumors- usually progressive and slow.

May come to a standstill or regress. Mitotic
figures are rare and normal.
• Malignant tumors –Erratic growth ,may be
slow to rapid. Mitotic figures may be
numerous and abnormal.
 3.Local invasion
• Malignant tumors -Progressive invasion
• Infiltration of the surrounding tissue
• Destruction of the surrounding tissue
• Benign tumors grow slowly and develop a rim of fibrous
tissue called capsule .Example- Fibroadenoma of breast
• Exception to this are hemangiomas which are not
encapsulated and permeate the site in which they arise.
• Malignant tumors are poorly demarcated from the
surrounding normal tissue and well defined cleavage plane
is lacking. Example-Carcinoma of breast
• Invasiveness makes their surgical resection difficult. and
therefore a considerable margin of normal tissue adjacent
to the neoplasm has to be removed.