(1)

Inflammation: It’s a complex protective response in vascular, living tissue,

intended to eliminate the cause of injury (e.g. microbes, toxins) as well as the
results of injury (necrotic cells).
However it can causes harmful effects:
1. life-threatening anaphylactic shock due to drugs or insects bite & toxins
2. Inflammation of closed space e.g. larynx or pericardium (impaired cardiac
function)
3. Chronic diseases like autoimmune rheumatoid arthritis, atherosclerosis, and
lung fibrosis.
For this reason: Anti-inflammatory drugs used to control the harmful sequel of
inflammation yet not interfere with its beneficial effects.
Classification
Inflammation is divided into
1. Acute inflammation: of short duration (minutes to few days) & characterized
by fluid & plasma exudates together with neutrophils infiltration
2. Chronic inflammation, which may last days to years & characterize by
lymphoplasmacytes & macrophages infiltration together with vascular
proliferation, fibrosis & scaring.

Features of acute inflammation

 Short duration
 Tissue destruction: frequently lesser than in chronic inflammation.
 fluid & plasma exudates together with neutrophils infiltration
 Production of fibrous rather than exudative
 Production of fibrous lesser than exudative

-It is characterized by four key features (Latin terms in brackets):

 Redness (rubor) – secondary to vasodilatation and increased blood flow
 Heat (color) – localized increase in temperature, also due to increased blood
flow
 Swelling (tumoor) – results from increased vessel permeability,
allowing fluid loss into the interstitial space
 Pain (dolor) – caused by stimulation of the local nerve endings, from
mechanical and chemical mediators

Phases of Acute Inflammation

Acute inflammation can be discussed in terms of two stages; (1) the vascular
phase, which is followed by; (2) the cellular phase.

Vascular Phase

In the vascular phase, small blood vessels adjacent to the injury dilate

(vasodilatation) and blood flow to the area increases. The endothelial cells
initially swell, then contract to increase the space between them,
thereby increasing the permeability of the vascular barrier. This process is
regulated by chemical mediators (see Appendix).

Exudation of fluid leads to a net loss of fluid from the vascular space into the
interstitial space, resulting in oedema (tumour).

The formation of increased tissue fluid acts as a medium for which inflammatory

proteins (such as complement and immunoglobulins) can migrate through. It may
also help to remove pathogens and cell debris in the area through lymphatic
drainage.

Cellular Phase

The predominant cell of acute inflammation is the neutrophil. They are attracted

to the site of injury by the presence of chemotaxins, the mediators released into
the blood immediately after the insult.

The migration of neutrophils occurs in four stages :

 Margination – cells line up against the endothelium

 Rolling – close contact with and roll along the endothelium
 Adhesion – connecting to the endothelial wall
 Emigration – cells move through the vessel wall to the affected area

Features of chronic inflammation

• Long duration: persists for weeks, months or years
• Tissue destruction: frequently greater than in acute inflammation.
• The inflammatory infiltrate is a mixture of macrophages, lymphocytes and
plasma cells + - giant cells.
• Production of fibrous rather than exudative
• Formation of granulation tissue & new blood vessels formation .
-characteristic of chronic inflammation
 May follow acute inflammation
 Long in duration
 Associated with the presence of lymphocyte and macrophage
 Angiogenesis, fibrosis and tissue destruction may occur

(2)
Cancer :
 An uncontrolled division of abnormal cell in a part of the body in cancer cell
 When good cell go bed
 Loss of cell-cycle control
 Before a cell divides ,DNA is checked to make sure it has replicated
correctly.(if DNA does not copy itself correctly, gene mutation occurs.
Classification of cancer by the type of cell :
 Carcinoma
 Sarcoma
 Lymphoma and leukemia
 Germ cell tumor
 Blastoma

Properties of cancer cell :

• Two unique properties of cancer cells are

– ability to invade locally

– capacity to metastasize to distant sites to distant sites – cancer spreading

(patterns of spread)

Patterns of spread: Direct extension :Carcinomas begin as localized growths

(direct seeding of body cavities or surface ), when they arise .In early cancers do
not penetrate the basement membrane (carcinoma in situ .(When the in situ tumor
acquires invasive potentia extends directly to compromise neighboring cells and to
metastasize .E.g .Peritoneal carcinomatosis (metastatic ovarian carcinoma)

• Patterns of spread:

– Direct extension

– Metastatic spread: Transfer of malignant cells from one to another (not directly
connected with it)Invasive properties of malignant tumors bring them into contact
with blood and lymphatic vessels.

•Hematogenous metastases

•Lymphatic metastases

 Cancer cell show uncontrolled mitotic division causing unorganized growth

 Due to uncontrolled growth and division of cell ,a tumor ( also called
neoplasm is generally formed )
 They are far less adhesive than the normal cell
 They exhibit the number of alteration on cell surface ,in the cytoplasm and
their genes
 They don’t undergo differentiation
 They loss the ability to communicate with other cell through chemical
signals
 They also lose sensitivity to anti-growth signal from surrounding cell
 They lose the adhesion molecules that keep from bonded to neighboring
cell
 Cancer arises from a loss of normal growth control
 Cancer is a genetic disease :
  Inherited cancer
 Sporadic cancer
 Cancer typically involves a change in gene expression/function :
 -qualitative change
 -quantitative change
 Lack of contact inhibition
 Loss of limitation on the number of cell division
 Ability to grow in culture (medium)-normal cell do not grow well in
culture
 In laboratory cultures, normal cell divide only when attached to a surface
 Angiogenesis-secrete substances that cause blood vessel to grow toward
tumor

What is a tumor?

ANSWER
A tumor is a mass of tissue that's formed by an accumulation of abnormal cells.
Normally, the cells in your body age, die, and are replaced by new cells. With
cancer and other tumors, something disrupts this cycle. Tumor cells grow, even
though the body does not need them, and unlike normal old cells, they don't die. As
this process goes on, the tumor continues to grow as more and more cells are added
to the mass.
there are three main types of tumor:
Benign: These are not cancerous. They either cannot spread or grow, or they do so
very slowly. If a doctor removes them, they do not generally return.
Premalignant: In these tumors, the cells are not yet cancerous, but they have the
potential to become malignant.
Malignant: Malignant tumors are cancerous. The cells can grow and spread to
other parts of the body.
It is not always clear how a tumor will act in the future. Some benign tumors can
become premalignant and then malignant. For this reason, it is best to monitor any
growth.

Benign :
Most benign tumors are not harmful, and they are unlikely to affect other parts of
the body.
However, they can cause pain or other problems if they press against nerves or
blood vessels or if they trigger the overproduction of hormones, as in the endocrine
system
Examples of benign tumors include:
Adenomas

Adenomas develop in glandular epithelial tissue, which is the thin membrane that
covers glands, organs, and other structures in the body.

Fibroids
Fibroids, or fibromas, are benign tumors that can grow on the fibrous or connective
tissue of any organ.
Uterine fibroids are common and can cause:
-vaginal bleeding
-pelvic pain or discomfort
-urinary incontinence

There are many types of fibroma, including:

-angiofibromas, which can appear as small red bumps on the face
-dermatofibromas, which appear on the skin, often on the lower legs
Hemangiomas
Hemangiomas are benign tumors that form when blood vessels grow excessively.
They can appear as red “strawberry marks” on the skin or they can develop inside
the body. They are often present at birth and disappear during childhood.
Hemangiomas do not usually need treatment, but laser surgery and other options
are available if they do not go away.

Premalignant
This type of tumor is not cancerous, but it needs close monitoring in case it
changes

Malignant
Malignant tumors are cancerous. They develop when cells grow uncontrollably. If
the cells continue to grow and spread, the disease can become life threatening.
Malignant tumors can grow quickly and spread to other parts of the body in a
process called metastasis.
Characteristics of tumors
• Majority of neoplasms can be categorized clinically and morphological into
benign and malignant on the basis of certain characteristics listed bellow
Rate of growth
– Cancer phenotype and stem cells
– Clinical and gross features
– Microscopic features
– Local invasion (direct spread)
– Metastasis (distant spread)
– The tumor cell proliferate more rapidly than the normal cells.
– The tumor enlarge rate is depends upon
1. Rate of cell production, growth fraction and rate of cell loss
2. Degree of differentiation of the tumor
1. Rate of growth of a tumor depends upon
• Doubling time (mitotic rate of tumor cells)
• Number of cells remaining in preoperative pool (growth fraction)
• Rate of loss of tumor cells by cell shedding
(Cancer cell do not follow the normal cell controls in cells ,and are immortal .The
cell division rate is high and center of tumor do not receive adequate nourishment
and undergo ischemic necrosis ,loss shedding. Death tumor cells appear as
apoptotic figures and dividing tumors are seen as normal /abnormal mitotic figurea
ultimately tumor grow in size)
Rate of growth
2. Degree of differentiation
• Rate of growth of malignant tumor is directly proportionate to the degree of
differentiation.
• Poorly differentiated tumors show aggressive growth pattern compare to better
differentiated tumors.
• Rarely ,a malignant tumor may disappear spontaneously from the primary site
,due to good host immune attack
  Cancer phenotype and stem cells
Cancer cells
1. disobey the growth control –proliferate rapidly
2. escape from death signals –immortality
3. imbalance between cell proliferation and cell death –excessive growth
4. lose differentiation properties –no function
5. are unstable –newer mutations
6. overrun their neighboring tissue –invade locally
7. have the ability to travel from the site of origin to other part of body – distant
metastasis

Cancer stem cells /tumor-initiating cells have the properties of self-renewal ,

asymmetric replication and transdiffirentiation (i.e .plasticity )
• Clinical and gross features
– Benign tumor are generally slow growing and depending upon location remains
asymptomatic (subcutaneous lipoma (or may cause serous symptoms (meningioma
in the nervous system .(Benign tumors are generally spherical or ovoid shape.
– Malignant tumor grow rapidly ,invade locally into deeper tissue and spread to
distant sites) metastasis .( Malignant tumors are usually irregular in shape
,poorcircumscribed and extend into adjacent tissues)
• Microscopic features
– Microscopic pattern
– Cytomorphology of neoplastic cells
– Tumor angiogenesis and stroma
– Inflammatory reaction
• Local invasion (direct spread)
– Benign :expand and push aside without invading ,infiltrating or metastasizing
. – Malignant :expand ,invasion ,infiltration and destruction of the surrounding
tissue.
• Metastasis (distant spread)
– Metastasis (meta =transformation ,stasis =residence (: spread of tumour by
invasion
. – Routes of metastasis
• Lymphatic spread
• Haematogenous spread
• Spread along body cavities and natural passagesss