PATHOLOGY

Benign and malignant connective

tissue / mesenchymal tumors
Melanocytic tumors
Teratomas

Lab 9-10
MORPHOLOGY OF BENIGN AND MALIGNANT CONNECTIVE TUMORS

BENIGN CONNECTIVE TISSUE TUMORS MORPHOLOGY OF MELANOCYTIC TUMORS

•Macroscopy: •Macroscopy:
• Uterine leiomyoma • Malignant melanoma of the eye
• Lipoma - subcutaneous fat • Malignant melanoma of the skin
• Chondroma • Metastases of malignant melanoma (brain, lymph nodes,
• intestine, pancreas, liver)
Skin hemangioma
• Cavernous hemangioma - liver •Microscopy:
• Microscopy: • Compound melanocytic nevus
• Cutaneous malignant melanoma
• Chondroma
• Capillary hemangioma - skin  MORPHOLOGY OF TERATOMAS
• Cavernous hemangioma - liver
•Macroscopy:
MALIGNANT CONNECTIVE TISSUE TUMORS • Mature cystic teratoma - ovary
•Macroscopy: • Solid teratoma - testis

• Soft tissue sarcoma •Microscopy:

• Parosteal osteosarcoma - femur • Solid and cystic teratoma with mature tissues(testis,
ovary)
•Microscopy:
• Fibrosarcoma
• Osteosarcoma
Mesenchymal tumours
Benign and malignant
Mesenchymal tumours
• They are tumours with origin in multipotent mesenchymal cells that
can differentiate and form differentiated connective tissues.
• Classification &Terminology
• By evolution:
• Benign: suffix –oma added to the cell of origin
• Malignant: suffix – sarcoma added to the cell of origin
• By tissue origin:
Benign Mesenchymal Tumors Malignant Mesenchymal Tumors
+OMA +SARCOMA
Lipoma Liposarcoma
Chondroma Chondrosarcoma

Fibroma Fibrosarcoma
Osteoma Osteosarcoma
Hemangioma, limfangioma Angiosarcoma
Benign Mesenchymal Tumors
Chondroma
Macroscopy
•nodular tumor
•well circumscribed
encapsulated
•blue, translucent
•3 cm in diameter
•the tumor mass is
crossed by whitish
streaks

Benign tumor of the hyaline cartilaginous tissue

 Chondroma
• Benign tumor are formed by hyaline
cartilaginous tissue
• Origin; condroblast
• Microscopy
 Nodular, well circumscribed and
encapsulated tumor
 Is composed by lobules of mature
hyaline cartilage separated by
connective vascular axes with role of
support and nutrition
 The tumoral cartilage is composed from
basophilic cartilaginous matrix
(chondrin) presenting chondroplasts that
contains mature chondrocytes
• the capsule and the connective-vascular axes
differentiate the benign tumor from the
hyaline cartilage
Subcutaneous lipoma
Macroscopy
•Nodular, well
circumscribed tumor,
encapsulated
•On cross section - the
yellowish tumor mass is
crossed by whitish streaks
(adipose tissue lobules
separated by fibrous axes)

Benign tumor of the adipose tissue

 UTERINE LEIOMYOMA (LEIOMYOMATOSIS)

Gross - on the cross section

- well-defined tumors, non
encapsulated, with
fasciculate appearance
("whirlpools") and white-
pinkish in color.
- solitary or multiple nodules
(leiomyomatosis)
Location:
• submucosal
• intramural
• subserously

http://www.pathologyatlas.ro/leiomiomul-uterin-morfopatologie-genitala.php

Benign tumor of the smooth muscle tissue

FIBROID UTERINE LEIOMYOMA
(LEIOMYOMATOSIS)
 LEIOMYOMA

Location: myometrium
Hormonal stimulus:
hyperestrogenism
Microscopy:
nodular tumor, located in the
myometrium, well
circumscribed, not
encapsulated!
tumor consists of bundles of
smooth muscle cells disposed
in various directions
cells are elongated with
eosinophilic cytoplasm and
nuclei with rounded ends

HE
Benign tumor of the
smooth muscle tissue
 Capillary hemangioma-skin
• location: skin
• various dimensions: mm-cm
• red or bluish lesions
• flat or slightly raised
• irregular edges
• covered with intact
epithelium
• The vessels have a
functional character: the
skin discolors when is
compressed and recolors
when compression ceases
Benign tumor of the blood vessels
Capillary hemangioma-skin

• A benign tumor formed from

numerous blood vessels.
• Origin-endothelial cells
• The tumor is located at the level of
superficial and profound dermis.
• Is formed by tumoral lobules that
contain numerous capillary vessels
bounded by connective tissue bands.
• The tumor has a lobular growth that
confers a pseudo - infiltrative
character.
• The tumoral capillary vessels are lined
by a normal endothelium. Some of
them are unopened or collapsed, the
others are opened and contain blood.
Capillary hemangioma-skin

HE
 Capillary hemangioma-skin

HE HE

It has lobular growth - pseudoinfiltrative character. The tumor capillary vessels are lined by a normal
The vascular lobules contain numerous capillary vessels, endothelium. Some of them are unopened or collapsed,
being separated by bands of connective tissue. the others are opened and contain blood.
Cavernous hemangioma - liver

Gross - a dark-red, spongy mass, with variable dimensions

(1-2 cm or more); lobular structure & irregular edges.
• benign tumor
composed of large-
sized blood vessels
• location: liver
Gross:
• brown in color
• spongy appearance
• lobular structure
• irregular edges -
pseudoinfiltrative
character!
• Unencapsulated!
Cavernous hemangioma - liver

HE HE
HE
Cavernous hemangioma - liver
• Is a benign tumor formed by numerous
large vessels located in the liver
• The tumor is composed by tumoral
lobules containing many large vessels
separated by connective tissue.
• The large vessels
• have different shapes and size
• are lined by a normal endothelium
• contain blood or thrombi.
• The tumor has lobular growth and
irregular edges: pseudo- infiltrative
character
Malignant Mesenchymal Tumors
 Soft tissue sarcoma

• origin: in atypical fibroblasts

• bulky tumor
• rapid growth
• develops on wide fronts, compressing adjacent
tissues (pseudoencapsulation - by compression on
neighboring tissues)
• on cut surface - lobular, fleshy appearance
• pinkish-white color, resembling with fresh meat
("sarcos")
• areas of necrosis and hemorrhage
• gives early hematogenous metastases
Fibrosarcoma
• Is a malignant tumor resulting from
proliferation of atypical fibroblasts.
• Microscopy
 The tumor has a hypercellular
feature, is composed from
fusiform atypical cells, disposed
in bundles, with a reduce
production of collagen fibers.
 The tumoral cells are
resembling with fibroblasts,
they have moderate
pleomorphism and a greater
number of mitoses than
differentiated fibrosarcoma.
 The tumoral stroma contains
sarcomatous vessels.
 Fibrosarcoma
• Malignant connective tissue
tumor
• Origin: fibroblasts
• Hypercellularized tumor,
composed of:
• Atypical fusiform cells,
arranged in bundles and
reduced collagen fiber
formation
• Tumor cells resemble with
fibroblasts, have moderate
pleomorphism, and a higher
number of mitoses
• The tumor stroma contains
sarcomatous vessels

HE
Osteosarcoma
Macroscopy
•is a large tumor, white-gray in color
with areas of necrosis and
haemorrhage
•the tumor is covered by periosteum
and surrounds the metaphysis as a
collar, destroying suprajacent cortex
and adjacent soft tissues and
subsequently invades bone marrow
channel
 OSTEOSARCOMA

• malignant connective tissue tumor that forms

tumor bone (osteogenic sarcoma)
• Origin: osteoblast
• 2 macroscopic forms: central (origin: endost)
parosteal (origin: periosteum)
• Location: lower extremity femur
Gross:
• tumor with extra- and intraosseous development
• forms a collar around the distal end of the femur
• Infiltration of the medullary canal
• white-pink color (fresh meat)
• areas of necrosis and hemorrhage
 Well-
differentiated
osteosarcoma

HE HE
 Osteosarcoma
• Is a malignant tumor that forms
tumoral bone = osteogenic
sarcoma
• Origin-osteoblast
• In the structure of the tumor we
can put in evidence:
 Areas of fusiform non-
differentiated cells with
sarcomatous aspect.
 Strands of osteoid tissue
(unmineralized bone)
 The osseous lamellae
containing atypical cells
(mineralized bone)
 The tumor contains
sarcomatous vessels,
necrosis and hemorrhage
Osteosarcoma

HE HE
BENIGN AND MALIGNANT
MELANOCYTIC TUMORS
Melanocytic tumors

• Melanocytic tumors originate in melanocytic

cells
• These cells are synthesizing melanic pigment
• There are 2 types of melanocytic tumors:
• benign: nevi
• malignant: malignant melanomas
Skin-Melanocytic Nevi
• They are cutaneous benign melanocyte tumors
• They have origin in the melanocytes from basal layer of
epidermis
• Microscopically, nevi could be
 jonctional
 compound
 intradermal
 2 types
 congenital
 acquired
Acromic cerebriform nevus

• Giant congenital nevus

• It is large
• The external surface is irregular
and resembles cerebral
convolutions
• It has a wide implantation base
• The congenital nevus has hairs
• It's achromic
Pigmented cerebriform nevus

• Pigmented giant congenital

nevus
• It is large
• The external surface is irregular
and resembles cerebral
convolutions
• It has a wide implantation base
 MELANOCYTIC NEVUS

• benign melanocytic tumor

Microscopy:
• architecture: islands of
tumor cells:
• melanocytes without atypia
• some with melanin pigment
in the cytoplasm
• show deep maturation (as
they descend into the
dermis they become smaller
and longer)

HE
HE
 Compound nevus
• Nests of nevus cells in
epidermis and subjacent
dermis
• The nevus cells have uniform,
round nuclei, without mitotic
activity
• By passing from epidermis
toward dermis the nevus cells
become smaller and elongated
– phenomena called
maturation
Morphological changes that indicate
the malignant transformation of a
nevus into melanoma

ABCD rule
•Asymmetry
•Irregular borders
•Varied coloration
•Greater diameter than 6 mm
 Cutaneous malignant melanoma
• It is a malignant tumor with origin in epidermal melanocytes
• Macroscopy: 2 types of growing
• Horizontal or radial growth superficial malignant melanoma
• Vertical growth  nodular malignant melanoma
• Microscopically, there are two histological types:
 Round or poligonal cells  Epitheloid malignant melanoma
 Fusiforme cells  Sarcomatoid malignant melanoma
Development of melanoma

http://cancerlink.ru/enmelbiology.html
Malignant melanoma
malignant melanocytic
tumor

Location: skin

Gross: nodular tumor

blackish-brown in color,
uneven pigmentation
ulcerated
irregular margins
Infiltrative character !!

vertical growth type

(nodular tumor)

Nodular prominent pigmented lesion,

with irregular margins (black in color)
 Malignant skin melanoma
developed on a giant nevus

• giant nevus with hairs

• location: posterior thorax
• irregular lesion with
variable pigmentation and
irregular edges
MM metastasis -Multiple nodules black in color
 Eyeball melanoma

• Origin: melanocytes of
the pigment layers of the
choroid, iris, ciliary body
• Black-brown tumor
occupying the posterior
chamber of the eyeball
• Melanoma metastasizes
through the lymph, blood
or optic nerve
Melanoma metastases
in the occipital lobe

Melanoma metastases in
the occipital lobe
•well-defined nodules
•color: brown-black
•location: occipital lobe
•metastasis via the optic
nerve
 Lymph node metastasis of
malignant melanoma

• enlarged lymph node

• on the cut surface -
brown-black areas →
melanoma metastases
• location: latero-cervical
lymph node
Malignant melanoma metastasis in the pancreas

• multiple nodules
located in the
pancreatic
parenchyma
• variable
dimensions
• black brown color
Metastasis of melanoma in the duodenum

metastatic nodule in the duodenum covered with normal mucosa

Intestinal metastases of melanoma

• multiple black
nodular lesions
• various sizes
• covered with
normal or
ulcerated
mucosa
Mesenteric lymph node metastases of melanoma

• the lymph
nodes are
enlarged
• on the cut
surface -
brown-black
areas →
melanoma
metastases
Liver metastases of melanoma

• multiple nodules
• variable dimensions
• well delimited
• brown-black color
HE
Cutaneous malignant melanoma

HE HE
 Cutaneous malignant melanoma

HE
• malignant melanocytic tumor
Microscopy:
• architecture: islands, non-cohesive
cells
• cells: polygonal, with abundant
amphophilic cytoplasm, pleomorphic
nuclei, some with nucleoli
• some cells contain brown melanin
pigment in the cytoplasm
• high mitotic activity & atypical mitoses
• ulcerated on the surface
• Infiltrative character !!
Malignant melanoma

MICROSCOPY
The tumor has an infiltrative
character in the subjacent dermis
The tumor is composed from
sheets of atypical, spindle
melanocytes with elongated,
hyperchromatic and pleomorphic
nuclei & atypical mitoses
The stroma is reduced and
contains melanophages
(macrophages with melanic
pigment)
The tumor contains necrotic
areas
TERATOMAS
 Teratomas with mature tissues
• The tumor develops from multipotent germ cells
(originating in the 3 embryonic sheets)
• Location: ovary and testis, midline
• They appear as solid or cystic tumors
• Association of various mature tissues: nerve tissue,
bone tissue, cartilaginous tissue, digestive
epithelium, respiratory epithelium, thyroid
Cystic ovarian teratoma with mature tissues
Gross
•is a unilocular cyst:
• wall with internal epidermal
and external dermal
structures;
• Localized wall protuberance
• prominence containing
various tissues: neural
tissue, respiratory and
intestinal epithelium,
cartilage, teeth
presence.
• Cavity content: hair,
sebaceous material &
keratin
Cystic ovary teratoma with mature tissues

Cystic tumor
•wall
• Internal surface - epidermis
• External surface – dermis;
→ A prominent structure
containing teeth & various
mature tissues
•cavity
• sebum, hair, keratin
Cystic ovarian teratoma

HE HE
 Cystic ovarian teratoma with
mature tissues
• The tumor has origin in the germinal
multipotent cells (with origin in the
3 embryonic layers)
• Histological section through the cyst
wall  numerous mature tissues:
 Sheets of hyaline cartilage
 Fibrous tissue
 Muscular cells
 Neural tissue
 Respiratory epithelium
 Adipose tissue
 Microcystic spaces lined by a
mucosecretory glandular
epithelium
• The tissues are chaotically disposed
and have no relation with the place
where they develop.
 Cystic ovarian teratoma
Histological section
through the cyst wall

- numerous mature
tissues arranged
disorderly and unrelated
to the place where they
develop
- hyaline cartilage sheats
- fibrous tissue
- muscle cells
- nervous tissue
- microcystic spaces lined
by a mucosecretory
glandular epithelium HE
 Microcystic teratoma - testis
• The tumor is solid; on cut surface - different types of mature
tissues can be seen: cartilage, fibrous tissue & microcystic spaces
lined by respiratory epithelium
Microcystic teratoma of the testis with mature tissues

Gross
•Teratoma is composed
of collections of
heterogeneous organized
structures with benign
appearance:
•solid translucent areas
(cartilage) and
•microcystic spaces
Micro cystic
testicular teratoma
with mature tissues
• The tumor has origin in
multipotent germinal
cells (origin in the 3
embryonic layers)
• Is composed from
multiple normal tissues :
• Sheets of hyaline
cartilage
• Fibrous tissue
• Microcystic spaces
lined by respiratory
epithelium
• The tissues are
disorderly disposed and
normaly, they are not
located in this place
References