Dr. Manal M.

Sami
Learning Objectives
By the end of this session you should be able to:

 Define: Neoplasm, tumor, cancer, oncology

 Describe the nomenclature of neoplasms.
 Define: "benign" and "malignant".
 Define: "papilloma“, "teratoma" ,"hamartoma" and “Choristoma”
and give examples..
 Define: "mixed tumor and give examples.
 Define: "carcinoma" and "sarcoma" and give examples.
 State the correct name for benign and malignant tumors arising in
each of the following tissues: fibrous tissue, adipose tissue,
cartilage, bone , blood vessels , lymph vessels , stratified squamous
epithelium, epithelium of glands, smooth muscle and striated
muscle.
 Describe the characteristics of benign and malignant neoplasms.
 Define "differentiation", "anaplasia", "desmoplasia".
 Compare the features of "well-differentiated" with
"undifferentiated" neoplasms.
 Compare the relative rates of growth of benign tumors versus
malignant tumors; well-differentiated versus undifferentiated
tumors.
 List the histologic characteristics of dysplasia.
 Identify factors that affect the growth rate of tumors.
 Define "carcinoma-in-situ".
 Define "metastasis" and describe its mechanisms.
 Contrast the pathway of dissemination of carcinoma versus
sarcoma.
Definitions
 Neoplasia = new growth
 Tumor= swelling due to inflammation
 Oncology= oncos is tumor, logy is study
 Cancer= malignant tumors (crab)
NEOPLASM

 "A neoplasm is an abnormal mass of tissue,

the growth of which exceeds and is
uncoordinated with that of the normal tissues
and persists in the same excessive manner
after cessation of the stimuli which evoked the
change“
 Autonomous.
 Clonal.
Nomenclature

Parenchyma Stroma
Proliferating neoplastic Connective tissue and
cells blood vessels
Nomenclature – Benign Tumors
 -oma = benign neoplasm
 Mesenchymal tumors
 chrondroma: cartilaginous tumor
 fibroma: fibrous tumor
 osteoma: bone tumor
 Epithelial tumor
 adenoma: tumor arising from or forming glands
 papilloma: tumor with finger like projections
 papillary cystadenoma: papillalry and cystic tumor forming glands
 polyp: a tumor that projects above a mucosal surface
“He has
melanoma…carcinoma
…some kind of noma.”
 Benign Tumors: Examples
 Adenoma: derived from glands/ glandular pattern
Tubular adenoma,
colon

Normal

Thyroid adenoma
 Papillomas: architecture  finger like projections

Oral papilloma
 Polyp: macroscopic  projection of mucosal surface
Ovarian cystadenoma
 Chondroma

Leiomyoma
Malignant tumors
 Mesenchymal = sarcomas ( sar, fleshy). Fibrosarcoma,
liposarcoma, leiomyosarcoma

 Epithelial = carcinomas, glandular –

adenocarcinoma, squamous – squamous cell
carcinoma
 Squamous cell carcinoma

Adenocarcinoma

Angiosarcoma
Chondrosarcoma Rhabdmyosarcoma
 Mixed: tumors with (divergent) differentiation: epithelial
and stromal component, same origin, i.e. pleomorphic
adenoma
What is this?
 Teratoma: tumor comprised of cells from more than one
germ layer
 arise from totipotent cells (usually gonads)
 benign cystic teratoma of ovary is the most common
teratoma
Teratoma, ovary

Various tissue components of mature cystic

teratoma of ovary: A, skin adnexa, glial
tissue, and choroid plexus; B, gastric mucosa
of pyloric type; C, anterior pituitary gland.
 Confusing Terms
 Malignant tumors that sound benign:
• Lymphoma, mesothelioma, melanoma, seminoma
 Non-tumors that sound like tumors (Aberrant
differentiation):
• hamartoma – mass of disorganized indigenous tissue

• choristoma – ectopic focus of normal tissue (heterotopic)

 Names that seem to come out of nowhere

• Nevus, leukemia, hydatidiform mole
 Know these names!
Tissue of origin Benign Malignant
Fibrous tissue Fibroma Fibrosarcoma
Fat Lipoma Liposarcoma
Cartilage Chondroma Chondrosarcoma
Bone Osteoma Osteogenic sarcoma
Blood vessels Hemangioma Angiosarcoma
Mesothelium Mesothelioma
Hematopoietic cells Leukemia
Lymphoid cells Lymphoma
Squamous epithelium Squamous cell papilloma Squamous cell carcinoma
Glandular epithelium Adenoma Adenocarcinoma
Papillary
Papilloma
adenocarcinoma
Cystadenoma Cystadenocarcinoma
Smooth muscle Leiomyoma Leiomyosarcoma
Skeletal muscle Rhabdomyoma Rhabdomyosarcoma
Melanocytes Nevus Melanoma
More than one neoplastic cell- MIXED
Salivary gland Pleomorphic adenoma Malignant mixed tumor
of salivary gland origin
Renal Wilms tumor

Teratogenous ( from more than one germ cell layer

Totipotential cells Mature teratoma/ Immature teratoma,

dermoid cyst teratocarcinoma
Sample board question
Which of the following describes a benign
tumor arising from skeletal muscle?

A. Leiomyoma
B. Papilloma
C. Rhabdomyoma
D. Leiomyosarcoma
E. Rhabdomyosarcoma
Sample board question
Which of the following describes a benign
tumor arising from skeletal muscle?

A. Leiomyoma
B. Papilloma
C. Rhabdomyoma
D. Leiomyosarcoma
E. Rhabdomyosarcoma
 Biology of Tumor Growth
Benign vs. Malignant
 Malignant
tumors:  Slow growing
1. Malignant change  Encapsulated
in target cell-  Expansile growth
transformation  No Metastasis
2. Growth of  Well Differentiated
transformed cells
3. Local invasion  Rapidly growing
4. Distant  Non encapsulated
metastases  Infiltrative growth
 Metastasis
 Well-Poorly differentiated
Differentiation
 Well differentiated neoplasm
 Resembles mature cells of tissue of origin

 Poorly differentiated neoplasm

 Composed of primitive cells with little differentiation

 Undifferentiated or anaplastic tumor

 Correlation with biologic behavior

 Benign tumors are well differentiated

 Poorly differentiated malignant tumors usually have

worse prognosis
Leiomyoma of the uterus. This benign, well-
differentiated tumor contains interlacing
bundles of neoplastic smooth muscle cells that
are virtually identical in appearance to normal
smooth muscle cells in the myometrium.
 A hallmark of well differentiated squamous cell
carcinoma is that the nests of invading cells still
attempt to make keratin which then gets deposited in
the center of the nests, resulting in a keratin "pearl".

the transition from normal squamous

epithelium into invasive carcinoma
Another characteristic of a well differentiated
squamous cell carcinoma is that it still makes visible
intercellular bridges
Squamous cell carcinoma, well-differentiated

moderately-differentiated

poorly-differentiated Intercellular bridges

 1. Anaplasia  Pleomorphism
 Size
 Lack of differentiation  shape
(Literally, “to form (-  Abnormal nuclear
plasia) backwards morphology
(ana-)”
 Hyperchromasia
 High nuclear cytoplasmic
 Hallmark of malignant ratio
transformation  Chromatin clumping
 Prominent nucleoli
 Numerous  Mitoses
morphologic changes  Mitotic rate
 Location of mitoses
 Loss of polarity
 Pleomorphism: variation in size and shape
 Abnormal nuclear morphology: hyperchormatic
(abundant DNA), increased N:C ratio (normal 1:4- 1:6)
Mitosis

 Mitoses: increased,
bizarre
Loss of polarity

Tumor giant cells

 Dysplasia
 Literally means abnormal growth, it is used to describe
disorderly changes in non-neoplastic epithelial cells.
 Dysplasia may develop into malignancy
 Uterine cervix
 Colon polyps
Graded as low-grade vs high-grade or mild, moderate or severe.
Mild-moderate: usually reversible, Severe: usually progresses to
carcinoma in situ (CIS).
Next step after CIS: invasive carcinoma. Severe dysplasia

Normal squamous epi. Moderate dysplasia

Normal gland Mild dysplasia

Moderate dysplasia Severe dysplasia

 Carcinoma in situ:
Note intact basement
membrane
Tumor Growth Rate
 Growth is dependent on:
• Blood supply
• Hormonal factors
• Emergence of aggressive sub-clones
 Doubling time of tumor cells
 Lengthens as tumor grows
 30 doublings (109 cells) = 1 g
 10 more doublings (1 kg) = lethal burden
 Fraction of tumor cells in replicative
pool
 May be only 20% even in rapidly growing
tumors
 Rate at which tumor cells are shed or
lost
 Apoptosis
 Maturation
 Implications for therapy
Scematic representation of Tumor Growth

Tumor cells undergoing apoptosis

 Features of Malignant Tumors
 Cellular features
 Local invasion
 Capsule
 Basement membrane
 Metastasis: Unequivocal sign of malignancy

Malignant tumor invading kidney Liver studded with metastatic cancer

Fibroadenoma of the breast:
invasive ductal carcinoma of the breast:
Encapsulated, well-demarcated
retracted, infiltrating the surrounding breast
substance.
 Metastasis
 Metastasis = development of secondary tumor
implants in distant tissues
 Metastasis depends on:
• Type of tumor
• Size of tumor
• Degree of differentiation of tumor
 Routes of metastasis:
• Seeding
• Lymphatic spread
• Hematogenous spread

Liver seeded with metastatic ovarian ca.

Carcinoma in situ

Invasive carcinoma
Invasive carcinoma
Metastasizing carcinoma
Lymphatic spread

Tumor in lymphatic

Lymph node
with
metastatic
adeno-
carcinoma
Hematogenous spread
• Veins are easier to invade
than arteries
• Liver and lungs are most
common metastatic
destinations
• Some tumors like other
sites better:
 prostate → bone
 most lung cancers →
adrenals, brain

Sarcoma metastatic to lung