CBL neoplasia

Dr.Shorouk Abdel Gawad Eldeeb

• Case 1
• A 40-year-old man has stool sample is positive for
occult blood during a routine physical examination.
A colonoscopy is performed and a 0.9-cm,
circumscribed, sessile mass found in the upper
rectum which was excised. Which of the following
terms best describes this gross lesion?
• A. Adenoma
• B. Carcinoma
• C. Choristoma
• D. Hamartoma
• E. Hyperplasia
• Discrete small mass such as that described is
probably benign. Adenomas arise from
epithelial surfaces. Though adenocarcinoma
may arise from a colonic adenoma, such
malignant lesions tend to be larger and more
irregular. A choristoma is a benign mass
composed of tissues not found at the site of
origin. A hamartoma is a rare benign mass
composed of tissues usually found at the site
of origin. A hyperplastic colonic lesion tends to
be smaller and flatter.
• Case 1
• A 40-year-old man has stool sample is positive for
occult blood during a routine physical examination.
A colonoscopy is performed and a 0.9-cm,
circumscribed, sessile mass found in the upper
rectum which was excised. Which of the following
terms best describes this gross lesion?
• A. Adenoma
• B. Carcinoma
• C. Choristoma
• D. Hamartoma
• E. Hyperplasia
• Case 2
• 13ys old boy present with slowly growing lesion
at knee joint, X ray revealed mushroom shaped
lesion at distal femur, which was excised, this was
the microscopic picture, Which of the following is
the most likely diagnosis?
• A. lipoma
• B. Osteochondroma
• C. Osteosarcoma
• D. osteoclastoma
• E. Metastatic tumour
• Case 2
• 13ys old boy present with slowly growing lesion
at knee joint, X ray revealed mushroom shaped
lesion at distal femur, which was excised, this was
the microscopic picture, Which of the following is
the most likely diagnosis?
• A. lipoma
• B. Osteochondroma
• C. Osteosarcoma
• D. osteoclastoma
• E. Metastatic tumour
• Case 3
• A 69-year-old woman has experienced increasing
malaise and a 10-kg weight loss over the past year.
She dies of massive pulmonary thromboembolism.
The gross appearance of the liver at autopsy is
shown in the figure. Which of the following best
describes the lesions seen in her liver? ‫اﺧذ ﻋﯾﻧﺔ ﺑﻌد‬
• A. Hepatocellular carcinoma ‫اﻟﻣوت‬
• B. Invasive angiosarcoma
• C. Metastatic adenocarcinoma
• D. hepatic adenomas
• E. Leukemic infiltration
• The figure shows the appearance of multiple
variably sized tan metastatic lesions in the liver
from hematogenous spread of carcinoma.
Adenocarcinomas from abdominal primary sites
such as colon, pancreas, and stomach are most
likely. Thromboembolism suggests a
hypercoagulable state such as a paraneoplastic
syndrome. Angiosarcomas of the liver are
uncommon.
• A primary malignancy typically appears as a
dominant mass, not multiple masses.
Although some benign tumors, such as
leiomyomas of the uterus, can be multiple,
this is not the rule in the liver, and hepatic
adenomas are rare. Although hepatocellular
carcinomas can have “satellite” nodules,
widespread nodules such as those seen in the
figure are more characteristic of metastases.
• leukemic infiltrates typically do not produce
large mass lesions.
• Case 3
• A 69-year-old woman has experienced increasing
malaise and a 10-kg weight loss over the past year.
She dies of massive pulmonary thromboembolism.
The gross appearance of the liver at autopsy is
shown in the figure. Which of the following best
describes the lesions seen in her liver?
• A. Hepatocellular carcinoma
• B. Invasive angiosarcoma
• C. Metastatic adenocarcinoma
• D. hepatic adenomas
• E. Leukemic infiltration
• Case 4
• A 32-year-old woman has experienced dull pelvic pain for
the past 2 months. Physical examination shows a right
adnexal mass. An abdominal ultrasound scan shows a 7.5-
cm cystic ovarian mass. The mass is surgically excised. On
gross examination, the cystic mass is filled with hair.
Microscopically, squamous epithelium, tall columnar
glandular epithelium, cartilage, and fibrous connective
tissue are present and resemble normal tissue counterparts.
Which of the following is the most likely diagnosis?
• A. Adenocarcinoma
• B. Fibroadenoma
• C. Glioma
• D. Mesothelioma
• E. Teratoma
• A teratoma is a neoplasm derived from
totipotential germ cells that differentiate into
tissues that represent all three germ layers:
ectoderm, endoderm, and mesoderm.
• When the elements all are well differentiated,
the neoplasm is “mature” (benign).
• Adenocarcinomas have malignantappearing
glandular elements.
• Fibroadenomas have a benign glandular and
stromal component; they are common in the
breast.
• Gliomas are found in the central nervous
system.
• A mesothelioma arises from the lining of
thoracic and abdominal body cavities.
• Case 4
• A 32-year-old woman has experienced dull pelvic pain for
the past 2 months. Physical examination shows a right
adnexal mass. An abdominal ultrasound scan shows a 7.5-
cm cystic ovarian mass. The mass is surgically excised. On
gross examination, the cystic mass is filled with hair.
Microscopically, squamous epithelium, tall columnar
glandular epithelium, cartilage, and fibrous connective
tissue are present and resemble normal tissue counterparts.
Which of the following is the most likely diagnosis?
• A. Adenocarcinoma
• B. Fibroadenoma
• C. Glioma
• D. Mesothelioma
• E. Teratoma
Case 5
A Pap smear obtained from a 29-year-old woman
during a routine health maintenance examination is
abnormal. She has a history of multiple sexual
partners. Cervical biopsy specimens are obtained and
the microscopic appearance is shown in the figure.
Which of the following is the most likely diagnosis?
A. Adenocarcinoma
B. Carcinoma in situ
C. Dysplasia
D. Metaplastic transformation
E. Squamous cell carcinoma
•
• In the figure there are infiltrating nests of
squamous epithelium into the underlying
stroma, a process known as invasion. The
ectocervix and the squamous metaplasia of
endocervix give rise to dysplasia from which
squamous cell carcinoma can arise. Carcinoma
in situ is confined to the epithelium; if the
basement membrane is breached, the lesion is
no longer in situ, but rather invasive.
• An adenocarcinoma is a malignant neoplasm
arising from glandular epithelium, such as the
endocervix or endometrium, not the
ectocervix. A dysplastic process could precede
development of carcinoma in situ and
squamous carcinoma; dysplasia involves only
part of the thickness of the epithelium.
Metaplasia can occur in response to
persistent infection with human
papillomavirus (HPV) and other inflammatory
conditions. Metaplasia can be the precursor to
dysplasia.
• Case 5
• A Pap smear obtained from a 29-year-old woman
during a routine health maintenance examination is
abnormal. She has a history of multiple sexual
partners. Cervical biopsy specimens are obtained
and the microscopic appearance is shown in the
figure. Which of the following is the most likely
diagnosis?
A. Adenocarcinoma
B. Carcinoma in situ
C. Dysplasia
D. Metaplastic transformation
E. Squamous cell carcinoma
• Case 6
• A 45 -year-old woman has noted a rapidly growing
nodule on the forehead. It is excised, and the
microscopic appearance is shown in the figure.
Which of the following neoplasms is this lesion
most likely to be?
A. Fibroadenoma
B. Hemangioma
C. Lipoma
D. Squamous cell carcinoma
E. Basal cell carcinoma
• Case 6
• A 45 -year-old woman has noted a rapidly growing
nodule on the forehead. It is excised, and the
microscopic appearance is shown in the figure.
Which of the following neoplasms is this lesion
most likely to be?
A. Fibroadenoma
B. Hemangioma
C. Lipoma
D. Squamous cell carcinoma
E. Basal cell carcinoma
• Case 7
• A 57-year-old woman has experienced an increasing
feeling of fullness in her neck along with a 3-kg weight
loss over the past 3 months. On physical examination,
there is a firm, fixed mass in a 3 × 5 cm in the right side
of the neck. A CT scan shows a solid infiltrating mass in
the region of the right lobe of the thyroid gland. A
biopsy of the mass is performed and the microscopic
appearance is shown in the figure. Which of the
following terms best describes this neoplasm?
A. Anaplastic
B. Apoptotic
C. Dysplastic
D. Metaplastic
E. Well-differentiated
• The cells shown in the figure show marked
pleomorphism and hyperchromatism
(anaplasia), and it is difficult to discern the
cell of origin because no differentiation is
noted. A bizarre tripolar mitotic figure is
present. This degree of anaplasia is consistent
with an aggressive, high-grade malignancy
called anaplastic carcinoma.
• Apoptosis is single cell necrosis, but the cells
shown appear viable and not fragmented.
• Dysplasia refers to changes within an
epithelium that percede a neoplasm.

• Metaplasia with one epithelial cell type

substituted for another may presage dysplasia
and malignancy. Well-differentiated
neoplasms tend to be less aggressive and
slower growing and resemble the cell of origin
• Case 7
• A 57-year-old woman has experienced an increasing
feeling of fullness in her neck along with a 3-kg weight
loss over the past 3 months. On physical examination,
there is a firm, fixed mass in a 3 × 5 cm in the right side
of the neck. A CT scan shows a solid infiltrating mass in
the region of the right lobe of the thyroid gland. A
biopsy of the mass is performed and the microscopic
appearance is shown in the figure. Which of the
following terms best describes this neoplasm?
A. Anaplastic
B. Apoptotic
C. Dysplastic
D. Metaplastic
E. Well-differentiated
• Case 8
• A 44-year-old woman feels painless lumps in her
armpit, which were not present a month ago. On
examination, right axillary lymphadenopathy is
present. The nodes are painless but firm. Which
of the following is the most likely lesion in her
right breast?
• A. Acute mastitis with abscess
• B. Fibroadenoma
• C. Infiltrating lobular carcinoma
• D. Intraductal carcinoma
• E. Leiomyosarcoma
• Lymphatic spread, especially to regional lymph
nodes draining from the primary site, is typical
of a carcinoma.
• An intraductal carcinoma has not extended
beyond the basement membrane, but an
infiltrating carcinoma has acquired the ability
to invade and spread via metastasis. The
primary site may be difficult to detect if small
or deep, and hence the need for radiologic
imaging, such as mammography.
• A fibroadenoma is a benign neoplasm and
cannot invade or metastasize.
• Infection from a breast abscess can spread to
the lymph nodes, but the resulting nodal
enlargement is typically associated with
pain—a cardinal sign of acute inflammation.
Sarcomas uncommonly metastasize to lymph
nodes, and a leiomyosarcoma of breast is rare
• Case 8
• A 44-year-old woman feels painless lumps in her
armpit, which were not present a month ago. On
examination, right axillary lymphadenopathy is
present. The nodes are painless but firm. Which
of the following is the most likely lesion in her
right breast?
• A. Acute mastitis with abscess
• B. Fibroadenoma
• C. Infiltrating lobular carcinoma
• D. Intraductal carcinoma
• E. Leiomyosarcoma
• Case 9
A 54-year-old woman notes a lump in her right axilla. Physical
examination shows a 3cm firm, non tender axillary mass fixed
to the underlying tissues. She had history of breast cancer. An
excisional axillary lymph node biopsy is performed, and
microscopic examination shows the findings in the figure, The
appearance of the axillary node is most likely related to which
of the following?
A. Primary neoplasm in LN.
B. Metastatic breast cancer in LN.
C. Lymphoma.
D. Leukemic infiltrate.
E. Metastatic sarcoma
• The patient had history of breast cancer which
spread through lymphatics into axillary lymph
nodes which are site of lymphatic drainage of
breast.
• Adenocarcinoma is not a primary neoplasm in LN.
• Lymphoma is primary neoplasm in LN but don’t
form malignant glands. Leukemic infiltrate can
involves LN but don’t form malignant glands.
• Sarcoma usually spread through blood not to
lymph nodes and don’t form malignant glands.
• Case 9
A 54-year-old woman notes a lump in her right axilla. Physical
examination shows a 3cm firm, non tender axillary mass fixed
to the underlying tissues. She had history of breast cancer. An
excisional axillary lymph node biopsy is performed, and
microscopic examination shows the findings in the figure, The
appearance of the axillary node is most likely related to which
of the following?
A. Primary neoplasm in LN.
B. Metastatic breast cancer in LN.
C. Lymphoma.
D. Leukemic infiltrate.
E. Metastatic sarcoma
• Case 10
• 40 ys old man presents with painful swelling with
restricted movement at his left knee, the mass was
excised, the microscopic picture is shown in the figure,
what is the most likely diagnosis?

A. Osteosarcoma.
B. Osteochondroma
C. Osteoclastoma.
D. Chondroma
E. Metastatic adenocarcinoma
• Case 10
• 40 ys old man presents with painful swelling with
restricted movement at his left knee, the mass was
excised, the microscopic picture is shown in the figure,
what is the most likely diagnosis?

A. Osteosarcoma.
B. Osteochondroma
C. Osteoclastoma.
D. Chondroma
E. Metastatic adenocarcinoma