‫الفصل ادلرايس الثاين‬

Lab No.1 for 3rd Stage

Neoplasia

Neoplasia
Is an abnormal mass of tissue, the
growth of which is exceeds and
uncoordinated that of normal tissue,
and it persists even after cessation of
the external stimuli which evoked the
change.

Neoplasia is divided into benign and

malignant tumors.
 Differences between Benign and malignant tumours:
Feature Benign Malignant
Histological Similar to tissue of origin. Many differ from tissue of origin.
1- 2- ‫ﺗﻌﺪد اﻷﺷﻜﺎل‬

feature Nuclei are normal. Nuclei are enlarge, pleomorphic,

3-
7-
Cells are uniform in size
and shape.
Mode of growth Remain localized.
Rate of growth Slower.
Clinical effects Local pressure effects.
Hormonal secretion.
Cure by local excision
4-
hyperchromatic, prominent
5-
nucleoli, increase mitotic
6-
activity and abnormal mitosis,
nuclear / cytoplasm
increase N/C ratio.
Cells are pleomorphic in size and
shape.
Infiltration and metastasis.
Faster.
Local pressure and destructive
effects.
Inappropriate Hormonal
secretion (paraneoplastic
syndrome), metabolic and
neurological complications.
Not cure by local excision.

The examples of benign tumors are:

Lipoma
It's a benign tumor of adipose tissue of
connective tissue origin (most common form
of soft tissue tumor), its arise anywhere in
the body most commonly in the back,
shoulder and proximal parts of limbs, usually
affect women over forty years old.
40
Clinically
It presents as a
single mass, usually
found just below the
skin, mostly painless
but can be painful,
in this condition
called angiolipoma.
blood vessel

My sister
Macroscopically:
1- 2- 3- 4-
It either single or multiple, soft, mobile ,ill
5-

defined or well defined yellow color mass.

‫راسه مضلع‬

Microscopically: !‫بالغ و سم‬

It consists of mature fat cells, the cells

1-

‫ مضلع‬/ ‫متعدد ا(ض&ع‬

uniform in size and shape ( large polygonal

2-

3-
cell, peripheral nucleus , empty cytoplasm )
4-

5-

the tumor surrounded by fibrous capsule.

 mmobile
yyellow
ssingle or multiple
iill defined or well defined
ssoft

Lipoma grossly

At low power magnification, a lipoma of the small intestine is seen to

be well demarcated from the mucosa at the lower center-right. This
neoplasm is so well-differentiated that, except for its appearance as a
localized mass, it is impossible to tell from normal adipose tissue.
 uniform in size and shape ( large polygonal cell )

consists of mature fat cells

peripheral nucleus
empty cytoplasm ‫ﺑﺎﻟﻎ و ﺳﻤﯿﻦ‬
fibrous capsule

Here is the lipoma at high magnification

Leiomyoma (Fibroids) of uterus

It's a benign tumor of smooth muscle cell
arise in the myometrium of the uterus.
❖ There is:
1- Genetic predisposition (40% of cases
have chromosomal abnormalities, more in
black female than white)
2- Estrogen dependent tumor, that increase
in size during pregnancy and in women
taking oral contraceptive pills and regress
post menopausal.
‫ﯾﺘﺮاﺟﻊ ورم ﺑﻌﺪ ﺳﻦ اﻟﯿﺄس‬
 Clinically:
It affect women at the reproductive age
group, presents as either asymptomatic
(small size) or large mass to cause a
different symptoms like 1- prolong heavy
menstrual bleeding, 2- back pain, 3- pelvic
discomfort.

Complications:
1- 2- 3-
Vaginal Bleeding, Abortion, Infertility.

Macroscopically:
1- 2- 3-

It either single or multiple, firm, gray-white

4-
color, small or large mass full the pelvis or
5- ‫زهرة‬ ‫ احادي او متعدد‬-1
abdominal cavity, the whorl pattern of smooth ‫ صغير او جبير‬-4
‫ رمادي صلبة‬-‫ زهرة بيضاء‬-2,3,5
‫ موقعها‬-6
muscle bundles is characteristic.
6- within walls

The tumor can be intramural, submucosal,

subserosal.

Microscopically:
‫ﺷﺎﺑﻚ‬
1- Interlacing bundle of smooth muscles fibers ‫ترتيبها اشلون ؟‬
1- 2- ‫و شتحتوي ؟‬
arranged in the whorl pattern contain densely
packed smooth muscle cells.
2- We may see the degenerative changes include
‫غیر كامل‬
1-
fibrosis, patchy necrosis, hyaline changes,
2- 3-

4- 5-
calcification, thrombosis and hemorrhage.
In the upper fundus of the uterus protruding into
the endometrial cavity is a nodule that proved
to be a a submucosal leiomyoma.

Leiomyoma of uterus (multiple)

 ‫ﺗﺮﺗﯿﺒﮭﺎ اﺷﻠﻮن ؟‬ ‫اهنا صايرة هوسة‬
‫و ﺷﺘﺤﺘﻮي ؟‬
arranged in the whorl pattern
contain densely packed
‫اعتبرها وردة‬ smooth muscle cells
fibrosis
osis
osis
necrosis
osis
thrombosis
h
hemorrhage
h
hyaline changes
calcification

Here is the microscopic appearance of a benign leiomyoma.

Normal myometrium is at the left, the leiomyoma at the
right hardly appears different. Bundles of smooth muscle
are interlacing in the tumor mass.

The microscopic appearance of a leiomyoma indicates

that the cells do not vary greatly in size and shape
and closely resemble normal smooth muscle cells.
 Babylon University
College of Medicine
Department of Pathology
‫الفصل الدراسي الثاني‬
Lab No.2 for 3rd Stage

Benign tumor

Fibroadenoma of breast
This is the most common benign tumor of the
female breast. Occurring at any age within
the reproductive period of life,
fibroadenomas are somewhat more common
before age 30. They are frequently multiple
and bilateral.
The epithelium of the fibroadenoma is
hormonally responsive, and a slight increase
in size may occur during the late phase of
‫تراجع‬

each menstrual cycle and regression usually

occurs after menopause.
Clinically: Mass
a

Fibroadenomas grow as spherical nodules

‫بحدة‬ ‫مقيد‬

that are usually sharply circumscribed and

freely movable in the surrounding breast
substance.

Macroscopically: grow
o via
ia …
‫مطاطي‬

The tumors are well-circumscribed, rubbery,

grayish white nodules. They vary in size from
less than 1 cm in diameter to large tumors
that can replace most of the breast.

This is a fibroadenoma (macroscopically)

 Microscopically:
1-
There is proliferation of both epithelial and
stromal components.
2-
Epithelial proliferation form glandular structure
lined by single layer or multiple layers of cells
that are regular and intact basement membrane.
stroma = supportive tissue of organ
3- ‫رﻗﯿﻖ‬

The stroma is usually delicate, cellular, and often

‫ﻣﺨﺎطﻲ‬

myxoid, resembling intralobular stroma,

enclosing glandular and cystic spaces lined by
4-
epithelium. The epithelium may be surrounded
by stroma called (pericanalicular pattern) or
5-
compressed and distorted by it called
(intracanalicular pattern) appears elongated slit
like structures. The 6-border is sharply delimited
from the surrounding tissue by capsule.

The normal microscopic appearance of female breast tissue is shown

here. There is a larger duct to the right and lobules to the left. A
collagenous stroma extends between the structures. A variable amount
of adipose tissue can be admixed with these elements.
 Here is the microscopic appearance of a fibroadenoma.
To the right is compressed breast connective tissue forming a
"capsule" to this mass

Thyroid Adenoma
separated

Adenomas of the thyroid are typically discrete,

‫ﻣﻨﻌﺰل‬

solitary masses, they are derived from follicular

epithelium and so might all be called follicular
adenomas. A variety of terms have been
proposed for classifying adenomas on the basis
of degree of follicle formation and the colloid
content of the follicles.
Simple colloid adenomas (macrofollicular
adenomas), a common form, resemble normal
thyroid tissue; others recapitulate stages in the
embryogenesis of the normal thyroid (fetal or
microfollicular, embryonal or trabecular).
There is limited utility in these classifications
macro + micro

because mixed patterns are common

 Clinically:
It affect women more than male, many
thyroid adenomas present as either
unilateral painless mass. often discovered
during a routine physical examination. Larger
masses may produce local symptoms, such as
difficulty in swallowing. hormonal secretion
(toxic adenoma).

Macroscopically:
1- 2- 3-
Solitary, spherical encapsulated lesion, some
4-
are smaller and others are much larger (up to
5-
10 cm in diameter). The color ranges from
gray-white to red-brown, depending on the
cellularity of the adenoma and its colloid
c on t e n t . T h e n e op l a s t i c t i s s u e s a r e
‫ﻣﺤﺪد‬
demarcated from the adjacent parenchyma
by a well-defined, intact 6-capsule. 7-Areas of
hemorrhage, fibrosis, calcification, and
cystic change are common in follicular
adenomas.
 Here is a follicular adenoma (grossly) that is
surrounded by a thin white capsule

Microscopically:
We will see:
1- compressed normal thyroid follicles.
2- fibrous capsule.
3- the constituent cells of adenoma often
form uniform-appearing follicles that
contain colloid, these follicles either macro
follicle (large thyroid follicle , huge amount
of colloid), or micro follicle (small thyroid
follicle, little or no colloid) or mixed
pattern. The epithelial cells composing the
follicular adenoma reveal little variation in
cell and nuclear morphology.
 Normal thyroid follicles appear at the lower right. The follicular
adenoma is at the center to upper left. The follicles of the adenoma
contain colloid, but there is greater variability in size than normal.

Babylon University
College of Medicine
Department of Pathology
‫الفصل الدراسي الثاني‬
Lab No.3 for 3rd Stage
Malignant Neoplasms
 Pathological features that Differentiate
malignant neoplasms from benign
neoplasms

1. Differentiation and anaplasia

2. Rate of growth
3. Invasion
4. Metastasis

* Differentiation and Anaplasia

‫يا ا*نسجة ا*صلية ا&ماثلة‬/‫يا السرطانية مع خ‬/‫التمايز هو مدى تشابه الخ‬

* Differentiation :The extent to which neoplastic cells

resemble the normal cells well differentiated cells resemble
the cells from which the tumor has originated
* Anaplasia = Lack of differentiation (considered as a hallmark
of malignancy
* Benign neoplasms are well differentiated
* Malignant neoplasms range can be well , moderate or poorly
differentiated
 Morphological features of anaplastic cells
‫شكال‬%‫تعدد ا‬

1. Pleomorphism ( variation in size and shape)

Malignant cells are not uniform
2. Abnormal nuclear morphology
* High N/C ratio nucleus become large compared to normal cell
nuclear to cytoplasm

* Prominent nucleolus
* Hyperchromasia (dark staining of the nucleus)
3. Loss of polarity cells arranged in an unorganized manner

4. Frequent abnormal mitoses

2. Rate of growth
Benign neoplasms have slow rate of growth
Malignant neoplasms have rapid growth rate

3. Local invasion
* Benign neoplasms lack the ability to invade ,infiltrate and metastasize
they grow slowly and develop a fibrous capsule which separate it from
host tissue . Benign neoplasms can be easily palpated and resected
* Malignant neoplasms are associated with invasion infiltration and
destruction to adjacent tissues

4. Metastasis

Is a feature of Malignant neoplasms that distinguish it from beingn ones

 Hyperchromatism

Here are three abnormal mitoses which are highly indicative of

malignancy. The marked pleomorphism and hyperchromatism
of surrounding cells also favors malignancy.
Several mitoses are seen here, just in this one high power field

Nomenclature

Benign Malignant
* By attaching the suffix “-oma” to Depends on tissue of origin
the name of cell type from which
the tumor originate Mesnchymal tissue Sarcoma
E.g : Liposarcoma
* E.g: Lipoma ,leiomyoma Epithelial tissue carcinoma
E.g squamous cell carcinoma
c
*Liposarcoma
Liposarcomas are one of the most common sarcomas 40 to 60 years of age

of adulthood and appear in those in their forties to

sixties; they are uncommon in children.
They usually arise in the deep soft tissues of the
proximal extremities and retroperitoneum and are
‫مشهور‬
notorious for developing into large tumors.
Grossly
Large, yellowish, irregular mass.

Lipo

This large , yellowish, irregular mass is a liposarcoma (grossly)

* Histologically
Liposarcomas can be divided into well-
differentiated, moderately differentiated and
poorly differentiated variants.
The cells in well-differentiated liposarcomas
are readily recognized as lipocytes. In the other
‫مختلف‬
variants, most of the tumor cells are not ‫دال على‬
obviously adipogenic, but some cells indicative of
fatty differentiation are almost always present.
These cells are known as lipoblasts; they mimic
fetal fat cells and contain round clear
cytoplasmic vacuoles of lipid that scallop the
nucleus. they mimic fetal fat cells and contain round clear
cytoplasmic vacuoles of lipid that scallop the
nucleus indicate malignant tumour.

Pleomorphism
Hyperchromatism
Large nucleus
Loss of polarity
Lipoblast

Liposarcoma (microscopically)
Mixture of normal- appearing adipocytes intermixed
with atypical adipocytes (hyperchromatic, pleomorphic irregular cells)
and lipoblasts which have a multivacuolated cytoplasm in which
the vacuoles dent the atypical nucleus
 Pleomorphism B.
Hyperchromatism
Large nucleus
Loss of polarity
Lipoblast

A.
A. Liposarcoma (microscopically)
‫غريب‬
B. At high magnification, large bizarre lipoblast is shown seen

Pleomorphism
Hyperchromatism
Large nucleus
Loss of polarity
Lipoblast

At high magnification, large bizarre lipoblasts are seen

in this liposarcoma
 smooth Muscle

Leiomyosarcoma of uterus:

These uncommon malignant neoplasms arise de novo directly

from the myometrium. Leiomyosarcomas are equally common
before and after menopause, with a peak incidence
Pain
at 40 to 60
years of age. The patient presented with back ache and vaginal
bleeding.

Grossly:
Leiomyosarcomas grow within the uterus in two somewhat
1- ‫ضخم‬ ‫لحمي‬
2- 3-
distinctive patterns: bulky, fleshy masses that invade the
1- 2-
uterine wall, or polypoid masses that project into the uterine
3- 4-
lumen and usually it is large and irregular outline.

This is a leiomyosarcoma (grossly)

 Microscopically:
atypical

they contain a wide range of atypia, from those that are

anaplastic

extremely well differentiated to anaplasti lesions. The

‫تميز‬

distinction of leiomyosarcomas from leiomyomas is based

1-
on the combination of degree of nuclear atypia (features
2- 3-
of malignancy), large (epithelioid) dell, increase mitoses,
4-
and zonal necrosis.

Here is the microscopic appearance of a leiomyosarcoma. It is much

more cellular and the cells have much more pleomorphism and
hyperchromatism than the benign leiomyoma. An irregular mitosis is
seen in the center.