UNIT 15.

EPITHELIAL
TUMORS
G E N ERAL PAT HOLOGY
I . M . S ECHE NOV F I RST M OS COW STATE M E DI CAL U N I V ERSITY
A N ATOMIC PAT HOLOGY DE PA RTMENT N A M E D A F T E R A . I . ST R U CKOV
Epithelial tumors
These are tumors developing from epithelial tissue
The presence between the complexes (strata) of the parenchyma
and stroma clear boundary
May be benign or malignant
The possibility of malignancy of many benign epithelial tumors –
precancer lesions
Organ specificity: organ-specific & non organ-specific
Simple benign epithelial tumors are
essentially of two histogenetic types:
• Papillomas (from surface epithelium)
• Adenomas ( from glandular epithelium)
Papilloma
Take origin from an epithelial surface and may be derived from
squamous cell epithelium or transitional cell epithelium:
Squamous cell papilloma
Transitional cell papilloma
Localization: skin, mucosa of the urinary and respiratory tract, oral
cavity, esophagus, vagina
Gross appearance: villous or papillary, usually a mobile tumor,
growing on a wide base or thin stalk
 *
Gross "Skin papiloma"
The papilloma is detected as a soft, flesh-
colored, bag-like tumor attached to the skin
surface by a small, often slender stalk. Typical
examples of this tumor are found in the skin
(e.g. common wart), vocal cords and urinary
bladder.

*
Large squamous papilloma involving a
transgender neovagina

*Reed HM (2018) Large squamous papilloma involving a transgender neovagina. Surg Case Rep Rev,
2018 DOI: 10.15761/SCRR.1000111
Slide N72 "Skin squamous papilloma"
(hematoxylin and eosin)
1. finger-like projections
from epithelial
surface
2. fibrovascular stroma
3. hyperkeratosis
Slide N 99 "Squamous cell carcinoma of
the esophagus" (hematoxylin and eosin)
1. basal membrane
destroyed from the
layers of atypical
squamous epithelium
2. layers of atypical
squamous epithelium
in the submucosa and
muscularis propria
 Adenomas are derived from the ductal
and acinus epithelium of glands
The name is also used to cover simple tumors arrising in In cases in which retention of secretion is marked, a cyst
forms and a tumor is often called a cystadenoma which
epithelial organs can reach an enormous size.
Morphogenesis of adenomas is based on the The proliferating epithelium may form papillaries and the
proliferation of glandular epithelium. That causes the tumor then becomes a papillary cystadenoma. These two
variants of tumors are common in the ovary.
formation of tubules that ramify and become increasingly
compound. The original communication with the parent
gland tens to become lost.

In the case of a hollow viscus, such as intestine or gall

bladder, the adenomatous proliferation, instead of
growing down into the subjacent connective tissue, is
usually pushed upwards into the lumen of the viscus. The
term adenomatous polyp is often applied in such a case.
 Fibroadenoma of the female breast
benign organ-specific breast tumor of glandular origin Fibroadenoma has a characteristic clinical picture:
a characteristic difference between fibroadenoma
and adenoma is the predominance of connective tissue
stroma over the glandular parenchyma
Detection peaks in 20-30 years; asymptomatic
fibroadenoma can be detected for the first time at a
much later age with a preventive examination
Most often, fibroadenoma is detected as a single
breast tumor, however, cases of multiple
fibroadenomas, which can be localized simultaneously
in both mammary glands, are not uncommon
On examination, a large fibroadenoma can be determined
visually as a subcutaneous tumor formation of the breast
On palpation, it is defined as a clearly delimited displaced
tumor of dense-elastic consistency from 1 to 5 cm in the
largest dimension
It is usually located outside the areolar zone. The most
frequent localization is the upper outer quadrant of the
mammary gland
After menopause, breast fibroadenoma regresses and
calcifies
Differential diagnosis should be carried out with the
following conditions: breast cancer/ breast cyst/
cystadenopapilloma
Histological types of fibroadenoma of
the female breast
INTRACANALICULAR PERICANALICULAR
 connective tissue grows into the wall of the ducts and  Connective tissue grows around the ducts
squeezes them
 the ducts take on the form of narrow slits

Tumor parenchyma is made up of tubular glands of various sizes and shapes, stroma - intralobular connective tissue.
Slide "Fibroadenoma of the female
breast"(hematoxylin and eosin)
1. delicate, cellular, fibroblastic
stroma, enclosing glandular
and cystic spaces lined by flat
or cuboid epithelium
2. epithelium surrounded by the
stroma (pericanalicular
fibroadenoma)
3. epithelium compresed by the
stroma (intracanalicular
fibroadenoma)
Pericanalicular type
Gross "Papillary mucinous cystadenoma
of the ovary"
The mucinous cystadenoma is grossly
characterized by the great number of cysts of
variable size, filled with sticky, gelatinous fluid.
The inner surface of the cysts is rough and has
numerous projections.
Organ-specific tumour
 Papillary serous cystadenoma Borderline serous tumor showing
revealing stromal papillae with a increased architectural complexity and
columnar epithelium epithelial cell stratification

Serous
cystadenomas

Complex micropapillary growth Papillary serous cystadenocarcinoma

defines a low-grade “micropapillary” of the ovary with invasion of
serous carcinoma underlying stroma
Slide "Papillary mucinous ovary
cystadenoma" (hematoxylin and eosin)
1. cysts lined by tall
columnar epithelial
cells with apical
mucin and absence
of cilia
2. papillary structures
formed by columnar
epithelial cells
 CARCINOMA - MALIGNANT EPITHELIAL
TUMOR
Carcinoma (Greek: Karkinos - a crab) - This refers to the
irregular shape
There are three main histogenetic types of carcinomas:
Squamous cell carcinomas (squamous differentiation)
Transitional cell carcinomas (transitional cell
differentiation)
Adenocarcinomas (glandula cell differentiation)
Some carcinomas may arise in different organs and are
called organ nonspecific carcinomas, while others
develops only in definite organs - organ specific
carcinomas
Two tumours at the same stage may have very different
outcomes as one may behave more aggressively than the
other. The aggressiveness of the tumour is often reflected
by the 'grade' of malignancy. The grade is usually based on
the degree of similarity of the tumour to the fully mature
'differentiated' state of the tissue of origin.
Well differentiated/low grade — closely resembles
tissue of origin
Moderately differentiated/intermediate grade
Poorly differentiated/high grade — difficult to
recognize the tissue of origin
Metastasis: primary – in regional lymph nodes, later -
hematogenous
Slide N71 "Endometrial adenocarcinoma"
(hematoxylin and eosin)

1. glandular tubular patterns

2. malignant stratified
columnar epithelial cells,
lining well defined gland
patterns

The adenocarcinoma is characterized by well defined gland patterns lined by malignant stratified
columnar epithelial cells with signs of cell atypia. The well differentiated tumor cells form easily
recognizable glandular tubular patterns.
Gross "Renal cell carcinoma"
The upper pole of the kidney is replaced by a
rounded shape by a tumor. The tumor is mottled in
the section: against a bright yellow background,
areas of hemorrhage and necrosis. The tumor
consists of light, lipid-rich cells, which is why it is
also called clear-cell cancer.
Choriocarcinoma
Malignant tumor, the source of which is trophoblast
It occurs in young women after abortion, childbirth, often against the
background of a destroying cystic drift (chorioadenoma)
In the vast majority of cases, choriocarcinoma develops in the uterus;
occasionally, the development of ectopic choriocarcinoma (outside the uterus);
extremely rare in men
The tumor gives early hematogenous metastases to the lungs, brain, liver, etc;
in metastases, hemorrhages often occur - characteristic manifestation of lung
metastases is hemoptysis
Gross: the tumor looks like a rounded soft knot of dark red color
Slide N80 "Choriocarcinoma"
(hematoxylin and eosin)
1. clusters of cuboid
cytotrophoblast cells
2. masses of
syncytiotrophoblast
giantcells with marked
atypia

The tumor is composed of clusters of cuboid cytotrophoblast cells separated by streaming masses of
syncytiotrophoblast giant cells with marked atypia, resulting in a characteristic dimorphic pattern.
Hemorrhages and necrosis are present. The tumor does not produce chorionic villi.
Neuroendocrine Tumors - carcinoids
Neuroendocrine cells (APUDocytes - cells of APUD system) are normally dispersed along the
length of the gastrointestinal tract mucosa as well as in many other organs, such as lung,
pancreas, biliary tract, and elsewhere; tumors of these cells are called “carcinoids” on the basis
of their slow growth pattern.
The cells of carcinoid tumors resemble the neuroendocrine cells of the gut ultrastructurally and
have a similar capacity to synthesize and secrete a variety of bioactive and hormonal products,
as described earlier. For these reasons, the cell of origin is presumed to be the immature,
functionally uncommited gut endocrine cell, which undergoes further differentiation during
tumorigenesis.118 Although multiple bioactive products may be synthesized by a single tumor,
most secrete a predominant product to produce a clinical syndrome called by that name, e.g.,
gastrinoma, somatostatinoma, VIPoma, and insulinoma.
Electron micrograph "Growth hormone
secreting pituitary adenoma"
The tumor is composed of atypical cell layers,
that are tightly pressed to each other and
contain numerous cytoplasmic
neuroendocrine granules. The supportive
stroma is absent.
Case 34
A 70-year-old man was seen by his
family doctor because of an area of
white thickening on the lateral border
of the anterior of his tongue with a
small a lightly painful ulcer. The lesion
was biopsied to confirm the clinical
diagnosis.
Questions
Squamous cell carcinoma
1.What is the most likely clinical diagnosis?
2.If the biopsy confirm the clinical diagnosis
what further examinations you would
recommend? cytology, lymph nodes exammination
3.What is the commonest site for spread of the
lesion? regional lymph nodes
4.What other variants of tumors can develop
in the tongue? adenoma, adenocarcinoma, leiomyoma,
leiomyosarcoma, fibroma, fibrosarcoma.
5.Describe histology of the precancer lesion of
the tongue.
Case 35
A 57-year-old woman was admitted to the
hospital because of a smooth, enlarging mass
at the angle of the jaw on the left side that
had been present for some years. On
examination, the mass appeared to be the
parotid gland. It was firm and rubbery, with a
smooth well-circumscribed outline, and was
non-tender. The biopsy revealed parotid
pleomorphic gland adenoma.
Questions
1.What is the differential diagnosis? Adenoma benign,
adenosarcoma.
2.What is the characteristic histological
appearance of the benign parotic pleomorphic
adenoma? cell atypia,
3.What precautions must be taken during
surgery and why?
4.Describe other histological types of
adenomas.
5.What is the commonest site for spread of the
parotic carcinoma?
Case 36
A 65-year-old woman presents to her
doctor with a five-month history of
irregular postmenopausal bleeding. She
has not been taking hormone replacement
treatment. Patient undergoes dilatation
and curettage which produces bulky
uterine curettings. Histological
examination shows severe cytological and
architectural atypia of the endometrium
and a diagnosis of endometrium
adenocarcinoma is made.
Questions
1.What is the association between
endometrial carcinoma and endometrial
atypical hyperplasia?
2.How do endometrial carcinoma spread?
3.How are endometrial carcinomas staged?
What is the prognosis for such patients?
4.Describe other histological types the
endometrium adenocarcinoma.
5.What further investigation may be helpful
and what would confirm the diagnosis?