PATHOL 3101: Essentials of Pathology

Tutorial 2 – Neoplasia and Cancer

By the end of this tutorial and in association with relevant reading (including lecture notes and textbooks), students
should have a knowledge and understanding of:
 Identification and key features of benign vs. malignant tumours
 An understanding of the genetic basis of neoplasia, the role of tumour suppressor and proto-oncogene genes and
how this drives loss of control of cell proliferation
 Identification and key features of primary vs. secondary (metastatic) tumours
 Identification of key histopathological features of cancer
 Identification of dysplasia and carcinoma in situ and their role in cancer development

PRE-TUTORIAL QUESTIONS (answer these before the tutorial!)

1. What is neoplasia?

Neoplasia describes a state of autonomous cell divison, occurring due to a genetic disorder of cell growth triggered
by mutations affecting a single cell and its divided cells in the absence of an external stimuli.

2. What are the key differences between benign and malignant neoplasms?

3. What is differentiation? How does this equate to grading of a cancer?

4. What are the key morphological changes exhibited by cancer cells?

5. Define the terms dysplasia and carcinoma in situ. Why can’t dysplastic lesions metastasise?

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Tutorial 2 – Neoplasia and Cancer

6. What features are important in the prognosis of carcinoma?

7. Mutations in which two classes of genes promotes self sufficiency in growth signals to permit the development of
neoplasia?

8. Describe the role of one oncogene and one tumour suppressor gene in how mutation promotes the development
of neoplasia.

9. Apart from self sufficiency, what are the other hallmarks that are required by cancer cells?

Needs it own vasculature,

10. At diagnosis, cancer cells within a tumour are heterogenous (ie different from each other). Why is this the case?

Because they have different roles to do

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 PATHOL 3101: Essentials of Pathology
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11. Exposure to UV radiation is a key initiator of cancer. What is the difference between an initiator and a promotor
in the development of cancer?

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 PATHOL 3101: Essentials of Pathology
Tutorial 2 – Neoplasia and Cancer

TUTORIAL QUESTIONS
STATION 1: BENIGN VS. MALIGNANT TUMOURS

Examine the pairs of specimens, identify which is a malignant and which is a benign tumour.

Brain
Specimen 19985 - benign Specimen 25280 - malignant

Breast
Specimen 2398 - benign Specimen 13152 (with lymph nodes) - malignant

Prostate
Specimen 19897 – malignant – because its invasive Specimen 23354 – benign - encapsulated

1.1 Which is benign and which is malignant? What macroscopic features helped you to decide?

Brain:

20934:

10744:

Breast

Prostate

1.2 How would you make the diagnosis definitive?

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 PATHOL 3101: Essentials of Pathology
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1.3 Which is associated with a risk of metastasis? Why?

1.4 Why do malignant tumours often contain areas of necrotic tissue?

STATION 2: PRIMARY VS SECONDARY

2.1: Examine the pairs of specimens, label which is a primary and which is a secondary tumour.

Brain
Specimen 20934: (21463) primary – 1 lesions, the original Specimen 10744: (17008) secondary – spread around,
multiple

Lung
Specimen 20934: (20642) primary Specimen 50157 82: (13938/82) secondary

2.1 What macroscopic features helped you to decide?

 Primary has only one lesion with ill-defined margins whereas secondary tumours have multiple lesions of varying
sizes with the same colour and consistency.

STATION 3: METASTASES

3.1 What are the three potential routes of metastasis?

Through lymp
Through blood
Direct invasion

3.2 Can you identify the lymph nodes in the following specimens that show evidence of metastasis to the lymph nodes?
(Note: lymph nodes are well-circumscribed, encapsulated oval or round structures. They are normally tan or cream coloured and
only normally up to around 5-10mm in diameter)

Lung Specimen 24236 Breast Specimen 13152

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 PATHOL 3101: Essentials of Pathology
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What route of metastasis can be seen in this specimen containing the breast, chest wall and lung?

From breast, to pec, to lung, straight through, 22836

3.3 The following images depict common sites of metastasis. Label the organ from which the specimens are taken. IN
THE EXAM. What are the 4 most common?

Organ: vertebrae. bone Organ: brain

Organ: lung Organ: liver

STATION 4: HISTOPATHOLOGICAL FEATURES

4.1 Label the images- one is an adenocarcinoma and the other a squamous cell carcinoma.

Picture A – adenocarcinoma, the white thing is glands, Picture B – squamous cell carcinoma, due to the big pink
which is in glandular cells. balls which are keratin found in epithelium. Keratin pearls.
Keratinised stratified squamous epithelium is from the skin.
Keratin stops moisture from leaving the body.

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 PATHOL 3101: Essentials of Pathology
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4.2 What features allow you to determine which was an adenocarcinoma and which was a squamous cell carcinoma?

Examine this image of normal gastrointestinal histology (in this case the colon):

4.3 Compare the previous image to this image of an adenocarcinoma. First identify the neoplastic cells and the surrounding
reactive stroma made up of connective tissue, blood vessels and immune cells. Label these with an N and a S. Can you see
evidence of mitoses? Label these with an M. stroma is the tissue inbetween. N = neoplastic cells, S = stroma, M = mitoses

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4.4 In this higher power view can you identify the key morphological changes in cancer cells including nuclear and cellular
pleomorphism and hyperchromatism?

4.5 One key diagnostic factor is the grade of a cancer. Label the below images of adenocarcinoma as moderately well
differentiated, well differentiated or anaplastic. Which has the best prognosis?
Image A: poorly differentiated, beginning to go out of control

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Image B: well diff – better prognosis, still resembles normal tissue

Image C: anaplastic - worst

4. 6 What do the arrows in this image depict? Mitoses?

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 PATHOL 3101: Essentials of Pathology
Tutorial 2 – Neoplasia and Cancer
STATION 6: EXAMPLE PATHOLOGY REPORT

6.1 Examine the pathological report provided. What information would be used to determine stage (Don’t worry about the
specific number here)?

T = tumour size, N = lymph node involvement, M = metastes

T = 2.5 cm, N = 2

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6.2 The prognostic markers examined include estrogen receptors (ER), progesterone receptors (PR) and HER2. Is oestrogen
an initiator or promoter of cancer development? Why?

Is HER2 an oncogene or tumour suppressor gene? How does the presence of HER2 drive neoplasia development?

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