Neoplasia

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benign epithelial neoplasms

Back 1

adenoma
papilloma
cystadenoma
papillary cystadenoma
polyp

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adenoma

Back 2

benign epithelial neoplasm from glands or forming glandular structures
thyroid, bronchial, renal tubular, hepatic cell adenomas

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papilloma

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benign epithelial neoplasm forming finger like projections or warty projections
choroid plexus papilloma, intraductal papilloma of the breast

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cystadenoma

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benign epithelial neoplasm forming from cystic structure; common site is ovary

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papillary cystadenoma

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papillary projections on its internal surface; ovary is common site

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polyps

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produce visible protrusion above the mucosal surface; colonic (tubular adenoma) and uterine; benign and malignant; malignant = polypoid cancers

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mesenchymal tissues--benign
CT?

Back 7

lipoma, fibroma, chondroma, osteoma

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endothelial and related tissue

Back 8

hemangioma, lymphangioma, meningioma

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muscle?

Back 9

smooth (leiomyoma), and striated (rhabdomyoma)

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Lipoma

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tumor of adipose tissue; well circumscribed mass of mature adipose tissue; cut surface is yellow; most common benign tumor in males

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fibroma

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benign mesenchymal tumor of fibrous tissue; seen in ovary

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chondroma

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tumor of hyaline cartilage; nodular configuration; well circumscribed nodules of hyaline cartilage with hyaline matrix and neoplastic chondrocytes in lacunae

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osteoma

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tumor of bone; composed of woven and lamellar bone

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hemangioma

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benign tumor of blood vessels; closely packed blood vessels on micro

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lymphangioma

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characterized by cystic or cavernous spaces; seen in skin or deeper regions of the neck, axilla, mediastinum, and retroperitoneum

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leiomyoma

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benign tumor of smooth muscle; uterus is common location; also noted in the GI tract; most common tumor in females

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rhabdomyoma

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benign mesenchymal tissue of striated muscle; heart is common site

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hydatidiform mole

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benign neoplasm of chorionic villi; grossly appear like bunch of grapes

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melanocytic nevus

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benign tumor of melanocytes

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pleomorphic adenoma (mixed tumor)
from more than one cell type from one layer.

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benign neoplasm of salivary gland (parotid); neoplastic cells have two different morphologic patterns but derive from same germ cell layer.

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teratoma

Back 21

from totipotent cell and is common in gonads; benign form is mature teratoma. dermoid cyst (mainly ectodermal differentiation); malignant form is an immature teratoma or teratocarcinoma

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malignant tumors
mesenchymal?
immune system?
hematologic?
epithelial?

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sarcomas
lymphomas
leukemias
carcinomas

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squamous cell carcinoma

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malignant epithelial neoplasm that arises from squamous epithelium; microscopically pavement epithelium and keratin pearls are noted; lung, skin, cervix, esophagus.

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adenocarcinoma

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malignant epithelial neoplasm that forms glands or arises from glandular tissue; colon, lung, stomach, endometrium

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transitional cell carcinoma

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malignant epithelial neo that arises from transitional epithelium; common site is urinary bladder

Front 26

malignant mesenchymal tumors
(sarcomas)

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lipo, fibro, chondro, osteogenic, angio, leiomyo, rhabdomyo

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osteosarcoma

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malignant tumor of bone; micro: malignant osteoid is noted; seen in young males

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choristoma

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ectopic rest of normal tissue//normal tissue misplaced within another organ. pancreatic tissue in Meckel's diverticulum; adrenal tissue in renal cortex

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hamartoma

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non=neoplastic overgrowth of disorganized tissue indigenous to a particular site; bronchial hamartoma that contains cartilage

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dysplasia

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loss of uniformity and architectural orientation; carcinoma in situ-- dysplastic cells that involve the entire epithelial thickness and do not penetrate the BM; pre-invasive stage

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carcinoma in situ; can't tell which is top and which is bottom b/c epithelium looks similar throughout. has not invaded BM

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what is this

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differentiation and anaplasia

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-extent to which parenchymal tumor cell resembles a comparable normal cell
-lack of differentiation and it is a feature of malignancy
benign tumors are well differentiated;

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functional changes in malignant cells

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well differentiated SCC produces keratin; hepatocellular Ca produces bile; endocrine tumors elaborate hormones

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rate of growth?

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correlates with degree of differentiation--slow with well differentiated and rapid with poorly differentiated

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what is feature that differentaites benign from malignant?

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local invasion

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metastases

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tumor implants discontinuous with the primary tumor; the presence of metastases indicates a tumor is malignant (rare benign metastasizing lesions have been reported)

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pathways of spread

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1. seeding
2. lyphatic spread
3. hematogenous spread

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seeding of body cavities

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malignant cells exfoliate from the surface and implant and invade tissue; primary ovarian cancers and peripherally located lung cancers

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lymphatic spread

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usual for carcinomas; spreads to nodes along route of drainage; lung to hilar nodes; breast to axillary nodes

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hematogenous spread

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usual for sarcomas; cells entering the portal vein go to liver; cell entering vena cava go to lung; renal cell and hepatocellular ca, lymphatic and hematogenous.

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bone metastasis

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vertebral column is most common site
osteoblastic metastasis: prostate ca, radiodensities, increased serum alkaline phosphatase indicates reactive bone formation
osteolytic: lung cancer; radiolucencies, pathologic fractures, hypercalcemia

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grade of cancer

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based on degree of differentiation; correlates with aggressiveness; four grades; I is well differentiated and IV is poorly differentiated

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stage of tumor

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determines extent of spread; based on Tumor size, spread to lymph Nodes, and presence or absence of Metastases. two major staging systems; TNM staging; AJC

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Dukes' for Colon ca

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A: carcinoma limited to wall of GI tract
B: extends to pericolic fat
C: involvement of LN
D: visceral mets

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predisposing factors

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geographic/ethnic
environment/culture
age/childhood cancer
hereditary and cancer

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nasopharyngeal

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EBV, far east

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esophageal

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alcohol and tobacco, poor, african american

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stomach

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japan

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colorectal

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US, low fiber, high fat

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hepatocellular

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hep B, aflatoxin B in diet

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skin

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color of skin and exposure to sunlight; new zealand and australia

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breast ca

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north america and europe

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cervix

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HPV, multiple partners

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choriocarcinoma

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pacific rim

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prostate

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high in american blacks

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testicular

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high in african blacks

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penile

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nonexistant in circumscribed

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urinary bladder

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squamous cell ca in area where schistosomal infection

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burkitt

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common in africa

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multiple myeloma

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american and south african blacks

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chronic lymphocytic leukemia

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elderly in europe and north america

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asbestos

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lung, GI tract, pleural, and peritoneal mesotheliomas

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alcohol

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oropharynx, larynx, esophagus, hepatocellular

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aflatoxin B

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hepatocellular

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arsenic

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skin, lung, hemangiosarcoma

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alkylating agents

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acute leukemia

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aniline dyes, aromatic amines, beta naphthylamine

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TCC of bladder

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benzene, ethylene oxide

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acute leukemia

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cigarette smoke

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mouth, pharynx, larynx, lungs, esophagus, pancreas, bladder

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sun

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SCC, BCC, and melanomas of skin

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mitrosamines (smoked fish)

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gastric adenocarcinoma

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polyvinyl chloride and thorotrast

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hepatic angiosarcomas

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nickel, chromium & uranium, radon, beryllium

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lung

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DES

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clear cell Ca of vagina

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low fiber diet

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adenocarcinoma of colon

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high fat diet

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breast ca

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hereditary and cancer

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inherited cancer syndrome AD
familial cancers
AR syndromes of defective DNA repair

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familial cancer

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early onset; tumors arising in 2 or more close relatives of index case; multiple and bilateral tumors; not assoc with specific marker phenotypes; sibs have relative risk between 2-3

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AR syndrome

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XP- basal and squamous cell ca of skin
ataxia telangiectaia- acute leukemia
bloom's syndrome--acute leuk
fanconi's anemia-- acute leuk

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chronic atrophic gastritis of pernicious anemia

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gastric adenocarcinoma

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actinic keratosis of skin

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SCC

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ulcerative colitis

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adenocarcinoma of colon

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chromosomal breakage syndrome

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leukemia

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leukoplakia of oral cavity, vulva, and penis

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squamous cell carcinoma