Patomorph cycle 1 neoplasms PUM 3rd year

the term tumor was originally applied to the swelling caused by inflammation, but the nonneoplastic usage of „tumor" has

almost vanished, thus the term is now equated to

neoplasm

non neoplastic tumors

inflammatory; Hamartoma now considered benign neoplasm ; Choristoma

neoplastic tumores

benign and malignant

Disorganized benign mass composed of

cells indigenous to the involved site (it is

composed of tissue elements normally

found at that site)

Hamartoma

The most common benign lung tumor

lung Hamartoma

>90% of pulmonary Hamartoma are located

peripherally

pulmonary Hamartoma are composed of

hyaline cartilage; CT; adipose tissue; irregular disorganised spaces with ciliated epithelium

term applied to a heterotopic rest of

cells

Choristoma

does not have stromal invasion and metastases

benign neoplasm

does have stromal invasion and metastases

malignant neoplasm

has stromal invasion but does not metastise

locally invasive neoplasm

A tumor is said to be benign when its

gross and microscopic appearences are

considered relatively innocent, implying

that it

will remain localised; will not spread; amendable to local surgical removal

NOMENCLATURE of epithelial tumors

name of cell type + micro/macroscopic pattern + Oma at end

benign neoplasm arising from

glandular epithelium

Adenoma

benign epithelial neoplasm that

produces micro- or macroscopically visible

fingerlike or warty projections

Papilloma

benign epithelial neoplasm

forming cystic spaces

Cystadenoma

cystic spaces + warty

projections

Papillary cystadenoma

4 Benign epithelial

neoplasms are

papillary cyst adenoma; cyst adenoma; Papilloma; Adenoma

neoplasm of Stratified squamous epithelium

squamous cell papilloma

neoplasm of Epithelial lining of glands and ducts

adenoma; papilloma; cyst adenoma

neoplasm of respiratory epithelial origin

brachial adenoma

neoplasm of renal epithelium

renal tubular adenoma

neoplasm of epithelial origin of liver cells

hepatic adenoma

NOMENCLATURE of mesenchymal tumors

name of cell type of origin + Oma

neoplasm of mesenchymal origin of ct

fibroma

neoplasm of mesenchymal origin of adipose tissue

Lipoma

neoplasm of mesenchymal origin of cartilage

chondroma

neoplasm of mesenchymal origin of bone

osteoma

neoplasm of mesenchymal origin of vessels

Haemangioma and Lymphangioma

neoplasm of mesenchymal origin of muscle

Leiomyoma and Rhabdomyoma

neoplasm of mesenchymal origin of nerve sheaths

Schwannoma and Neurofibroma

microscopy of Lipoma

well-encapsulated mass of mature adipocytes

characteristics of Lipoma

most common soft tissue tumour in adults; soft mobile and painless

lipomas is found

subcutis of proximal extremities and trunk

The most common tumor in women

uterine Leiomyoma

uterine Leiomyoma characteristics

bening smooth muscle neoplasm

symptoms of uterine Leiomyoma if present

abnormal bleeding/ urinary freq; pain; impaired fertility

microscopic characteristics of uterine Leiomyoma

bundles of Smooth muscle resembling univolved myometrium

macroscopic characteristics of uterine Leiomyoma

sharp circumscribed, round, firm, grey-white; from barely visible to whole pelvis

Well-circumscribed, encapsulated masses

associated with nerves without invading it

Schwannoma

symptoms of Schwannoma are associated with

compression of involved nerve

location of Schwannoma

8th cranial nerve and sensory trigeminal; peripheral nerves (usually large trunks)

histology of Schwanomma

Antoni A with verocay bodies and Antoni B

More heterogenous in composition than

Schwannomas

Neurofibroma

Neurofibroma can be sporadic or associated with

NF1 (neurofibromatosis type 1)

pedunculated nodules arising in the

dermis and subcutaneous fat, isolated or

multiple

localised cutaneous neurofibroma

localised cutaneous neurofibroma; diffuse neurofibroma and plexiform neurofibromas are all

NF1 associated

Very common tumor characterized by

increased number of normal or abnormal

vessels filled with blood

Hemangioma

7% of tumors of infancy and childhood are

Hemangioma

characteristics of Hemangioma

usually present at birth with initial growth following spontaneous regression

Hemangioma are located at

head/ neck and internally 1/3 in liver

most common type of Hemangioma

capillary type (composed of thin-walled capillaries)

strawberry type" 1:200 births of hemangioma

Juvenile type

type of Hemangioma that is composed of large dilated

vascular channels, more infiltrative, do not regress

cavernous type

Type of capillary hemangioma that

presents as rapidly growing (1-2cm in few

weeks), red, pedunculated lesion on the

skin, gingival or oral mucosa

Pyrogenic granuloma

characteristics of Pyrogenic granuloma

bleeds easy; often ulcers; 1/4 after trauma; 1% in pregnancy

types of Malignant gastric neoplasms

Carcinoma (90%), lymphoma, carcinoid, GIST (gastrointestinal stromal tumore)

gastric carcinoma are common in

Japan, china, Chile, Russia

gastric carcinoma are uncommon in

USA, UK, Canada, Australia

5 year survival of gastric carcinoma

in general 20%; early gastric 80-95% (total survival rate is 4-13%)

environmental risk factors of gastric carcinoma

diet; smoking; social economic statues

genetic risk factors of gastric carcinoma

blood group A; familial occurrence

diet increasing risk for gastric carcinoma

h2O, preserved food (has nitrates); meat; fish; lack of fresh fruit/vegetables

gastric diseases that are risk factors for gastric carcinoma

H. pylori; chronic gastritis; partial gastric resection; adenoma; menetrier disease; peptic ulcer

Gastric epithelial cells are replaced by intestinal epithelial cells in

intestinal metaplasia (ciliated; goblet, paneth cells)

cytologic features of intraepitehelial neoplasia in gastric carcinoma

nuclear atypia, polymorphism; increase in mitosis

histologic features of intraepitehelial neoplasia in gastric carcinoma

cellular crowding, nuclear stratification, tubular anarchy

intraepithelial carcinoma that progress into carcinoma

low grade 2%; high grade 70%

intraepithelial carcinoma that regress

low grade 60%; high grade 20%

localisation of gastric carcinoma

pre/pyloric region(50-60%); cardia (25%); body/fundus (15-25%); lesser curvature (40%); greater curvature (12%)

gastric carcinoma can be classiedid due to

depth of neoplastic infiltration; macroscopic growth pattern; histologic type

early gastric carcinoma according to classification via depth of neoplastic infiltration

infiltration of mucosa; submucosa; LN pos or neg

advanced gastric carcinoma according to classification via depth of neoplastic infiltration

infiltration of also muscular proper and serosa

Early gastric carcinoma are found in

distal part of stomach along lesser curvature (10% are multifocal) with radius less 2cm

metastasis of early gastric carcinoma

intramucosla 0-17%; submucosal 13-30%

metastasis of early gastric carcinoma depends on

radius of tumor; type of growth; ulceration

macroscopic growth pattern classification of gastric carcinoma (borrman classification of advanced carcinoma)

I polypoid; II fungating; III ulcerated; IV diffusely infiltrative

diffuse infiltration of cancer cells + demo plastic reaction of stroma (fibrosis)

linitis plastica

gastric carcinoma classification according to Lauren

intestinal type; diffuse type; mixed type

characteristics of intestinal type of gastric carcinoma according to Lauren

mean age 55; more males; better prognosis; has environmental factors; declining incidence

characteristics of diffuse type of gastric carcinoma according to Lauren

mean age 48; equal in gender; worse prognosis; constant incidence; has no environmental factors

gastric carcinoma metastases into

regional LN, liver, lungs, adrenals, peritoneum, bones, virchofs node, ovaries (aka krukenberg tumor)

gastric carcinoma is asymptomatic in late course these symptoms occur

epigastric abdominal pain; anorexia; weight loss, vomiting, dysphagia

diagnosis of gastric carcinoma is made using

gastrofiberoscopy taking several samples and brush smears (96% sensitivity)

gives the only one possibility to cure gastric carcinoma

surgical excision of tumor with margins of univolved tissue

Malignant tumors of large intestine

adenocarcinoma 98%; carcinoid; GIST; NHL

epidemiology of colorectal carcinoma

60-70 years; M>F; 1-3% with familial syndrome

incidence of colorectal cancer

high: US, australia, europe; low: Mexico, South America, Africa

colorectal carcinoma is equally distrubuted (25%) in

cecum & ascending colon; rectum & distal sigmoid; descending colon & proximal sigmoid; remaining

characteristics of tumors of proximal colon (cecum + ascending colon)

often asymptomatic; chronic low grade bleeding causing anemia; bulky pokpoid lesions; obstructions are uncommon (because of large lumen and liquid fecal content)

characteristics of tumors of distal colon (descending colon + sigmoid + rectum)

changes in bowel habits; bleeding; angular encircling tumors; tumurs are more infiltrative; poor prognosis

It is a clinical maxim that iron-deficiency anemia in an older male means

gastrointestinal cancer until proven otherwise

colorectal carcinoma metastase to

lymph nodes, liver, lungs, bones, peritoneal cavity

diet increasing/ decreasing risk for colorectal cancer

increasing: sugar, fat, red meat; decreasing: vegetable fiber, vitamin A,C,E

neoplastic polyps (mass arising from the epithelium of the mucosa that protrudes into the lumen) are

adenomas

non neoplastic polyps are

hyperplasticity; hamartomatous; inflammatory, lymphoid

polyp that occurs in 6-7th decade of life with diameter less 5mm; caused by decrease in epithelial cell apoptosis causing increase of mature cells on surface

hyperplasticity polyp

malformations of the glands and the

stroma

hamartomatous polyp

hamartomatous polyp types are

juvenile polyp (children; diameter of 1-3cm); retention polyp (adults; diameter < 1cm); Peutz - Jeghers polyp

adenoma are found in

50% of adults by age 50 sized 0.3-10 cm