Workshop 9 - malignant epithelial tumors Flashcards
(56 cards)
1
Q
What differences can we have between BT and MT?
( morphological caracteristics )
A
- differentiation and anaplasia
- rate of growth
- local invasion
- metastasis
2
Q
Differentiation
of MTs and BTs
A
Refers to morphological and functional similarity of neoplastic cells with cell origin
MTs : showing various degrees of differentiantion
- WD - well differentiated forms
- ND - non differenciated forms
- anaplastic forms
BTs : well - differentiated tumors
***anaplasia or lack of differentiation is a characteristic feature of malignancy
3
Q
characteristic feature of malignancy
( differentiation )
A
anaplasia
and
lack of differentiation
4
Q
what rate of growth have the MTs and the BTs?
A
MTs : rapid rate
- WD MTs : grow more slowly
- ND Mts : grow rapidly
BTs : slow rate
5
Q
Invasion of BTs
A
- grow as masses at the site of the origin of the tumor
- grow locally - causing compression of adjacent tissues
- usually have capsules that separate them from the tissue
- they are not all encapsuled but they are clearly defined
- not all are wel defined , except hemangioma
6
Q
Invasion of MTs
A
- the growth is not limited at the site of the origin
- grow rapidly , invading adjacent tissues, cause damage
- not well defined
( exc renal nuclear cell carcinoma - has capsule )
7
Q
MTs are not well defined
Name an exception
A
renal clear cell carcinoma
- grows slowly
- has capsule
8
Q
Metastasis
definition
A
Metastasis are tumoral implants located at distance from primary tumor site
characteristic of MTs
4 ways of spreading
9
Q
Metastasis
4 ways of spreading
A
- Local
- Lymphatic dissemination
- vascular dissemination
- Transcelomic
10
Q
Local metastasis
A
tumor spreads by direct way
in adjacent tissues
along cleavage plans and nervous fibers
11
Q
Lymphatic spread
Macro and micro
A
tumor cells disseminate along lympthatic vessels
causing secondary lymphatic metastasis
- Macro
lymph nodes : increase volume, loss of structure - Micro
tumor cells replace the normal lymph node
12
Q
Vascular dissemination
Macro , Micro
A
tumor cells disseminate by hematogenous way
( tumor emboli)
in this way a primary tumor cause secondary visceral metastases in :
liver, lung, adrenal, brain etc
- Macro
Affected organ is increased in volume and presents many tumor nodules, well defined, uncapsuled - Micro
can be similar to primary tumor or not
13
Q
transcelomic dissemination
A
primary abdominal and thoracic tumor disseminate alog the mesothelial surfaces
ex. pleural cavities
14
Q
Histological features of BT and MT
A
Benign
-
Differentiation : Well - diff.
resembling with cell origin - Mitosis : few
- Nucleus / Cytoplasm Ratio : normal 1/4
- homogenous cell shape and size
Malignant
- Differentiation : Failure of cell diff.
- **Mitosis : **many
- **Nucleus / Cytoplasm Ratio : **high 1/1
- cell and nuclear pleomorphism
15
Q
histological feature of BT
A
Benign
- **Differentiation **: Well - diff.
resembling with cell origin
- **Mitosis **: few
- Nucleus / Cytoplasm Ratio : normal 1/4
- homogenous cell shape and size
16
Q
Histological features of MTs
A
Malignant
- Differentiation : Failure of cell diff.
- Mitosis : many
- Nucleus / Cytoplasm Ratio : high 1/1
- cell and nuclear pleomorphism
17
Q
Characteristic features of Mts
A
- aplasia of lack of differentiation
- rapid rythm of growth
- invasion
- metastasis
18
Q
Stages of development of neoplasia
and
progression of dysplasia to neoplasia
A
- normal epithelium
- dysplastic epithelium
- CIS - carcinoma in situ
- micro invasive carcinoma
- invasive carcinoma
19
Q
Stages of development of neoplasia
and
progression of dysplasia to neoplasia
Dysplastic epithelium
A
mild , moderate and severe
- cytologically : defines morphological neoplastic features of cells characterized by incomplete maturation and increasing of mitosis number
- causes : ex. chronic inflammation
- may develop into neoplasia
20
Q
Stages of development of neoplasia
and
progression of dysplasia to neoplasia
CIS- carcinoma in situ
A
- represents an early stage of neoplasia
previous to invasion - Cytologically : characterized by cell and nuclear pleomorphysm and increased mitotic activity
- Histologically : disruption of normal architecture , but BM remains intact
- may progress to neoplasia
21
Q
Stages of development of neoplasia
and
progression of dysplasia to neoplasia
Micro invasive carcinoma
A
results by invasion of cancer cells
into subjacent stroma ( 5 mm in diameter )
22
Q
Stages of development of neoplasia
and
progression of dysplasia to neoplasia
Invasive Carcinoma
A
corresponds to an advanced cancer
presenting clinical manifestation
23
Q
Features of malignant epithelial tumors
A
- common in adults and elderly
- diagnosis established in stahe 0 (CIS) :
100% healing - usually present lymphatic metastasis
24
Q
Histogenic classification of carcinomas
A
- Epidermoid / squamocellular carcinoma
- adenocarcinoma
25
```
Squamocelullar carcinoma ( epidermoid )
( SCC )
```
origin
* **epidermis**
( skin )
* **mucous epidermoid membrane**
( lip , tongue, pharynx, larynx, exocol, vagina )
* **epidermoid areas of squamous metaplasia **
( pluristratified gut epithelium )
( bronchial epithelium-smoking, billiary duct-stone )
26
Squamocelullar carcinoma ( epidermoid )
Macroscopically 2 types of growth
| ( SCC )
* vegetative tumor
* ulcerative tumor
27
Squamocelullar carcinoma ( epidermoid )
macro. Vegetative
| ( SCC )
tumor has a **large** basis of **implantation** and
**irregular surface **
areas of **necrosis** and **bleeding**
and may **ulcerate**
28
Squamocelullar carcinoma ( epidermoid )
Macro. Ulcerative tumor
| ( SCC )
Tumor has a broad -base of implantation and
prominent margins
consisting of tumoral infiltration
29
Squamocelullar carcinoma ( epidermoid )
Micro. 3 degress of differentiation
WD
| ( SCC )
invasive tumor
forming nests or islands of polygonal atypical cells
which syntheses keratin
forming concentric globes
called keratosic pearls
30
Squamocelullar carcinoma ( epidermoid )
Micro. 3 degress of differentiation
MD
| ( SCC )
aggregates of *polygonal* tumor cells
with nuclear **atypia** and reduced **keratonization**
31
Squamocelullar carcinoma ( epidermoid )
Micro. 3 degress of differentiation
PD
| ( SCC )
invasive tumor
composed of **individual polygonal **cells
with marked nuclear atypia
and _no_ keratinization
32
Squamocelullar carcinoma ( epidermoid )
Keratizined , differentiated epidermoid carcinoma
| ( SCC )
The tumor,
with *origin* in **cutaneous squamocellular epithelium**
invades dermal connective support,
forming **tumoral islands**
separated by reducted **connective stroma**
infiltrated by **lympocytes**
The tumoral islans are compoused of atypical polygonal cells ,resembling with epidermal squamous :
through defferentiation the tumoral cells synthetise keratin forming central concentric lamellae
( **keratin pearl** is a mark dignostic element for differentiated epidermoid carcinoma )
33
Squamocelullar carcinoma ( epidermoid )
general
| ( SCC )
Cutaneous SCC has metastatic potential
Lymphatic dissemination and metastases in regional lymph nodes occur lately
SCC us not radiosensitive cancer
34
Basal cell carcinoma
BSC
Is a particular form of skin carcinoma , located at face
Originates on basal cell layer of
epidermis and hair
35
Basal cell carcinoma
BSC
macro
```
there is an ulcerative carcinoma with prominent
pearled edges ( ulcus rodens )
```
36
Basal cell carcinoma
BSC
Microscopically
presents two main histological subtypes :
1. superficial
2. nodular
The nodular tumor originates from the basal layer of epidermis, infiltrates the subjacent dermis, where it forms islands of tumor cells separated by a connective - vascular stroma that is infiltrated by mononuclear inflammatory cells , tumoral islands are composed of tumor cells resembling with basal cells with peripheral parallel disposition and central disordely disposition.
37
Basal cell carcinoma
BSC
general
BCC is a local invasive tumor
without metastatic features
is a radiosensitive tumor
38
Basal cell carcinoma
BSC
basocellular carcinoma of skin
The tumor has origin in skin basocellular layer , invades derman connective tissue support ,
forming tumoral islands separetaed by reduced connective stroma,
infiltrated by lymphocytes
The tumoral islands are composed by atypical cells, resembling with epidermal basal cells , arranged in parallel manner to the periphery of the tumoral sheets and chaotically in the center of this tumoral island.
39
Adenocarcinoma
what is it?origin?
Ia s tumor with origin in glandular epithelium from **cavitary** organs ( stomach , colon ) or **parenchymal** organs ( lungs, liver )
40
Adenocarcinoma
Macro
In cavitary organs
present 3 appearances
1. **vegetative carcinoma **
cauliflower tumor mass
with large base of attachement
and irregular surface
2. **ulcerative carcinoma**
crater ulcer , with broad , deep basis and raised edges
3. **Infiltrative carcinoma**
tumor infiltrates entire wall , causing thickness of the wall and narrowing of the lumen ( stenosis )
41
Adenocarcinoma
Macro
in parenchymal organs
present 2 macro. appearances
1. **Nodular carcinoma**
nodular, large tumor with irregular edges , due to local invasive feature
2. **Inflitrative carcinoma**
Diffuse tumor replacing gradually adjacent tissues and finally, entire organ
42
Adenocarcinoma
Micro. degrees
WD
MD
PD
ND
43
Adenocarcinoma
Micro. degrees
WD adenocarcinoma
* **Tubular**
Colonic ADC is composed of tumor glands , lined by atypical epithelial cells arranged on one or multiple layers and forming a lumen
* **Papillary**
Of the thyroid.
composed of connective-vascular axis covered by atypical cells
* **Vesicular or Follicular**
of thyroid
* **Trabecular**
Hepatic carcinoma is composed of tumor hepatocytes forming cords or trabecules
44
Adenocarcinoma
Micro. degrees
MD ADC
composed of differentiated tumor elements ( tubes ) and athypical tumor cells with chaotic disposition,
forming masses, cords, etc
45
Adenocarcinoma
Micro. degrees
PD ADC
composed of athypical tumor cells forming irregular masses that are no-cohesive one to each others, and with no specific epithelial differentiation ( or specific architecture )
46
Adenocarcinoma
Micro. degrees
ND carcinoma
No-cohesive masses of anaplastic cells
47
Adenocarcinoma
colonic moderate differentiated tubular carcinoma
* The tumor *originates* in the **glandular** epithelium of the colon and **penetrates** the *muscularis mucosa* and **infiltrates** the *submucosa* and *muscular layer*
* Is *composed* from tubular elements separated by a **reduced stroma**
The tumoral glands are lined by *atypical* epithelium disposed on one or multiple layer with an irregular lumen
48
Particular Forms of ADC
| (2)
* Cordonal carcinoma
* Mucinous Carcinoma
49
Cordonal carcinoma : the two parts
* Schirrous
* Medullary
50
Schirrous carcinoma
Micro and macro
Micro :
Think cords of tumor cells in an abundant connective stroma
Macro:
tumor of firm , hard consistency ( schir )
51
Medullary carcinoma
Micro and Macro
Micro :
Large cords of tumor cells produced in reduced connective stroma
Macro :
Tumor of soft consistency ( encephaloid appearance )
52
Mucinous carcinoma :
2 parts
* colloid carcinoma
* signet ring cell carcinoma
53
Colloid carcinoma
Micro , Macro
Micro :
Large **mucous sheets** , containing tumor cells arranged individually or in groups ( tubes , cords ) which dissect the wall layers and inflitrate the affected organ
Macro :
tumor of **gelatinous** appearance
54
Signet ring cell carcinoma
Micro
tumor cell produce, retain and excrete mucus,
resulting cells loaded with mucus
55
Carcinoma metastasis :
Lymph nodes
Macro, Micro
Macro
Lymph nodes are increased in volume
Micro :
tumor cells invade and replace the lymph node structure
56
Visceral metastasis : lung, liver
Macro , Micro
Macro :
the organ has increased volume
presence of multiple , well defined uncpasuled nodular tumor
Micro :
Metastatic tumors resemble or not with the primary tumor
