NEOPLASIA Dr. Manal Maher Hussein

44.1 - Thyroid, follicular adenoma Characteristics of benign tumors: fibrous pseudocapsule separating the adenoma from adjacent non-neoplastic thyroid tissue. Adenoma resemble the tissue from which they arose, = well differentiated. Very low power Dr. Manal Maher Hussein

–Well differentiated- What term is used to describe the resemblance of tumor cells to the tissue from which they arose? –Well differentiated- What histological features would you look for to rule out follicular carcinoma? Follicular carcinomas may be very well differentiated; hence, the presence of capsular invasion is essential to make the diagnosis of carcinoma. Dr. Manal Maher Hussein

44.2 - Thyroid, follicular adenoma This neoplastic tissue is very well differentiated showing follicles containing colloid. The nuclei are uniform and round and no mitotic figures are seen, and polarity of the cuboidal cells toward follicular lumens is preserved. Dr. Manal Maher Hussein

How do follicular cells in an adenoma compare with normal thyroid parenchyma? Follicular cells in adenomas tend to have larger nuclei and a slightly higher N:C ratio than non-neoplastic thyroid tissue. Dr. Manal Maher Hussein

Thyroid, follicular adenoma Very low power low power high power Thyroid, follicular adenoma Normal thyroid Dr. Manal Maher Hussein

45.1 - Colon, multiple adenomatous polyps Normal mucosal surface. Note many round smooth projections arising from the mucosa (polyps). They are benign glandular tumors (adenomas). Polyps are attached to the mucosa by stalks (not seen). Dr. Manal Maher Hussein

45.2 - Colon, adenomatous polyp Mucosa Submucosa Is there evidence of malignancy at this magnification? No, the adenoma seems to be confined to the mucosa with no evidence of invasion of the submucosa. Dr. Manal Maher Hussein

45.2 - Colon, adenomatous polyp normal mucosa stalk muscular layer Attached to the normal mucosa by a stalk is a well- demarcated polyp. It is apparent that the polyp is made up of glandular structures; hence, it is an adenoma. Adenomatous polyps in the colon may be solitary or multiple. Dr. Manal Maher Hussein

What is the term for a malignant tumor of glandular tissues? Adenocarcinoma. - Are all polyps neoplastic? No. Polyps can result from focal hyperplasia of the mucosa. Hyperplastic polyps do not have malignant potential. Dr. Manal Maher Hussein

45.3 - Colon, adenomatous polyp the junction of normal mucosa and the mucosa of the adenomatous polyp. Normal mucosa shows evidence of normal differentiation because the cells have clear vacuoles containing mucin. By contrast, the epithelial cells of the polyp have lost the specialized function of mucin production. The adenomatous cells are hyperchromatic. Dr. Manal Maher Hussein

Colon, adenomatous polyp the junction of normal mucosa and the mucosa of the adenomatous polyp. the epithelial cells of the polyp have lost the function of mucin production. The adenomatous cells are hyperchromatic. Attached to the normal mucosa by a stalk is a well- demarcated polyp.

What term is used to describe the intense staining of the adenomatous cells? - Hyperchromatic Dr. Manal Maher Hussein

46.1 - Colon, adenocarcinoma Dr. Manal Maher Hussein

46.1 - Colon, adenocarcinoma The mucosa on either side of the ulcer shows normal transverse folds. The edges of the ulcer are elevated and irregular. This is an indication of local invasion at the peripheral parts of the adenocarcinoma The adenocarcinoma is seen as a large, irregular mass How is ulceration of the mucosa used to diagnose the disease clinically? Ulceration causes bleeding, and this is detected as blood in the stools. Dr. Manal Maher Hussein

47 - Colon, adenocarcinoma The carcinoma is composed of irregular glands infiltrating the submucosa, muscularis propria, serosa, and mesentery The deeper the tumor extends into the muscularis propria and as lymph nodes become involved, the worse the prognosis. Dr. Manal Maher Hussein

46.2 - Colon, adenocarcinoma Note the ulceration of the mucosa and the deep invasion of the colon wall by malignant glands. Muscularis Serosal fibro-fatty tissue Dr. Manal Maher Hussein

Local invasion is highly related to distant spread. ulceration of the mucosa deep invasion of the colon wall by malignant glands. Serosal fibro-fatty tissue Muscularis What is the relation between the extent of local invasion and the possibility of distant metastases in this disease? Local invasion is highly related to distant spread. Dr. Manal Maher Hussein

46.3 - Colon, adenocarcinoma serosa Invasion of the muscular layer of the colon wall by irregular (malignant) glands. This tumor arose in the mucosa and is penetrating the muscular layer as it advances toward the serosa. Dr. Manal Maher Hussein

46.4 - Colon, adenocarcinoma Note the morphology of the malignant glands: irregular shapes, varying sizes, dark nuclei, multiple layers of cells, lack of mucin producing cells, and loss of normal architecture. They exist in abnormal site as submucosa, muscular layer or serosa due to infiltration (invasion) Dr. Manal Maher Hussein

46.4 - Colon, adenocarcinoma What term is used to describe cells and nuclei with irregular sizes and shapes Pleomorphism. Dr. Manal Maher Hussein

47 - Colon, adenocarcinoma What is the relation between local invasion and prognosis? The deeper the tumor extends into the muscularis propria, and as lymph nodes become involved, the worse the prognosis. Dr. Manal Maher Hussein

Dr. Manal Maher Hussein Adenocarcinoma Normal mucosa muscularis propria Mesentery Uninvolved lymph nodes Dr. Manal Maher Hussein

48 – Neurofibroma Arise within or are attached to the nerve trunks in the skin & may also be found internally, attached to nerves. Dr. Manal Maher Hussein

48 – Neurofibroma Spindle-shaped cells that have the features of fibroblasts. The cells are arranged in wavy bundles, cells are uniform in shape and size. The nuclei are elongated or sometimes curved. There is no nuclear pleomorphism, and mitotic figures are very rare. This is a typical neurofibroma. Dr. Manal Maher Hussein

49 – Neurofibrosarcoma What route of metastasis is commonly used by sarcomas? blood vessels This neurofibrosarcoma consists of large, spindle-shaped cells with large, irregular, deeply stained nuclei. variation in the shape and size of the cells and nuclei (pleomorphism), mitotic figures. nuclear/cytoplasmic ratio is increased Red blood cells in poorly formed capillaries. Dr. Manal Maher Hussein

52 - Normal adipose tissue Thin cytoplasmic membrane that bounds a large fat globule Nucleus is peripheral and flat Connective tissue septa divide lobules of fat and carry the vascular supply. Dr. Manal Maher Hussein

52.1-Lipoma, small intestine Here is a benign lipoma on the serosal surface of the small intestine. What are the characteristics of benign lipoma? Well bounded, non-invasive, closely resembles the tissue of origin (fat). Dr. Manal Maher Hussein

52.2 - Lipoma, small intestine capsulated lipoma of the small intestine It is composed of groups of fat cells. This neoplasm is so well differentiated that, except for its appearance as a localized mass, it is impossible to distinguish from normal adipose tissue. Dr. Manal Maher Hussein

52.3 - Lipoma, small intestine Well differentiated The fat cells appear large, polyhedral with vacuolated cytoplasm. These neoplastic adipocytes are indistinguishable from normal adipocytes. Dr. Manal Maher Hussein

53 – Liposarcoma This liposarcoma has enough differentiation to determine the cell of origin How do these tissue changes differ from those in normal one? pleomorphism Hyperchromatic nuclei, blood cells large strange lipoblasts are seen in this liposarcoma. Dr. Manal Maher Hussein