Thanaa Helal Professor of Pathology Faculty of Medicine – Ain Shams University.

Proliferation Differentiation

According to Behaviour Benign Locally malignant Malignant  Basal cell Ca  Craniophayngioma  Amelablastoma  Giant cell tumor  Basal cell Ca  Craniophayngioma  Amelablastoma  Giant cell tumor

 Increased N/C ratio  Nuclear pleomorphism  Nuclear hyperchromatism  Prominent nucleoli  Irregular nuclear membrane  Abnormal mitotic figures  Increased N/C ratio  Nuclear pleomorphism  Nuclear hyperchromatism  Prominent nucleoli  Irregular nuclear membrane  Abnormal mitotic figures

Differences Between Benign and Malignant Tumours BenignMalignant Size SmallLarge Capsule +- Similarity to tissue of origin +- Criteria of malignancy -+ Rate of growth SlowRapid Mode of growth CompressionInfiltration Spread -+ DNA pattern DiploidAneuploid

Malignant (Leiomyosarcoma) Benign (Leiomyoma)

Epithelial Mesenchymal Benign Malignant Benign Malignant Carcinoma Sarcoma

Differences between carcinoma and sarcoma CarcinomaSarcoma Origin EpitheliumConnective tissue Age More in oldMore in young Vascularity Less vascularMore vascular Rate of growth Less rapidMore rapid Cut section Less hgeMore hge Spread Early by lymphatics Early by blood Prognosis Less worseMore worse Microscopic Cells arranged in groups Cells arranged individually

Carcinoma Sarcoma

Epithelial Tumours BenignMalignant 1. Squamous epithelium S. cell papillomaS. cell carcinoma 2. Basal cells of skin ---Basal cell carcinoma 3. Melanocytes NaevusMalignant melanoma 4. Glandular epithelium Adenoma (Cystadenoma) Adenocarcinoma (Cystadenocarcinoma) 5. Transitional epithelium T.cell papillomaT.cell carcinoma 6. Trophoblastic epithelium Vesicular moleChoriocarcinoma

1) Papilloma  Gross: Sessile or pedunculated polypoid mass 1) Papilloma  Gross: Sessile or pedunculated polypoid mass Precancerous

 Microscopic: A central core of connective tissue covered by epithelium which may be A)Squamous: Skin, upper resp. tract, upper GIT  Microscopic: A central core of connective tissue covered by epithelium which may be A)Squamous: Skin, upper resp. tract, upper GIT

B)Transitional: UB, ureter, renal pelvis

2.Junctional naevus: Dermoepidermal junction 2.Junctional naevus: Dermoepidermal junction

3.Compound naevus: Both dermis and DEJ

C)Columnar: Duct papilloma of the breast

2) Adenoma, Arises from: A. Mucous membrane: GIT, Bronchi, Breast, Ovary B. Endocrine glands: Thyroid, adrenal Gross A)Endocrine glands: Encapsulated mass B) GIT: Adenomatous polyp (Precancerous) C) Ovary: Cystadenoma, Papillary cystadenoma D) Breast: Fibroadenoma 2) Adenoma, Arises from: A. Mucous membrane: GIT, Bronchi, Breast, Ovary B. Endocrine glands: Thyroid, adrenal Gross A)Endocrine glands: Encapsulated mass B) GIT: Adenomatous polyp (Precancerous) C) Ovary: Cystadenoma, Papillary cystadenoma D) Breast: Fibroadenoma (Precancerous) Microscopic: Similar to normal tissue

Encapsulated mass Papillary cystadenoma Fibroadenoma Polyp Adenoma

GrossGross InfiltratingInfiltrating Fungating UlcerativeUlcerative

Microscopic  Squamous cell carcinoma  Transitional cell carcinoma  Adenocarcinoma  Basal cell carcinoma Microscopic  Squamous cell carcinoma  Transitional cell carcinoma  Adenocarcinoma  Basal cell carcinoma

Site  Surfaces originally covered by sq. epith. as: skin, upper resp. tract and upper GIT  Surfaces covered by any epith. after sq. metaplasia as: bladder, bronchi, cervix Gross  Fungating mass  Malignant ulcer Site  Surfaces originally covered by sq. epith. as: skin, upper resp. tract and upper GIT  Surfaces covered by any epith. after sq. metaplasia as: bladder, bronchi, cervix Gross  Fungating mass  Malignant ulcer

Microscopic  Masses of squamous epithelium with central keratin (cell nests) Grading: Broder’s classification  Grade 1 : > 50% cell nests  Grade 2 : 25-50% cell nests  Grade 3 : < 25% cell nests Spread: Direct, Lymphatic, Blood Microscopic  Masses of squamous epithelium with central keratin (cell nests) Grading: Broder’s classification  Grade 1 : > 50% cell nests  Grade 2 : 25-50% cell nests  Grade 3 : < 25% cell nests Spread: Direct, Lymphatic, Blood

Well diff. SCC: grade I Poorly diff. SCC: grade III

Site: Face Gross  Early: Papule  Late: Rodent ulcer Site: Face Gross  Early: Papule  Late: Rodent ulcer

Microscopic  Infiltration of the dermis by masses of basaloid cells (oval with dark nuclei and minimal basophilic cytoplasm)  Peripheral palisading Microscopic  Infiltration of the dermis by masses of basaloid cells (oval with dark nuclei and minimal basophilic cytoplasm)  Peripheral palisading

Spread  Local spread only  Lymphatic spread: Only in case of  Secondary infection  Squamous Ca + Basal CC  Blood spread: Never Spread  Local spread only  Lymphatic spread: Only in case of  Secondary infection  Squamous Ca + Basal CC  Blood spread: Never

(1) Classic adenocarcinomas  Site: As adenoma  Gross: (1) Classic adenocarcinomas  Site: As adenoma  Gross: InfiltratingInfiltrating Fungating UlcerativeUlcerative

 Microscopic: Malignant acini + solid masses  Grading Grade 1 : > 50% acini Grade 2 : % acini Grade 3 : <25% acini  Microscopic: Malignant acini + solid masses  Grading Grade 1 : > 50% acini Grade 2 : % acini Grade 3 : <25% acini

(2) Mucoid carcinoma  Site : Stomach, large intestine, breast  Gross: Soft and gelatinous mass  Microscopic: Lakes of mucin containing malignant cells (2) Mucoid carcinoma  Site : Stomach, large intestine, breast  Gross: Soft and gelatinous mass  Microscopic: Lakes of mucin containing malignant cells

(3) Signet ring carcinoma  Site : Stomach, large intestine  Gross: Diffusely infiltrating lesion  thickening of wall of stomach or large intestine  Microscopic: Diffuse infiltration by signet ring cells (3) Signet ring carcinoma  Site : Stomach, large intestine  Gross: Diffusely infiltrating lesion  thickening of wall of stomach or large intestine  Microscopic: Diffuse infiltration by signet ring cells

 Benign: Naevus (benign melanoma)  Gross Size: Small Shape: Rounded Consistency: Firm Capsule: Not encapsulated, well circumscribed well circumscribed Cut section: Brownish  Benign: Naevus (benign melanoma)  Gross Size: Small Shape: Rounded Consistency: Firm Capsule: Not encapsulated, well circumscribed well circumscribed Cut section: Brownish

 Microscopic 1.Intradermal naevus: Dermis only 1.Intradermal naevus: Dermis only

Risk factors  Sun exposure  Fair skin  Nevus  Rapid growth  Increased pig.  Ulceration Site: Face, neck, chest Risk factors  Sun exposure  Fair skin  Nevus  Rapid growth  Increased pig.  Ulceration Site: Face, neck, chest

Gross  Size : Small  Shape: Rounded  Consistency: firm  Capsule: non-encapsulated and infiltrating adjacent and infiltrating adjacentstructures  Cut section: Brownish Gross  Size : Small  Shape: Rounded  Consistency: firm  Capsule: non-encapsulated and infiltrating adjacent and infiltrating adjacentstructures  Cut section: Brownish

Microscopic 1- In situ malignant melanoma: Intraepidermal pagetoid spread Microscopic 1- In situ malignant melanoma: Intraepidermal pagetoid spread

Microscopic 2- Invasive malignant melanoma  Diffuse infiltration of the dermis by malignant melanocytes which are epithelial or spindle-shaped and usually contain melanin Microscopic 2- Invasive malignant melanoma  Diffuse infiltration of the dermis by malignant melanocytes which are epithelial or spindle-shaped and usually contain melanin

Site  Original epith. as: skin, bladder, breast, cervix  Metaplastic epith.: bladder, bronchus, cervix Gross  Rough paplular areas  Superficial ulceration Site  Original epith. as: skin, bladder, breast, cervix  Metaplastic epith.: bladder, bronchus, cervix Gross  Rough paplular areas  Superficial ulceration

Microscopic  Criteria of malignancy in the whole thickness of epithelium with intact basement membrane  Later on: invasion of BM  invasive carcinoma Microscopic  Criteria of malignancy in the whole thickness of epithelium with intact basement membrane  Later on: invasion of BM  invasive carcinoma

Mesenchymal Tumours (Soft tissue tumours) Mesenchymal Tumours (Soft tissue tumours) BenignMalignant 1. Fibrous tissue FibromaFibrosarcoma 2. Fatty tissue (lipocytes) LipomaLiposarcoma 3. Smooth m. (leios) LeiomyomaLeiomyosarcoma 4. Striated m. (Rhabdos) RhadomyomaRhabdomyosarcoma 5. Blood vessels HaemangiomaAngiosarcoma 6. Lymph vessels LymphangiomaLymphangiosarcoma 7. Cartilage (Chondrocytes) ChondromaChondrosarcoma 8. Bone (osteoid) OsteomaOsteosarcoma 9. Mesothelium B. mesotheliomaM. mesothelioma 10. Lymphoid tissue ---Lymphoma.

 Benign: Fibroma  Site: Any area of fibrous tissue  Gross  Size: variable  Shape: Rounded or oval  Consistency: Firm  Capsule: present  Cut section : Whitish  Benign: Fibroma  Site: Any area of fibrous tissue  Gross  Size: variable  Shape: Rounded or oval  Consistency: Firm  Capsule: present  Cut section : Whitish

 Microscopic Parallel bundles of spindle-shaped fibroblasts  Microscopic Parallel bundles of spindle-shaped fibroblasts

 Site: Mainly in the extremities  Gross Size: variable Shape: rounded or oval Consistency: firm Capsule: may be encapsulated encapsulated Cut section: whitish  Site: Mainly in the extremities  Gross Size: variable Shape: rounded or oval Consistency: firm Capsule: may be encapsulated encapsulated Cut section: whitish