NEOPLASIA DR. AYESHA IMTIAZ PATHOLOGY DR. AYESHA IMTIAZ PATHOLOGY

NEOPLASM : An abnormal mass of tissue, the growth of which is uncontrolled (exceeds) and is uncoordinated with that of the normal tissues and persists in the same excessive manner after cessation of the stimuli which evoked the change. DEFINITION

Oncology (Greek oncos = tumor) is the study of tumors or neoplasms

Adenoma is applied to a benign epithelial neoplasm derived from glands Papillomas :Benign epithelial neoplasms producing microscopically or macroscopically visible finger- like or warty projections from epithelial surfaces are referred to as papilloma TERMINOLOGIES

Polyp : Macroscopically visible projection above a mucosal surface or epithelial surface is termed as polyp Cystadenomas : Benign tumors that form large cystic masses, are referred to as cystadenomas. TERMINOLOGIES

TERATOMA : Tumors which contain tissues representative of more than one germ cell layer and sometimes all three. Teratomas originate from totipotential cells, such cells have the capacity to differentiate into any of the cell types found in the adult body and so, give rise to neoplasms that reveal bits of bone, epithelium, muscle, fat, nerve, and other tissues. E.g.: ovarian cystic teratoma (dermoid cyst) TERMINOLOGIES

BENIGN EPITHELIAL (ADENOMA ; PAPILLOMA) MESENCHYMAL (FIBROMA ; LEIOMYOMA) MALIGNANT EPITHELIAL CARCINOMA MESENCHYMAL SARCOMA CLASSIFICATION

Malignant neoplasms of epithelial cell origin, are called carcinomas CARCINOMA

Carcinomas may be further qualified. Squamous cell carcinoma : A malignant cancer in which the tumor cells resemble stratified squamous epithelium Adenocarcinoma : A malignant cancer in which the neoplastic epithelial cells grow in glandular patterns. CARCINOMA

Malignant tumors arising in mesenchymal tissue are called sarcomas SARCOMA

Malignant neoplasms of lymphoid cell origin, are called lymphomas LYMPHOMA

HODGKIN’S LYMPHOMA NON-HODGKIN’S LYMPHOMA MULTIPLE MYELOMA CLASSIFICATION

HODGKIN’S LYMPHOMA Less common than Non-Hodgkin’s lymphoma. (1 : 7) Highly treatable and curable, even when disseminated. Presence of Reed-Sternberg cell is necessary to make diagnosis. Reed-Sternberg cells are the malignant cells. Less common than Non-Hodgkin’s lymphoma. (1 : 7) Highly treatable and curable, even when disseminated. Presence of Reed-Sternberg cell is necessary to make diagnosis. Reed-Sternberg cells are the malignant cells.

HODGKIN’S LYMPHOMA Cell of origin is unknown: T lymphocyte, B lymphocyte ; both. Etiology : EBV infection Male > Female Bimodal age distribution children after age 50 Cell of origin is unknown: T lymphocyte, B lymphocyte ; both. Etiology : EBV infection Male > Female Bimodal age distribution children after age 50

Reed-Sternberg cell

HODGKIN’S LYMPHOMA Histologic subtypes 1.nodular sclerosis (most common subtype) 2.mixed cellularity 3.lymphocyte-rich 4.lymphocyte depleted 1.nodular sclerosis (most common subtype) 2.mixed cellularity 3.lymphocyte-rich 4.lymphocyte depleted

RS cell and variants popcorn celllacunar cellclassic RS cell (mixed cellularity)(nodular sclerosis) (lymphocyte predominance)

HODGKIN’S DISEASE Clinical Manifestations Lymphadenopathy Contiguous spread Extranodal sites relatively uncommon except in advanced disease Lymphadenopathy Contiguous spread Extranodal sites relatively uncommon except in advanced disease

NON- HODGKIN’S LYMPHOMA 85% B cell origin. Can occur at any age Overall incidence varies with location: – Burkitt’s in tropical Africa 85% B cell origin. Can occur at any age Overall incidence varies with location: – Burkitt’s in tropical Africa

NON- HODGKIN’S LYMPHOMA ETIOLOGY Immune suppression – Congenital – AIDS – increasing age DNA repair defects – xeroderma pigmentosum Chronic inflammation – Helicobacter pylori inflammation – Sjögren’s syndrome Viral infections – EBV – HTLV-I & HTLV-V – Hepatitis C ETIOLOGY Immune suppression – Congenital – AIDS – increasing age DNA repair defects – xeroderma pigmentosum Chronic inflammation – Helicobacter pylori inflammation – Sjögren’s syndrome Viral infections – EBV – HTLV-I & HTLV-V – Hepatitis C

NON- HODGKIN’S LYMPHOMA CLASSIFICATION Terminology (refers to natural history) – low grade = indolent – intermediate grade = aggressive – high grade = aggressive (indolent: slow growing, incurable) (aggressive: rapidly growing, curable) CLASSIFICATION Terminology (refers to natural history) – low grade = indolent – intermediate grade = aggressive – high grade = aggressive (indolent: slow growing, incurable) (aggressive: rapidly growing, curable)

Small lymphocyticImmunoblastic Mantle cellLarge Cell Types of Non-Hodgkin’s Lymphoma

The nomenclature of tumors and their biologic behavior are based primarily on the parenchymal component In general, tumors are designated by attaching the suffix -oma to the cell of origin. NOMENCLATURE

COMPARISON BETWEEN BENIGN TUMORS & MALIGNANT TUMORS

INVASION & METASTASIS ARE BIOLOGICAL HALL MARKS OF MALIGNANCY

CYTOPATHOLOGY

FINE NEEDLE ASPIRATION WASHINGS (BRONCHIAL ; ABDOMINAL ) CERVICAL SMEARS ( PAP )

IMMUNOHISTOCHEMISTRY

TUMOR MARKERS

Alpha Feto Protein (AFP) Human Chorionic Gonadotrophin (HCG) Calcitonin Prostatic Acid Phosphatase (PAP) Carcinoembryonic antigen (CEA) Ectopic hormones Alpha Feto Protein (AFP) Human Chorionic Gonadotrophin (HCG) Calcitonin Prostatic Acid Phosphatase (PAP) Carcinoembryonic antigen (CEA) Ectopic hormones

SUMMARY GOLD STANDARD -HISTOPATHOLOGICAL INVESTIGATIONS INTRA-OPERATIVE CONSULTANCY (FROZEN SECTION) CYTOLOGICAL STUDIES (FNA;SMEARS) BIOPSY INCISIONAL EXCISIONAL IMMUNOHISTOCHEMISTRY TUMOR MARKERS CYTOGENETIC & MOLECULOGENETIC STUDIES FISH ELECTRON MICROSCOPY PCR FLOW CYTOMETRY,etc. GOLD STANDARD -HISTOPATHOLOGICAL INVESTIGATIONS INTRA-OPERATIVE CONSULTANCY (FROZEN SECTION) CYTOLOGICAL STUDIES (FNA;SMEARS) BIOPSY INCISIONAL EXCISIONAL IMMUNOHISTOCHEMISTRY TUMOR MARKERS CYTOGENETIC & MOLECULOGENETIC STUDIES FISH ELECTRON MICROSCOPY PCR FLOW CYTOMETRY,etc.

FATE / OUTCOME Both malignant and benign tumors may cause problems because of (1)Location and impingement on adjacent structures (2)Functional activity such as hormone synthesis or the development of paraneoplastic syndromes (3)Bleeding and infections when the tumor ulcerates through adjacent surfaces (4)Symptoms that result from rupture or infarction (5)Cachexia or wasting. Both malignant and benign tumors may cause problems because of (1)Location and impingement on adjacent structures (2)Functional activity such as hormone synthesis or the development of paraneoplastic syndromes (3)Bleeding and infections when the tumor ulcerates through adjacent surfaces (4)Symptoms that result from rupture or infarction (5)Cachexia or wasting.

PARANEOPLASTIC SYNDROMES Cushing’s syndrome Hypercalcemia ; etc

THANX QUESTIONS & ANSWERS