Classification of Tumours Professor of Pathology Neoplasia 2 Dr. Faten Ghazal Professor of Pathology

Intended Learning Outcomes (ILOs) By the end of this lecture YOU will be able to: Differentiate between benign and malignant tumours as regards: differentiation, rate of growth, local invasion, metastases. (Revision of the previous lecture) Describe pathologic features of some benign epithelial & mesenchymal tumours

.Capsule (+/-), Borders .Local Growth .Secondary Changes Characteristic Benign Tumour Malignant Tumour I. Rate of Growth Slow Rapid II. Gross Features: .Capsule (+/-), Borders .Local Growth .Secondary Changes Capsulated or well circumscribed Grow by Expansion Less often Noncapsulated but some are well circumscribed e.g……………… Grow by infiltration & destruction More often III. Microscopic features: .Differentiation .Criteria of Malignancy (+/-) Well Differentiated No criteria of Malignancy Wide range of Differentiation Show Criteria of Malignancy IV. Metastases (+/-) Never occur Can occur

Intended Learning Ooutcomes (ILOs) By the end of this lecture the student will be able to: Differentiate between benign and malignant tumours as regards: rate of growth, gross features (local invasiveness & secondary changes), microscopic features (differentiation & criteria of malignancy) & metastases. (Revision of the previous lecture) Describe pathologic features of benign epithelial & mesenchymal tumours

Classification of Tumours According to Behaviour & Cell of Origin Benign Tumours Malignant Tumours Epithelial Mesenchymal Epithelial Mesenchymal Papilloma Adenoma According to origin Carcinoma Sarcoma Mixed Mixed

Benign Epithelial Tumours Surface Epithelial Tumours Glandular Epithelial Tumours Papilloma Adenoma Squamous Papilloma Transitional Papilloma Columnar Papilloma (e.g. ducts of breast) GIT Thyroid Gland Named according to the organ cell of origin

Benign Epithelial Tumours Pathologic Features Any Papilloma: Gross: A lesion arising above the surface that may be sessile or pedunculated (has a pedicle or a neck), simple or branched (finger like projection.) Microscopically: All types have a vascular central core of connective tissue covered by epithelium (which can be either squamous, transitional or columnar)

Suggest the type of Papilloma in the figures: Squamous Cell Papilloma An elevated small mass having finely mamillated outer surface

Papilloma of the Larynx What is the Organ?? Tongue Epiglottis The lesion: Well circumscribed Rounded Polypoid Mass On left Vocal Cord

Squamous Cell Papilloma Hyperkeratosis Papillomatosis Acanthosis Pathology Department

Squamous Cell Papilloma Acanthosis Hyperkeratosis acanthosis

Squamous Cell Papilloma ??? Acanthosis

Squamous Cell Papilloma Branched core of connective tissue covered by stratified squamous epithelium showing: Acanthosis: hyperplasia of stratum spinosum (refer to histology) Hyperkeratosis: increased keratin Papillomatosis: elongation of dermal ridges Typical examples are present in…………..?? Any organ covered by or lined by stratified squamous epithelium: skin, larynx, esophagus, ectocervix

Male patient 55 years old complained of hematuria. Cystoscopy( Male patient 55 years old complained of hematuria. Cystoscopy(?) was done and a small mass was excised and revealed the following figures. Transitional Cell Papilloma 2nd Type Urothelium (Transitional Epithelium) Papillary Core of Connective Tissue

Transitional Cell Papilloma 2nd Type Urothelium (Transitional Epithelium) Papillary Core of Connective Tissue

Columnar Duct Papilloma of Breast 3rd Type A female patient 50 year old presenting with bleeding per nipple Columnar Duct Papilloma of Breast Bleeding per nipple Due to ulceration

Benign Epithelial Tumours Back to Our Classification Benign Epithelial Tumours Surface Epithelial Tumours Glandular Epithelial Tumours Papilloma Adenoma ? Squamous Papilloma Transitional Papilloma Columnar Papilloma (ducts of breast) GIT Thyroid Gland

Adenoma Adenoma Benign tumour of glandular epithelium Encapsulated mass as in thyroid Or Non-capsulated polyp projecting in lumen as in GIT. Cystic mass thus named as cystadenoma May form papillae thus named as papillary cystadenoma (as in ovary) Adenomas arising in endocrine glands leads to hypersecretion of hormones May show varying degrees of epithelial dysplasia Thus can be precancerous as Colonic adenomas

Extended Modular Program Normal tissue? Adenoma Thyroid Gland Adenoma Extended Modular Program

Adenoma Normal tissue? Thyroid Gland Adenoma

Papillary Serous Cystadenoma An Opened Ovarian Mass Cystic Papillary Serous Cystadenoma

Colonoscopy showing: a single pedunculated polyp multiple polypi

A polyp: a “tumour” or a “mass” that projects above a mucosal surface It can be non neoplastic as nasal polyp (inflammatory) It is commonly used for benign tumours but some malignant tumours can grow as a polyp After the first sentence: ask can you remember a polyp you have taken before?? Pathology Department

Normal Epithelium of……. Tubular Adenoma of the Colon Compare the adenomatous glands (upper part) and the normal (lower part) Normal Epithelium of……. Tubular Adenoma of the Colon

Classification of Tumours According to Behaviour & Cell of Origin Benign Tumours Malignant Tumours Epithelial Mesenchymal Epithelial Mesenchymal Papilloma Adenoma According to origin Carcinoma Sarcoma Mixed Mixed

Tissue of Origin (Mesenchymal) Mesenchymal Tumours Tissue of Origin (Mesenchymal) Benign Tumours Malignant Ts Adipose Tissue Lipoma Liposarcoma Fibrous Tissue Fibroma Fibrosarcoma Cartilage Chondroma Chondrosarcoma Bone Osteoma Osteosarcoma Smooth Muscle Leiomyoma Leiomyosarcoma Skeletal Muscle Rhabdomyoma Rhabdomyosarcoma Mesothelium Benign Fibrous Tumor Mesothelioma Blood Vessels Haemangioma Angiosarcoma Meninges Meningioma Invasive Meningioma

Benign Mesenchymal Tumours Pathologic Features Gross: Tumours are encapsulated or well circumscribed Microscopically: They are formed of cells similar to the cell of origin. Thus called ………….……………. Well differentiated

An excised soft swelling in the back that was growing slowly. What does this mass look like, gross inspection?

?? Lipoma A capsulated tumour Formed of: lobules of proliferated oval cells (adipocytes or fat cells) with nucleus pushed to one side (signet ring appearance). Separated by: thin vascular fibrous tissue septa.

What is the organ? What are the lesions? How do they look like? 1:Submucosal, 2:Intramural, 3:Subserosal Benign tumour of the myometrium of uterus The cell of origin is the smooth muscle cell Well circumscribed but noncapsulated Whorly greyish white cut surface, & firm consistency What is the organ? What are the lesions? How do they look like? 1,2, 3 are different sites ……… Name these sites 3 2 1 Uterus Fresh Specimen of ……. Multiple Leiomyomas

Multiple Leiomyomas of the Uterus Submucous 3 1 Subserous 2 Intramural Outer Surface Cut Section

This is a line of cleavage and but no capsule Leiomyoma This is a line of cleavage and but no capsule ? ? Proliferated smooth muscle cells (elongated cells with eosinophilic cytoplasm and rod shaped nuclei) They are arranged in interlacing or intersecting bundles Myometrium Leiomyoma

Tumours of Blood Vessels Haemangioma (capillary, cavernous): Common benign tumour in infancy and children. Capillary Haemangioma Sites: in subcutaneous tissue as irregular red patch Microscopic: Proliferated capillary sized vessels lined by flattened endothelial cells and separated by fibrous tissue stroma.

Stratified Squamous Epithelium Cavernous Hemangioma Sites: Subcutaneous tissue, internal organs as liver appears as ill defined bluish mass. Microscopic: Formed of large irregular vascular spaces lined by flattened endothelial cells, filled with blood and separated by fibrous tissue stroma. Stratified Squamous Epithelium ??

Cavernous Haemangioma

Cavernous Lymphangioma Site: head & neck of infants & children Gross: a cystic mass Microscopic: cavernous spaces of lymphatic vessels lined by flattened endothelial cells & filled with lymph. Lymphocytes are seen in between the spaces & few are inside

Cavernous Lymphangioma

Cavernous Lymphangioma Large vascular spaces filled with lymph

Cavernous Lymphangioma Large vascular spaces filled with lymph Subcutaneous fatty tissue Fibrous septa infiltrated with lymphocytes

Chondroma

Tumours of Melanocyte Melanocytic Nevus Sites: Skin of face, neck, back…etc, Gross: Well demarcated colored papules or papillomatous lesions Microscopic types: Junctional nevus Compound nevus Intradermal nevus  

Benign Tumours of Melanocyte (Nevus) Normal Junctional Compound Intradermal

Junctional Nevus

Junctional and intradermal nests of melanocytes Compound Nevus Junctional and intradermal nests of melanocytes

Intradermal (only) nests of melanocytes Intradermal Nevus Intradermal (only) nests of melanocytes

A female patient 35 year old complained of a breast mass. Case A female patient 35 year old complained of a breast mass. On examination: well circumscribed firm rubbery freely mobile mass was detected. Mammography was done and was reported as a benign breast lesion. It was excised Capsulated Lobulated cut surface

Normal Breast Branching of large ducts (6-10) gives rise to terminal duct lobular unit. The duct & acini of lobules are lined by 2 cell layer: inner cuboidal epithelial cells & outer myoepithelial cells. Lobules are enclosed in loose connective tissue stroma (intralobular). The interlobular stroma is formed of fibrous tissue & adipose tissue.

Connective tissue stroma & Proliferated glands or ductules Fibroadenoma Fibrous stroma Fibrous Capsule Proliferated glands & ductules Gland like ducts Pericanalicular pattern Connective tissue stroma & Proliferated glands or ductules

Compressed ducts by fibrous stroma Fibroadenoma Fibrous capsule Compressed ducts by fibrous stroma Intracanalicular Pattern

Fibroadenoma The tumour is surrounded by a thin fibrous tissue capsule and formed of both glandular (epithelial) & connective tissue (mesenchymal) elements. The glands or ductules: are of variable size & shape lined by 2 cell layer inner epithelial cells and outer myoepithelial cells. Some have patent lumena (pericanalicular pattern) while others have compressed lumena (intracanalicular pattern). The proliferated connective tissue is formed of fibrous tissue

Match Fibroadenoma Quiz Transitional Cell Papilloma Adenoma Leiomyoma Formed of multiple branched (finger like) connective tissue fronds covered by stratified squamous epithelium showing hyperkeratosis, acanthosis & papillomatosis Formed of proliferated blood vessels, lined by flattened endothelial cells separated by fine connective tissue stroma Formed of thin connective tissue core covered by transitional epithelium Formed of benign glands or acini similar to the normal glandular tissue Formed of proliferated both connective tissue and epithelial elements forming glands or ductules Formed of interlacing bundles of smooth muscle cells 5 Match Fibroadenoma Transitional Cell Papilloma Adenoma Leiomyoma Squamous Cell Papilloma Haemangioma Quiz 6 2 3 1 4

Intended Learning Outcomes (ILOs) By the end of this lecture YOU will be able to: Differentiate between benign and malignant tumours as regards: differentiation, rate of growth, local invasion, metastases. (Revision of the previous lecture) Describe pathologic features of some benign epithelial & mesenchymal tumours