Chapter 4 Essential Concepts in Molecular Pathology Companion site for Molecular Pathology Author: William B. Coleman and Gregory J. Tsongalis

Companion site for Molecular Pathology Copyright © 2009 by Academic Press. All rights reserved. 2 Cancer incidence and mortality by site for both sexes (United States, 2008). Cancers of the reproductive organs include those affecting the prostate, uterine corpus, ovary, uterine cervix, vulva, vagina, testis, penis, and other organs of the male and female genital systems. Cancers of the digestive system include those affecting esophagus, stomach, small intestine, colon, rectum, anus, liver, gallbladder, pancreas, and other digestive organs. Cancers of the respiratory system include those affecting the lung, bronchus, larynx, and other respiratory organs. FIGURE 4.1

Companion site for Molecular Pathology Copyright © 2009 by Academic Press. All rights reserved. 3 FIGURE 4.2 Progression of dysplasia in the cervix. (A) Normal squamous epithelium of the cervix. (B) Low-grade squamous dysplasia. (C) Moderate squamous dysplasia. The dysplastic squamous cells and mitotic figures involve the lower two-thirds of the epithelium. (D) High-grade squamous dysplasia. (E) Invasive squamous cell carcinoma.

Companion site for Molecular Pathology Copyright © 2009 by Academic Press. All rights reserved. 4 FIGURE 4.3 Progression of neoplastic transformation in the colon. (A) Low-grade glandular dysplasia. (B) High-grade glandular dysplasia. (C) Invasive adenocarcinoma.

Companion site for Molecular Pathology Copyright © 2009 by Academic Press. All rights reserved. 5 Adrenal adenoma. The normal cortex of the adrenal gland is yellow-gold in appearance. The white arrow points to a well-delineated, round lesion arising in the adrenal cortex. It does not appear to invade into the adjacent tissue. Courtesy of Kirsten Boland, MHS, PA(ASCP). FIGURE 4.4

Companion site for Molecular Pathology Copyright © 2009 by Academic Press. All rights reserved. 6 Pancreatic adenocarcinoma. This is a cut section of a pancreatic tumor. It is poorly delineated (meaning it is difficult to identify the exact borders of the lesion) and appears to be infiltrating into adjacent adipose tissue (patchy bright yellow areas along the bottom of the specimen). Courtesy of Kirsten Boland, MHS, PA(ASCP). FIGURE 4.5

Companion site for Molecular Pathology Copyright © 2009 by Academic Press. All rights reserved. 7 Neoplasms of mixed cell type. (A) Mature teratoma. This example demonstrates mature cartilage (right) and skin (left). (B) Immature teratoma. This type of teratoma contains areas of primitive-appearing hyperchromatic cells, known as blastema. There is focal rosette formation (white arrow). FIGURE 4.6

Companion site for Molecular Pathology Copyright © 2009 by Academic Press. All rights reserved. 8 Metaplastic change in the stomach. (A) Normal glandular epithelium of the stomach. (B) Intestinal metaplasia. This image displays glandular epithelium of the stomach with goblet cells (white arrows). FIGURE 4.7

Companion site for Molecular Pathology Copyright © 2009 by Academic Press. All rights reserved. 9 Epithelial hyperplasia of the breast. Normal mammary ducts are lined by a single layer of cuboidal epithelial cells (duct second from the center bottom). The lumens of the remaining ducts are filled with bland-appearing epithelium cells, representing prominent ductal epithelial hyperplasia. FIGURE 4.8

Companion site for Molecular Pathology Copyright © 2009 by Academic Press. All rights reserved. 10 Nuclear pleomorphism and abnormal mitotic figures in neoplastic cells. (A) Pleomorphism. This is an example of leiomyosarcoma. Several of the malignant stromal cells are very large and different in shape from neighboring cells. (B) Mitotic figure (center). Malignant neoplasms often have an increased number of mitotic figures. FIGURE 4.9

Companion site for Molecular Pathology Copyright © 2009 by Academic Press. All rights reserved. 11 Progression of tumorigenesis in the breast. (A) Ductal carcinoma in situ (DCIS). This neoplastic process is in situ carcinoma because the dysplastic cells are confined to the lumen of the duct and have not invaded into the surrounding tissue. (B) Invasive adenocarcinoma of the breast. Glands lined by dysplastic cells haphazardly infiltrate into adipose tissue. FIGURE 4.10

Companion site for Molecular Pathology Copyright © 2009 by Academic Press. All rights reserved. 12 Childhood neuroblastoma. Neuroblastoma is considered one of the so- called small, round, blue cell tumors, as it is composed of small, hyperchromatic, monomorphic cells with scant cytoplasm. FIGURE 4.11

Companion site for Molecular Pathology Copyright © 2009 by Academic Press. All rights reserved. 13 Lymphoma. This image of lymphoma demonstrates sheets of large cells with prominent nucleoli. FIGURE 4.12

Companion site for Molecular Pathology Copyright © 2009 by Academic Press. All rights reserved. 14 Tumor necrosis. Necrotic (dead tissue) debris is present within the center of the malignant glands in this adenocarcinoma. FIGURE 4.13

Companion site for Molecular Pathology Copyright © 2009 by Academic Press. All rights reserved. 15 Metastatic spread of malignant cells through the lymphatic system. (A) Metastatic adenocarcinoma to a lymph node, low power. Lymph node tissue is present along the upper portion of the image, and infiltrating glands of adenocarcinoma are noted at the lower aspect of the image. (B) Metastatic carcinoma to a lymph node, high power. Two nests of plump malignant epithelial cells are present within the sea of smaller lymphocytes of the lymph node. FIGURE 4.14