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

2. 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

3. .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

4. 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

5. 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

6. 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

7. 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)

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

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

10. Squamous Cell Papilloma
Hyperkeratosis
Papillomatosis
Acanthosis
Pathology Department

11. Squamous Cell Papilloma
Acanthosis
Hyperkeratosis
acanthosis

12. Squamous Cell Papilloma
???
Acanthosis

14. 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

15. 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

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

17. 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

18. 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

19. 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

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

21. Adenoma
Normal tissue?
Thyroid Gland Adenoma

22. Papillary Serous Cystadenoma
An Opened Ovarian Mass
Cystic
Papillary Serous Cystadenoma

23. Colonoscopy showing:
a single pedunculated polyp multiple polypi

24. 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

25. 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

26. 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

27. 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

28. 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

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

30. ?? 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.

31. 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

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

33. 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

34. 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.

35. 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 ??

36. Cavernous Haemangioma

37. 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

38. Cavernous Lymphangioma

39. Cavernous Lymphangioma Large vascular spaces filled
with lymph

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

41. Chondroma

42. 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

43. Benign Tumours of Melanocyte (Nevus)
Normal
Junctional
Compound
Intradermal

44. Junctional Nevus

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

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

47. 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

48. 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.

49. 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

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

51. 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

52. 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

53. 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