1. 즐거운 강의되기 바랍니다
June 28, 2002

3. General Characteristics of Neoplasms
Jae Y. Ro, M.D.
Asan Medical Center
Seoul, Korea
June 28, 2002

4. single organism, cell, or gene
Clone : A group of genetically identical descended (progeny) produced by asexual reproduction of
single organism, cell, or gene
Cancer : Clonal overgrowth
Cell
proliferation
Cell loss

5. Cancer Incidence Age, sex, race, socioeconomic groups
men: 684/100,000 Luxembourg
84/100,000 El Salvador
women: 450/100,000 Denmark
126/100,000 El Salvador
USA, men 361/100,000
women 283/100,000
Korea, Japan, China: lower than USA

7. Ten Leading Cancer Sites for the Estimated New Cancer Cases and Deaths by Gender, US, 2002 *

9. Cancer Statistics in Korea (1/1999 - 12/1999)
1) Stomach (20.7%) 6) Uterine cervix (5.0%)
2) Lung (12.1%) 7) Thyroid (3.5%)
3) Liver (12.0%) 8) Hematopoietic (2.9%)
4) Colon ( 9.9%) 9) Bladder (2.4%)
5) Breast ( 6.4%) 10) Pancreas (2.2%)

10. For Men 1) Stomach (24.2%) 6) Esophagus (3.2%)
2) Liver (16.3%) 7) Hematopoietic (2.9%)
3) Lung (16.1%) 8) Prostate (2.5%)
4) Colon ( 9.7%) 9) Pancreas (2.4%)
5) Bladder ( 3.3%) 10) Kidney (1.8%)

11. For Women 1) Stomach (16.2%) 6) Lung (6.7%)
2) Breast (14.7%) 7) Liver (6.3%)
3) Uterine Cervix (11.6%) 8) Ovary (4.2%)
4) Colon (10.2%) 9) Hematopoietic (2.9%)
5) Thyroid ( 6.8%) 10) Pancreas (2.0%)

12. Definition Neoplasm = new growth
Tumor : swelling caused by inflammation
: equated with neoplasm
Oncology (Greek oncos = tumor)
Cancer : common term for all malignant tumors
(Latin for crab = cancer)
Neoplasm = abnormal mass of tissue
1) exceed growth and uncoordinated with that of
normal tissue
2) persists after cessation of stimuli
3) autonomous, purposeless, preys on host

13. Nomenclature (I)
Two basic components : Proliferating neoplastic cells (parenchyma) and supportive stroma (medullary/scirrhous)
Benign tumors
- oma to cell of origin (mesenchymal tumors)
- oma to cell of origin, microscopic architecture,
macroscopic patterns (epithelial tumors)
Malignant tumors
- sarcoma (Greek, sar = fleshy) (mesenchymal tumors)
- carcinoma (epithelial tumors)
Mixed tumor
- divergent differentiation of a single line of parenchymal cells
- epithelial & myoepithelial cell (pleomorphic adenoma)
Teratoma - more than one germ layer

14. Nomenclature of Tumors
Tissue of Origin Benign Malignant
Composed of One Parenchymal Cell Type
Mesenchymal tumors
Connective tissue and derivatives Fibroma Fibrosarcoma
Lipoma Liposarcoma
Chondroma Chondrosarcoma
Endothelial and related tissue
Blood vessels Hemangioma Angiosarcoma
Lymph vessels Lymphangioma Lymphangiosarcoma
Synovium Synovial sarcoma
Mesothelium Mesothelioma
Brain coverings Meningioma Invasive meningioma
Blood cells and related cells
Hematopoietic cells Leukemia
Lymphoid tissue Malignant lymphoma
Muscle
Smooth Leiomyoma Leiomyosarcoma
Striated Rhabdomyoma Rhabdomyosarcoma
Epithelial tumors
Stratified squamous Squamous cell papilloma Squamous cell or
epidermoid carcinoma
Basal cells of skin or adnexa Basal cell carcinoma
Epithelial lining
Glands or ducts Adenoma Adenocarcinoma
Papilloma Papillary carcinoma
Cystadenoma Cystadenocarcinoma

15. Nomenclature of Tumors
Tissue of Origin Benign Malignant
Composed of One Parenchymal Cell Type
Respiratory passages Bronchogenic ca
Bronchial adenoma
(carcinoid)
Neuroectoderm Nevus Malignant melanoma
Renal epithelium Renal tubular adenoma Renal cell carcinoma
Liver cells Liver cell adenoma Hepatocellular ca
Urinary tract epithelium (transitional) Transitional cell papilloma Transitional cell ca
Placental epithelium (trophoblast) Hydatidiform mole Choriocarcinoma
Testicular epithelium (germ cells) Seminoma
Embryonal carcinoma
More Than One Neoplastic Cell Type-Mixed
Tumors, Usually Derived From One Germ Layer
Salivary glands Pleomorphic adenoma Malig mixed tumor of
(mixed tumor of salivary origin) salivary gland
Breast Fibroadenoma Malignant cystosarcoma
phyllodes
Renal anlage Wilms tumor
More Than One Neoplastic Cell Type Derived
From More Than One Germ Layer-Teratogenous
Totipotential cells in gonads Mature teratoma, dermoid cyst Immature teratoma,
or in embryonic rests teratocarcinoma

16. Nomenclature (II) Choristoma - ectopic rest of normal tissue
Hamartoma - produce a mass of disorganized but mature specialized cells or tissue indigenous to particular site
Differentiation - parenchymal cells resemble comparable normal cells, both morphologically and functionally
Anaplasia - lack of differentiation, dedifferentiation
- hallmark of malignant transformation
- morphologic and functional change
* Metaplasia
* Dysplasia - loss of polarity, size & shape irregularity
* Tumor of borderline malignancy, low grade malignancy, uncertain malignant potential

17. Characteristics of Benign & Malignant neoplasms
1. Differentiation and Anaplasia
2. Rate of growth
3. Growth patterns
4. Metastasis
a) seeding of body cavities and surfaces
b) lymphatic spread
c) hematogenous spread

18. Benign vs Malignant Well diff: structure typical of tissue of origin
slow growth, mitoses rare and normal
expansile and encapsulated
no metastasis
Lack of diff with anaplasia: structure atypical
rapid growth, mitoses numerous and abnormal
infiltrative and no capsule
metastases

23. An Approach to the Morphologic Diagnosis of Cancer

24. Morphologic DX of Cancer
Lesions
Infectious
Mesenchymal
Non-neoplastic
Epithelial
Neoplastic
Non-Infectious
Benign
Malignant
(carcinoma)
(sarcoma)

25. Neoplastic vs
Non-neoplastic

26. Neoplastic vs Non-neoplastic

27. Epithelial vs Mesenchymal
oval, round or
polygonal
cell nests
desmoplastic stroma
vessels in stroma
spindle
diffuse
no desmoplastic stroma
vessels between tumor cells

28. Epithelial vs Mesenchymal

29. Epithelial vs Mesenchymal
oval, round or
polygonal
cell nests
desmoplastic
stroma
vessels in stroma
spindle
diffuse
no desmoplastic stroma
vessels between tumor cells

30. Epithelial vs Mesenchymal

31. Epithelial vs Mesenchymal
oval, round or
polygonal
cell nests
desmoplastic
stroma
vessels in stroma
spindle
diffuse
no desmoplastic stroma
vessels between tumor cells

32. Epithelial vs Mesenchymal

33. Epithelial vs Mesenchymal
oval, round or
polygonal
cell nests
desmoplastic
stroma
vessels in stroma
spindle
diffuse
no desmoplastic stroma
vessels between tumor cells

34. Epithelial vs Mesenchymal

35. Epithelial vs Mesenchymal
oval, round or
polygonal
cell nests
desmoplastic
stroma
vessels in stroma
spindle
diffuse
no desmoplastic stroma
vessels between tumor cells

36. Epithelial vs Mesenchymal

37. e.g., sarcomatoid ca, sarcoma with epithelioid cells, lymphoma, melanoma, NE tumors, small round cell tumors

38. Immunostain, EM and molecular analysis

39. Benign vs Malignant Well diff: structure typical of tissue of origin
slow growth, mitoses rare and normal
expansile and encapsulated
no metastasis
Lack of diff with anaplasia: structure atypical
rapid growth, mitoses numerous and abnormal
infiltrative and no capsule
metastasis

43. Malignant Tumors high cellularity necrosis nuclear features
enlarged nuclear size (N/C ratio)
pleomorphism
prominent nucleoli
hyperchromatism
increased mitoses (atypical mitoses)

44. Malignant Tumor

45. Malignant Tumor

46. Malignant Tumor

47. Classification of Tumors
cellular origin
microscopic architectures
macroscopic (gross) architectures
differentiation (H & E stain)
electron microscopic findings
immunohistochemistry
molecular pathology

48. Prognostic Factors Category I (well supported): stage, grade
Category II (extensively studied but not well established): DNA ploidy, nuclear proliferation, angiogenesis, apoptosis, tumor suppressor gene
Category III (currently studying): other oncogenes, cytogenetic analysis, growth factors, detection of circulating tumor cells in blood

49. TNM Classification T (tumor), N (node) & M (metastasis)
Primary tumor (T)
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
Tis Carcinoma in situ
T1-T4 Increasing size and/or local extent (depth of invasion) of tumor

50. TNM Classification Regional lymph nodes (N)
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1-N3 Increasing involvement of regional lymph node
* Direct extension of tumor into a lymph node classified as a lymph node metastasis
** Metastasis in other than regional lymph nodes classified as a distant metastasis
*** Tumor nodule up to 3mm in greatest extent is classified in T category. If tumor nodule is greater than 3mm without evidence of residual lymph node tissue, classified as a lymph node metastasis
Distant metastasis (M)
MX Distant metastasis cannot be assessed
M0 No distant metastasis
M1 Distant metastasis

51. Stage Grouping (Lung Ca)
Stage Tis N M0
Stage IA T N M0
Stage IB T N M0
Stage IIA T N M0
Stage IIB T2 (T3) N1 (N0) M0
Stage IIIA T1-T N1, N M0
Stage IIIB Any T N M0
T Any N M0
Stage IV Any T Any N M1

52. Tumor Grade malignant tumors (Arabic no. 1,2,-- )
histologic grade (overall proportional)
original Broders’ grading (4 tier)
modified Broders' grading (3 tier)
high and low grade (2 tier)
nuclear grade (worst areas)
Black NG for breast ca.
Fuhrman’s NG for renal cell ca.

53. Information for Pathologists
demographic data (age, sex, DOB---)
name of specimens
type of procedures
date specimen obtained
Submitting physicians
symptoms, signs and duration
abnormal lab findings
image findings
preop- and postop clinical diagnosis

54. Information for Clinicians
diagnosis (benign, malignant, uncertain malignant potential): in malignant tumor--grade
tumor size/depth of invasion
margins; structure involvement
vascular invasion
nodal status
treatment response
other abnormalities

55. Summaries Definition, nomenclatures
Neoplastic vs non-neoplastic, epithelial vs mesenchymal, benign vs malignant
Type of tumors: architectural patterns, differentiation of cells
H&E staining, EM, immunohistochemistry and molecular pathology
Prognostic factors: stage and grade

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