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NEOPLASIA
Marlon M. Maramion, MD, DPSP
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Neoplasia
Nomenclature
Characteristics of Benign and malignant neoplasm
EpidemiologyMolecular Basis of Cancer
Molecular Basis of Multistep Carcinogenesis
Carcinogenic agents and their Cellular Interactions
Host Defense against Tumors Tumor Immunity
Clinical Aspects of Neoplasia
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Nomenclature
Neoplasia- new growth
Tumor- swelling caused by
inflammation-non neoplastic usage
Cancer- malignant tumor
Latin for crab because a cancer adhereto any part
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Definition of Neoplasia
A neoplasm is an abnormal mass of tissue, the
growth of which exceeds and is uncoordinated
with that of the normal tissues and persists in
the same excessive manner after cessation ofthe stimuli which evoked the change- Willis
Genetic changes
Autonomous
Clonal
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Neoplasia
All tumors have two basic components
1. Parenchyma
2. Stroma- blood supply
- framework
- growth influenceDesmoplasia
Scirrhous
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Nomenclature Benign Tumors
-oma = benign neoplasm
Mesenchymal tumors
chrondroma: cartilaginous tumor
fibroma: fibrous tumor
osteoma: bone tumor
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Nomenclature Benign Tumors
Epithelial tumor
adenoma: tumor forming glands
papilloma: tumor with finger likeprojections
papillary cystadenoma: papillary and cystic
tumor forming glands polyp: a tumor that projects above a
mucosal surface
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Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 28 July 2005 03:41 PM)
2005 Elsevier
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Colonic Polyp: Tubular Adenoma
Stalk
Tumor
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Nomenclature Malignant Tumors
Sarcomas: mesenchymal tumor chrondrosarcoma: cartilaginous tumor
fibrosarcoma: fibrous tumor
osteosarcoma: bone tumor
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Nomenclature Malignant
Tumors
Carcinomas: epithelial tumors
adenocarcinoma: gland forming tumor
squamous cell carcinoma: squamous
differentiation
undifferentiated carcinoma: nodifferentiation
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Nomenclature Tumors with mixed differentiation
derived from one germ cell layer thatdifferentiates into more than oneparenchymal cell type
mixed tumors: e.g. pleomorphic adenoma
of salivary gland carcinosarcoma
Teratoma
tumor comprised of cells from more thanone germ layer
arise from totipotent cells (usually gonads)
benign cystic teratoma of ovary is the most
common teratoma
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Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 28 July 2005 03:41 PM)
2005 Elsevier
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Nomenclature Aberrant differentiation (not true neoplasms)
Hamartoma: disorganized mass of tissuewhose cell types are indiginous to the siteof the lesion
Choristoma: ectopic focus of normal tissue(heterotopia)
Misnomers
hepatoma: malignant liver tumor
melanoma: malignant skin tumor
seminoma: malignant testicular tumor
lymphoma: malignant tumor of
lymphocytes
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Characteristics of Benign andMalignant Neoplasms
The distinction between benign and malignant
tumors is based on
1. appearance (morphology)
2. behavior (clinical course)
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If cells LOOK BAD, they are probably going to BEHAVEBAD
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If cells LOOK GOOD, they are probably going to BEHAVE GOOD
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Characteristics of Benign andMalignant Neoplasms
Basis for distinction
1. Differentiation and anaplasia
2. Rate of growth3. Local invasion
4. Metastases
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Differentiation and Anaplasia
Differentiation- resemblance to the normal
Anaplasia- lack of differentiation
1. pleomorphism2. abnormal nuclear morphology
3. mitosis
4. loss of polarity5. tumor giant cells, necrosis
dysplasia (disordered growth)
- loss of uniformity & architecture
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Dysplasia
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Carcinoma in situ
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Rate of Growth
Factors affecting tumor growth
1. Doubling time of tumor cells
2. Fraction of tumor cells that are in replicativepool
3. Rate at which cells are shed or die
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Schematic Representation Of Tumor
Growth
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Factors affecting growth of benign
& malignant neoplasms
Hormonal stimulation
Adequacy of blood supply
Other unknown influences
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Fast Growing Tumors
High cell turnover
Susceptible to chemotherapy
GROWTH RATE correlates with level of
DIFFERENTIATION
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LocalInvasion
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Metastasis
-single most important feature
distinguishing malignant from benign
neoplasm.
Three routes
1. Seeding of body cavities
2. Lymphatics
3. Hematogenous
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Comparison between Benign and Malignant Tumors
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Characteristics Benign MalignantDifferentiation/anapla
sia
-well differentiated,
structure maybe typical of
tissue origin
-some lack of
differentiation with
anaplasia, structure isoften atypical
Rate of growth -usually progressive and
slow, mitotic figures are
rare and normal
-erratic and maybe slow to
rapid, mitotic figures
maybe numerous and
abnormalLocal Invasion Usually cohesive and
expansile, well
demarcated masses that
do not invade or infiltrate
surrounding normal
tissue
-locally invasive, infiltrating
the surrounding normal
tissues, sometimes
seemingly cohesive and
expansile
Metastasis absent -frequetly present, the
larger and more
undifferentiated the
primary the more likely are
metastases
p g g
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EPIDEMIOLOGY
G hi & E i l
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Geographic & Environmental
Factors
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Genetic Predisposition to Cancer
3 categories
1. Autosomal dominant inherited cancer
syndromes
2. Defective DNA-repair syndrome
3. Familial cancers
characterized by familial clustering but thetransmission pattern is not clear
-e.g CA breast, colon, brain and ovary
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