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Pathology
Lecture 16 Neoplasia IV – Clinical Features of Tumors
1) To understand the range of effects of tumors on their host.
Effect
Mass
Ulcer (non-healing)
Hemorrhage
Pain
Seizures
Obstruction
Bone destruction
Systemic Effects
Immuonsurveillence
Endocrine effects
Description
Presentation as tissue lump
Destruction of epithelial surfaces (ex. Stomach, mouth, colon, bronchus).
Serves as portal for infection.
From ulcerated area or eroded blood vessel.
Occurs near sensory nerve endings, in bone, in nerve plexuses, or in organ
obstruction. Brain and many visceral tumors are initially painless.
Tumor mass in the brain.
Growth in hollow organ walls, ducts, and passageways.
Fracture due to intraosteal growth, collapse of bone.
Immune system response to the presence of tumor antigens is increased in
most cancers, however immunosuppressed individuals have a greater
chance of lymphoma due to compensatory hyperplasia.
Topic or ectopic secretion of hormones.
hCG – carcinoma of the lung (30%), breast cancer
PTH – squamous cell carcinoma of the lung, renal adenocarcinoma.
ACTH – small cell lung carcinoma, pancreatic islet neoplasms (Cushings)
ADH – Small cell lung cancer.
Insulin – Hepatocellular cancer.
2) To gain specific knowledge on clinical approaches to diagnosing and evaluating
tumors. Tumors are graded by pathologists based on the following parameters:
a. Cells – pleomorphism, shape, associations.
b. Nuclei – size, density of nuclear staining, nuclear to cytoplasmic ratio
c. Mitosis – frequency, normal or abnormal.
d. Architectural – resemblance to parent tissue, close to very-different.
e. Necrosis – present or absent, more indicates higher grade.
Grading of Tumors
Grade 1
Grade 2
Grade 3
Well-differentiated – resembles adult tissue, both in architecture and cytology
Moderately differentiated – intermediate
Poorly differentiated – minimal resemblance to adult tissue, disorganized, high
nuclear/cytoplasmic ratio, many mitosies, often necrotic
Stage 0
Stage I
Stage II
Stage III
Stage IV
Carcinoma in situ – tumor has not penetrated the basement membrane
A small, locally invasive tumor
A large, locally invasive tumor
Tumor with metastases in the lymph nodes
Spread beyond the limits of operation; local extention to involve unremovable tissue;
hematogenous spread to distant sites; involvement of body cavity (pleura, peritoneum)
Staging of Carcinomas
3) To learn the more commonly used serum and tumor markers for human tumors.
Markers
Hormones
Human chorionic gonadotropin
Cacitonin
Catecholamine & metabolites
Ectopic hormones
Oncofetal antigens
Alpha-fetoprotein (AFP)
Carcinoembryonic antigen (CEA)
Specific proteins
Immunoglobulins
Prostate-specific antigen
Mucins & Other Glycoproteins
CA-125
CA-19-1
CA-15-3
Examples
Intermediate Filaments
Keratins
Desmin
Vimentin
Glial filaments
Neurofilaments
Immunophenotyping
Immunologic subtypes
Specific proteins
Immunoglobulins
PSA
ER & PR receptor
Oncogene products
c-erb B2
N-myc
Tumor Type
Carcinomas, some mesotheliomas
Muscle tumors: smooth, striated
Mesenchymal tumors, some carcinomas
Gliomatous tumors
Neuronal tumors
Trophoblastic tumors, nonseminomatous testicular tumors
Medullary CA of thyroid
Pheochromocytoma
Tumors producing paraneoplastic syndromes
Liver cell CA, nonseminomatous germ cell tumor of testis
CA of the colon, pancreas, lung, others
Multiple myeloma & other gammopathies
Prostate CA
Ovarian Cancer
Colon, pancreatic CA
Breast CA
Lymphomas, leukemias
Myeloma
Prostate CA
Breast CA
Breast CA
Neuroblastoma