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Download Epithelial tumours
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Epithelial tumours Z. Vernerová Epithelial tumours • Basic components:parenchyma (prolif. cells) supportive stroma • • • • Nomenclature: On the basis of parenchymal component Suffix - -oma BENIGN Carcinoma MALIGNANT Neoplasia • Benign: cells resemble the tissue of origin,uniform cells, local growing, pushing borders • Malignant: growth is not confined to the site of origin infiltrative growth- invasion spread to other parts of body-meta cells usually not ressemble the tissue of origin (failure of differentiation) Characteristics of tumours Gross pattern Microscopic pattern Cytomorphology Inflammatory reaction Local invasion Metastasis Gross pattern • • • • • Papillary Polypous Cystic Ulcerous Diffuse Papillary Polypous Polypous Ulcerous Diffuse Simple epithelium Microscopic pattern • • • • • • Adenocarcinoma: acinary-salivary glands Mucinous- gut, ovary Tubular- large intestine Cribriform- prostatic ca Trabecular- hepatocellular ca Papillary- serous papillary cystadenocarcinoma • Signet ring cell- stomach, gut • Solide- undifferentiated Microscopic pattern Microscopic pattern Microscopic pattern Microscopic pattern Cytological signs of malignancy Cytological signs of malignancy • • • • • • • Loss of polarity Increased N/C ratio Pleiomorphism: Anisocytosis Anisokaryosis Hyperchromatism Nucleolar changes Increased mitotic activity Loss of polarity N/C ratio Pleiomorphism • Anisocytosis • Anisonucleosis (anisokaryosis) • Hyperchromatism Cytological signs of malignancy • Loss of polarity • N/C ratio Differentiation • Extent to which neoplastic cells resemble comparable normal cells, both morphologically and functionally • Anaplasia: lack of differentiation • GRADING Histological assessment of neoplasms allows prediction of tumor behavior • Analysis of the degree of diferentiation and growth pattern: GRADING Stroma • Classification on the basis of the proportion of tumor cells to stroma: • Simple carcinomas: ratio 1:1 • Medullary carcinomas: epithelial tumor cells predominate- breast, thyroid gland • Scirrhous carcinoma: collagenous stroma predominate- infiltrative duct breast ca, diffuse ca of the stomach Scirhous carcinoma • Premalignant lesions: some benign neoplasms, are known to progress, with time to invasive neoplasia. • Adenomatous polyps • CIN, VIN, VAIN • Dysplasia in long standing ulcerative colitis • Dysplasia of the stomach epithelium • Actinic keratosis Local invasion Local invasion • Infiltration • Destruction Metastasis 1.Lymphatic spread: • Carcinomas • Regional lymph node x skip metastasis • Virchow‘s lymph node- stomach, colon, gall bladder Metastasis 2. Hematogenous spread • Sarcomas • Certain carcinomas:liver, lungs, kidney, thyroid gland, prostate • Common sites for blood born meta: liver, lungs, brain, bones, adrenals Metastasis 3. Along body cavities: • Transcoelomic spreadca of the stomach seeding to ovaries ca of the ovary---entire peritoneal cavitiy pseudomyxoma peritonei • Along epithelium lined surfacesthrough the bronchus into alveoli, fallopian tube from the endometrium • Via cerebrospinal fluid- CNS tumors • Implantation- papillary serous ovarian ca Krukenberg tumor • Late metastasis: conventional renal cell carcinoma, malignant melanoma Evaluation of how far a tumor has spread- STAGING
