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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