Serdar Balcı
Benign
Malignant
Good news
Genetically simple
Few mutations
Curable
Robbins and Cotran’s Pathological Basis of Diseases
Robbins Basic Pathology
MUIR’S TEXTBOOK OF PATHOLOGY
Leiomyoma of the uterus
Robbins and Cotran’s Pathological Basis of Diseases
Malignant Neoplasms
Well Differentiated
Moderately Differentiated
Poorly Differentiated
Undifferentiated
Anaplastic
Differentiation is defined as “grade” in certain classification shemes.
Grade is determined microscopically
Adenocarcinoma of Colon
Robbins and Cotran’s Pathological Basis of Diseases
Urologic Surgical Pathology, 3 rd __ Ed__
Urologic Surgical Pathology, 3 rd __ Ed__
Urologic Surgical Pathology, 3 rd __ Ed__
Well-differentiated squamous cell carcinoma of the skin
Robbins Basic Pathology
Well-differentiated squamous cell carcinoma of the skin
Similar to normal squamous cells
Robbins Basic Pathology
Rubin’s Pathology 7th Ed
Anaplastic tumor of the skeletal muscle (rhabdomyosarcoma)
Robbins Basic Pathology
Anaplastic tumor of the skeletal muscle (rhabdomyosarcoma)
Prominent nucleoli
Does not resemble any cell
Hyperchromatic nuclei
Fragmanted nuclei
Increased nuclear size
Increased N/C ratio
Irregular nuclear contours
Robbins Basic Pathology
Lack of differentiation is a hallmark of cancer
Dedifferentiation
Loss of the structural and functional differentiation of normal cells
Dedifferentiation or failure/ arrest in differentiation (stem cell origin)
Robbins Basic Pathology
Pleomorphism: variation in size and shape of nuclei
Atypical mitosis
Tripolar
chromatin is coarse and clumped
increased N/C ratio 1:1 (normal: 1:4-1:6)
Robbins Basic Pathology
Rubin’s Pathology 7th Ed
Rubin’s Pathology 7th Ed
Marked pleomorphism
Nuclei are extremely hyperchromatic (dark-staining)
Nuclei are large
Increased nuclear-to-cytoplasmic ratio that may approach 1:1 (normal 1:4-1:6)
Giant cells with one enormous nucleus or several nuclei
Nuclei are variable and bizarre in size and shape
Chromatin is coarse and clumped
Nucleoli may be of astounding size
Mitoses often are numerous and distinctly atypical
Fail to develop recognizable patterns of orientation to one another
Grow in sheets, with total loss of communal structures
Cancers of endocrine organs secrete hormones
Squamous cell carcinoma produce keratin
Hepatocellular carcinoma secrete bile
Urologic Surgical Pathology, 3 rd __ Ed__
Urologic Surgical Pathology, 3 rd __ Ed__
Robbins Basic Pathology
Carcinoma in situ
Hypechromasia
Mitosis in upper layers
Polarity is not preserved
No maturation
No normal stratified layer
Basal layer is intact
Robbins Basic Pathology
Carcinoma in situ
Robbins Basic Pathology
Until we detect it, tumor completed most of its lifespan
Most benign tumors grow slowly
Mitoses are usually rare and have normal configuration.
Most cancers grow much faster, eventually spreading locally and to distant sites (metastasizing) and causing death
Some benign tumors grow more rapidly than some cancers
Leiomyoma growth rate depend on circulating estrogen levels
Blood supply or pressure affect growth of benign tumors
In malignant tumors growth rate correlates inversely with differentiation
Wide variation in the rate of growth
Some grow relatively slowly and steadily
Growth may come almost to a standstill
Some primary tumors (choriocarcinomas) become totally necrotic, leaving only secondary metastatic implants
Robbins and Cotran’s Pathological Basis of Diseases
the doubling time of tumor cells
the fraction of tumor cells that are in the replicative pool
the rate at which cells are shed or die
Rapidly growing malignant tumors contain central areas of ischemic necrosis
Tumor blood supply fails to keep pace with the oxygen demand
In benign tumors necrosis may occur, degenerative type necrosis
In malignant tumor necrosis is abrupt, tumor necrosis
Robbins Basic Pathology
Robbins Basic Pathology
MUIR’S TEXTBOOK OF PATHOLOGY
MUIR’S TEXTBOOK OF PATHOLOGY
Malignant tumors should be removed with a wide margin of surrounding normal tissue because of this growth pattern
Surgical pathologists examine the margins of resected tumors to ensure that they are devoid of cancer cells (clean margins)
Like metastases, local invasiveness is the most reliable feature that distinguishes malignant from benign tumors
Robbins Basic Pathology
Robbins Basic Pathology
MUIR’S TEXTBOOK OF PATHOLOGY
Rubin’s Pathology 7th Ed
Adenocarcinoma of Colon, invading pericolonic adipose tissue
Robbins and Cotran’s Pathological Basis of Diseases
Secondary implants of a tumor
Discontinuous with the primary tumor
Located in remote tissues
Robbins Basic Pathology
30% of patients with newly diagnosed solid tumors present with clinically evident metastases
20% have occult (hidden) metastases at the time of diagnosis
The more anaplastic and the larger the primary neoplasm, the more likely is metastatic spread
Pathology - The Big Picture
Do not follow usual route
Miss one lymph node and develop metastasis in the next one
The first lymph node the tumor goes to
May be detected with certain dyes and radioactive methods
Rubin’s Pathology 7th Ed
Prostate carcinoma goes to bone
Bronchogenic carcinoma goes to adrenals, brain
Neuroblastoma goes to liver, bone
Skeletal muscle have abundant vascular structures but not a place for metastasis
Homing of tumor cells
Robbins Basic Pathology
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What we talk in this lecture are generic statements.
Some “benign” tumors may cause death, so they are clinically not benign at all.
Some “very malignant” tumors respond to therapy more quickly.
Some well-differentiated tumors do not respond to therapy.